Role of local factors

Question 1

Define periodontal diseases

Answer 1

A group of diseases that can affect single or multiple sites in the oral cavity and may lead to damage and loss supporting periodontal tissue

Question 2

What are the 2 broad groups all periodontal diseases fall under?

Answer 2

1. Gingival diseases

2. Periodontitis

Question 3

What is the primary aetiological factor that causes periodontal diseases?

Answer 3

Microbial plaque and its products that colonises the gingival crevice and root surface and

Question 4

What is a risk factor?

Answer 4

A factor that increases the probability of disease developing and progressing but not necessary causing the disease

Question 5

What do risk factors in disease progression comprise of?

Answer 5

1, Local (intra-oral) factors

2. Systemic factors which affect the appropriateness and magnitude of the host repose

Question 6

What are the local (intra oral) factors sometimes called?

Answer 6

Plaque retention factors

Question 7

Describe plaque retention factors

Answer 7

They may influence the accumulation of plaque and can allow certain bacterial species to flourish

Question 8

What can plaque retention factors prevent?

Answer 8

May prevent effective plaque removal

Question 9

Changes in what can lead to periodontal destruction?

Answer 9

1. Change in the local environment

2. Change in the systemic condition

Question 10

What can happen if there is a change in the patients systemic condition?

Answer 10

Can predispose the plaque to become more problematic resulting in disease formation and progression

Question 11

State some local factors that increase chances of getting periodontal disease

Answer 11

1. Anatomic factors
2. Patient’s habits
3. Iatrogenic factors
4. Microbiological factors
5. Pre-exisitng deposits and disease

Question 12

What do anatomic factors include?

Answer 12

1. Tooth malalignment

2. Idiosyncrasy of tooth and root morphology

Question 13

How does tooth malalignment increase a persons chance of getting periodontal disease?

Answer 13

As plaque retention can occur from sites due to crowding spacing, rotation, tilting and drifting
May be due to deep overbites and increased over jets

Question 14

Name some of the idiosyncrasies of tooth and root morphology

Answer 14

1. General morphology
2. Enamel projections / pearls
3. Root grooves
4. Cemental tears

Question 15

What are Enamel projections / pearls?

Answer 15

They are ectopic deposits of enamel

They are normally found apical to the normal cement enamel junction

Question 16

What percentage of lower molars have Enamel projections / pearls?

Answer 16

Up to 34%

Question 17

What percentage of upper molars have Enamel projections / pearls?

Answer 17

Up to 25%

Question 18

What are Enamel projections / pearls associated with?

Answer 18

Gingivitis and attachment loss

Question 19

Where are root grooves usually located?

Answer 19

Palatally especially on upper lateral incisors

Are also found on lower incisors and upper premolars proximally

Question 20

How many root grooves extend more than 5mm apically from the CEJ?

Answer 20

58%

Question 21

What are root grooves associated with?

Answer 21

Increased plaque and pocketing

Question 22

Where do cement tears occur?

Answer 22

Where there is separation along the cemento-dentinal junction

Question 23

What can cemental tears initiate?

Answer 23

Could initiate rapid ,non infected breakdown in isolates sites

Question 24

What to cemental tears disrupt?

Answer 24

Periodontal attachment

Question 25

What are some patients habits that can influence periodontal diseases?

Answer 25

Mouth breathing | Smoking

Question 26

How can mouth breathing lead to periodontal disease?

Answer 26

Mouth breathing results in lack of saliva flow Decreased salivary cleansing Dehydration of tissues Hyperplasia of gingival cells

Question 27

Which area is mostly affects if patients mouth breath?

Answer 27

The upper anterior gingiva

Question 28

What are the clinical effects of smoking?

Answer 28

1, Increased attachment loss 2. Increased bone loss 3. Increased pocket depths 4. Increased recession anteriorly 5. Increased staining 6. Increased fibrous gingival tissues 7. Decreased bleeding on probing

Question 29

What are the local effects of smoking?

Answer 29

1. Inhibits neutrophils 2. Increases keratinisation 3. Decreased vascular repose to inflammation 4. Alters gingival perfusion

Question 30

What are iatrogenic factors?

Answer 30

Factors that are injurious and that could have been prevented

Question 31

Name some iatrogenic factors

Answer 31

1. Orthodontic appliances and retainer 2. Poorly designed partial dentures 3. Poor restoration margins/ contours 4. Initiation of roughness / grooves by instrumentation

Question 32

What are the 2 types of orthodontic appliances?

Answer 32

1. Removable | 2. Fixed

Question 33

What are removable orthodontic appliances made up of?

Answer 33

Acrylic base with a wire clasp that keeps the appliance in place

Question 34

What are fixed orthodontic appliances made up of?

Answer 34

Brackets bands and arched wires

Question 35

What problems to orthodontic appliances cause?

Answer 35

Make it difficult for patients to clean inter proximal making it more likely for plaque to accumulate around the orthodontic appliance

Question 36

What must be checked when making a partial denture

Answer 36

The dentures stability Must follow the rules of gingival clearance Placement of class, rests and connectors should be done appropriately

Question 37

What must be avoided when designer dentures?

Answer 37

Gum strippers design must be avoided

Question 38

What is a gum stripper design

Answer 38

A denture that has no gingival clearance and no clasps so nothing preventing the denture from slipping into the mucosa

Question 39

What are some effects of

Answer 39

Tremendous gingival inflammation Hypoplastic gingival Gingival have been stripped from the surfaces of the palatal aspects of teeth High plaque retention

Question 40

What is important when carrying out a class 2 restoration

Answer 40

Make sure margins of there restoration are flushed and smooth with the tooth surface

Question 41

What must be used When making a class 2 restoration?

Answer 41

Matrix bands and tissue management to avoid overhangs and ledges

Question 42

What must crown margins not be when a restoration is made?

Answer 42

Crown margins must not be to sub gingival

Question 43

Which instruments are commonly used when undertaking periodontal root surface debridement?

Answer 43

Hoes and curettes

Question 44

What is consequence of using hoes?

Answer 44

They can leave grooves in the root surface dentine

Question 45

What can the precess on grooves in root surface dentine promote?

Answer 45

Promotes the retention of sub gingival plaque

Question 46

What can we use to try and smooth over grooves made by hoes?

Answer 46

Use a curettes to finish to ensure any slight grooves are covered Also use ultrasonics with a light grip and in a painting motion

Question 47

Colonisation of what area of the mouth can lead t increase risk of periodontal breakdown?

Answer 47

Colonisation of the ginigival crevice and root surface by particular microbes can increase risk of periodontal breakdown

Question 48

Name some species of bacteria implicated in periodontal diseases

Answer 48

1. Action actinomycetemcomitans 2. P ginigivalis 3. B. Forsythus

Question 49

The presence on what can increase the chances of getting periodontal disease?

Answer 49

1. Carious cavities 2. Existing periodontal disease 3. Calculus

Question 50

Which type of caries can increase you chances of getting periodontal diseases?

Answer 50

Carious lesion on the enamel and dentine at the gingival margin or below Root caries

Question 51

Why can root caries increase your chances of getting periodontal disease

Answer 51

These lesions can isolate and held periodontal pathogenic bacteria by acting as a plaque trap

Question 52

How can the existence of deep pockets increase your chances of getting periodontal disease?

Answer 52

1. Can lead to further destruction 2. Pocket physiology allows a toxic milieu to arise 3. Exposed furcations also collect plaque and make it harder for patients to properly clean their teeth

Question 53

What does calculus act as?

Answer 53

A plaque retention factor

Question 54

Describe supraginigival calculus

Answer 54

Lingual surface of lower anterior teeth | Cream yellow appearance

Question 55

What link is there between subginigival calculus and teeth?

Answer 55

Teeth with subgnigval calculus had a higher rate of attachment loss

Question 56

Colonisation of the ginigival crevice and root surface can lead to what?

Answer 56

increased risk of periodontal breakdown

Question 57

58% of root grooves extend more than how many mm apically from the CEJ?

Answer 57

5mm