extrinsic factors

Question 0

Features of Calculus? (5)

Answer 0

1. does not cause CIPD
2. surface plaque is responsible
3. not a mechanical irritant
4. extends radius of destructions
5. inhibits plaque removal

Question 1

What are extrinsic modifying factors?

Answer 1

enhance plaque retention and inhibit plaque removal i.e. calculus, overhangs

Question 2

There is no correlation b/t malocclusion and ….? (8)

Answer 2

1. angle’s classification
2. overbite
3. overjet less than 6mm
4. crowding
5. spacing
6. axial inclination of incisors
7. corssbite
8. destructive periodontal dx

Question 3

W/ malocclusion, ___% increase in bone loss was found for _____ inclined molars?

Answer 3

10%, mesially

Question 4

W/ malocclusion, buccally found an increase in……?

Answer 4

deposits and inflam in areas of overcrowding

Question 5

W/ malocclusion, what can overcome the ill effects of tooth overcrowding?

Answer 5

good OH

Question 6

W/ malocclusion, unless ______ and _______ are associated with ______, they are not related to severity of periodontal dx?

Answer 6

open contacts and uneven marginal ridges;

food impaction

Question 7

What is the definition of food impaction? What does it result in?

Answer 7

the forceful wedging of food into the periodontium by occlusal forces;

increased probing depth and attachment loss

Question 8

Food impaction may be associated with…? (3) Factors predisposing to food impaction should be?

Answer 8

1. open contacts
2. uneven marginal ridges
3. plunger cusps;

eliminated during initial therapy

Question 9

How does dental morphology effect oral health?

Answer 9

concavities, grooves, and furcations inhibit or prevent plaque removal

Question 10

Furcation anatomy: the size of the average furcation entrace is ____ than a small gracy currette ____% of the time. What are the sizes of each?

Answer 10

smaller, 58%; gracey = 1mm, furcation = 0.75 mm

Question 11

Furcation anatomy: ___% of furca root surfaces of mandibular molar have a furcal concavity. The majority of….?

Answer 11

100%; maxillary furca root surfaces also have concavities

Question 12

Which teeth have concavities?

Answer 12

the maxillary first premolar

mandibular incisors, cuspids, and 1st premolars have mesial and distal concavities

Question 13

Developmental grooves: ___% of maxillary lateral incisors have _____ grooves. The prognosis is….? These grooves are associated _______ as measured by….? (4)

Answer 13

2-6%, distopalatal grooves; poor when associated with deep pocketing;

poor perio health as measured by degree of plaque, inflam, probing depth, and attachment loss

Question 14

Cervical enamel projections on ____% of max and mandib molars which extend ….? Since only an ___ attachment can form to enamel, this may predispose to….?

Answer 14

4-5%; extend to the furcation entrance;

epithelial attachment, breakdown in presence of inflam.

Question 15

What are initiating factors?

Answer 15

can cause the disease by themselves, even in an immunologically competent host

Question 16

Extrinsic (local) factors influence……? influence is reflected and measured _____????????? Local factors generally act by…..?

Answer 16

proximally influence the periodontal health status; locally;

either enhancing plaque retention or inhibiting plaque removal

Question 17

Calculus plays a major role in…..?

Answer 17

maintaining and accentuating periodontal disease by keeping plaque in close contact with gingival tissue and creating areas where plaque removal is impossible

Question 18

Calculus always has…..?

Answer 18

living plaque on its surface

Question 19

Does calculus cause gingival inflammation?

Answer 19

No, sterile calculus does not cause gingival inflam; only when plaque is introduce is gingivitis initiated

Question 20

Is calculus a mechanical irritant?

Answer 20

No, it is not primarily a mechanical irritant, however calculus extends radius of destruction farther away from the tooth by providing a surface for plaque attachment beyond tooth surface

Question 21

Hancock found that with food impaction, probing area was least? intermediate? greatest?

Answer 21

areas with tight contacts;
with loose contacts;
with open contacts

Question 22

Malocclussions may predispose to…..? This has been associated with?

Answer 22

mouthbreathing; more severe gingival inflam when compared to non-mouth breathing controls but the mechnaism is unknown

Question 23

furcation anatomy: in max first molars, roof of furcation is ____ to all root separations ___% of the time

Answer 23

coronal; >50%

Question 24

The maxillary first bicuspid has a pronounced ____ _____ which is ___mm deep at the CEJ and deepens to ___mm at the 5mm level. Therefore, even.....?

Answer 24

mesial, 0.44mm; 1mm even very early periodontitis on this surface involves the concavity

Question 25

What is the fiber barrier principle?

Answer 25

gingival CT is superior barrier to the spread of inflam than the hemidesmosome-basement lamina attachment of epithelium. This principle is NOT universally accepted

Question 26

Mucogingival factors: No amt of gingiva necessary for perio health in the presence of....? an adequate width of gingiva should be present to prevent recession when....? (2)

Answer 26

adequate, atraumatic oral hygiene procedures; 1. a restoration is placed with subgingival margins 2. major or minor connectors of RPD's or overdentures infringe upon the gingiva

Question 27

Frenal attachments predispose....?

Answer 27

to gingival inflam only if they retain debris or interfere with OH procedures

Question 28

definition of caries affecting the gingiva?

Answer 28

carious lesions that retain plaque in contact with the gingiva

Question 29

If a ptn cannot remove the plaque from the carious lesion, the caries should be.....? Otherwise...? _______ is necessary in this case to achieve perio health.

Answer 29

excavated and the tooth at least temporarily restored during initial thearpy; otherwise gingival inflam will be difficult to control in this area; restorative dentistry

Question 30

Improper restoration ___ and ____ _____ tend to accumulate plaque and impede plaque removal (i.e.? (2)) The gingiva doesnt need excessive ___ ____ for protection. _____ is preferred over ____ for gingival health. Inadequate embrassure space......?

Answer 30

contours and marginal adaptation; over contoured restoration and open margins); bulge anatomy, under contoured over over contouring; displaces the interdental papilla and contributes to gingival health

Question 31

An average of ___% of adults and ____% of restorations have overhangs. One study showed that ___% of restorations show marginal defects and that ___% of the defects equal or exceed ___mm and are associated with....?

Answer 31

30%; 25-50%; | 75%, 55%; 2mm; increased interproximal bone loss

Question 32

What increases with increasing dimensions of overhangs?

Answer 32

1. alveolar bone loss 2. probing depth 3. attachment loss 4. inflam 5. plaque accumulation

Question 33

Removal of overhangs results in....? Overhangs cause _________ inflam until _____ _____ introduced. Subgingival margins associated with ________ and _____ vs supragingival margins.

Answer 33

better perio health and increased alveolar support; little or no inflam, bacterial plaque; increased plaque and inflam

Question 34

Mouth breathing results in......? May be caused by?

Answer 34

gingivitis of facial (usually max) gingiva; the reason is unknown but may be caused by malocclusion, blockage of nasal septum (deviated septum, adenoids), etc.

Question 35

Occlusal trauma does not initiate? (3) Only 1 group (gothenburg, sweeden group) showed trauma from occlusion....? This study used? Most studies?

Answer 35

gingivitis, periodontitis, or pocketing; accelerates deepening of preexisting perio pockets; A dog model in which only 2 teeth initially made contact, an extreme situation do not show any affect of occlusal trauma on the epi and CT attachment of tooth

Question 36

Occusal trauma can cause an increase in ___ ___ ___ from that caused by....? This __ __ ___ is ......?

Answer 36

alveolar bone loss, periodontitis alone; extra bone loss; reversible if traumatic forces is reduced and inflam eliminated

Question 37

Pocket depths: sites with previous hx of dx are.....? Microbiota in untreated deeper pockets shifts towards.....? Not yet know if....?

Answer 37

more likely to show future progression than sites with no previous dx hx; more anaerobic population; deeper pockets recolonize faster following cleaning

Question 38

What other local factors can lead to attachment loss independent of bacterial plaque?

Answer 38

1. factitious dx 2. chemical injury 3. toothbrush abrasion 4. mechanical injury

Question 39

What is a facitious disease?

Answer 39

ptns that gouge their tissues with their finger nails or derive pleasure by gouging their gingiva well beyond what is necessary to maintain plaque free tooth surface

Question 40

What chemical injuries involved in gingival health? The use of chewing tobacco may result in?

Answer 40

indiscriminate use of aspirin tablets, strong mouthwashes, and various escharotic drugs may result in ulceration use of chewing tobacco may result in loss of attachment as well as alteration of mucosa

Question 41

Toothbrush abrasion can completely....? The abrasion results in...?

Answer 41

destroy narrow band of attached gingiva and result in extensive recession; extensive grooving of the root surfaces, which may cause cleansing problems for ptn and management problems for dentist

Question 42

What mechanical injuries can occur?

Answer 42

injudicious use of wedges, gingival retraction cords, and impression materials may damage gingiva. improper use of elevators during tooth ext may traumatize gingiva and adjacent teeth

Question 43

What are the extrinsic modifying factors discussed in handout?

Answer 43

1. Calculus 2. malocclusion 3. food impaction 4. dental morphology 5. mucogingival factors 6. caries affecting the gingiva 7. faulty dentistry 8. mouth breathing 9. occlusal trauma 10. pocket depths 11. others: facitious dx, chemical injury, toothbrush abrasion, mechanical injury