Other Predisposing Factors of Dental Calculus

8/3/2019 Other Predisposing Factors of Dental Calculus

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FACTORS OF DENTAL

CALCULUS

PRESENTED BY: MANISH AGARWALBDS III YEAR


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PREDISPOSING FACTORS

Iatrogenic factorsa) Margins of restorations

-:changing ecologic balance of gingival

sulcus to an area that favoursgrowth of disease-associatedorganisms at the expense of

health associated organisms-:inhibiting patients access to removeaccumulated plaque


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Fig a):Radiograph ofamalgam overhang on

distal surface of max 2ndmolar that is thecontributing source of

plaque retention andgingival inflammation

Fig b): Radiograph of

same patient shwn infig a) after theexcessive amalgam has

been removed


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b) Contours and open contacts-:Overcontoured crowns and restorationstend to accumulate plaque and possiblyprevent self cleaning mechanism.-:Papillary inflammation

-:Under contoured crowns-:Food impaction and plunger cusp-:In males, proximal contact

0.7%to 76% defective

Marginal ridges33.5 uneven


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Fig a): Inflamedmarginal and papillarygingiva adjacent to

overcontouredproclain-fused to-metal crown on max

left central incisor

Fig b): Radiography

of poorly fittingproclain-fused-to-metal crown shown

in fig a


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c)Materials:-Restorative materials arenot inherently injurious to

the periodontal tissues.Exception: self-curingacrylics

:-gingival inflammation:-formation ofpseudopockets


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Inflamed palatal gingiva associated with a max.provisional acrylic partial denture. Note the

substantial difference in color of the inflamedgingiva adjacent to the premolars and Ist molar


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d) Design of removablepartial dentures

:-Partial dentures favor theaccumulation of plaque,

particularly worn day and nighte) Restorative dentistryprocedures

:-rubber dam clamps, matrixbands, burs, and gingival

retraction cord


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f)Malocclusion:-Missing Md. first molar:

:-Mesial drifting and tilting ofMd. secondary and third molar

:-Wedge between Mx. first andsecondary molar

:-Open contact, food impaction,interproximal bone loss

:-Tongue thrusting: Spreading

and tilting of anterior teeth


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Fig a) Lower incisorshowing prominent rootwith gingival recession and

lacking attached gingiva

Fig b) Same patient shown

in fig a after placement ofsoft tissue graft to gainattached gingiva and treatgingival recession

Fig c) Anterior open bitewith flared incisors, asobserved in association

with a habit of tongue


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Periodontal complications associated withorthodontic therapy

Plaque retention and composition

Bacterial plaque and food debris,

resulting in gingivitis A.a was found in at least one site in

85% of children wearing orthodontic

appliances

15% of control subjects


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Gingival inflammation andenlargement associated with

orthodontic appliance and poor oral


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Gingival trauma and

alveolar bone height Higher alveolar bone loss in adultthan in

adolescents

Tissue response to

orthodontic forcesExcessive force produce necrosis ofPDL,alveolar bone and increase the

risk of apical root resorption


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Fig a) Max central incisors inwhich an elastic ligature wasused to close a midline

diastema. Note inflamedgingiva and deep probingdepths.

Fig b) Same patient shown in

fig a. A full-thicknessmucoperiosteal flap has beenreflected to expose the elasticligature and angular intrabonydefects around the central

incisors. Fig c) Radiograph ofimpacted max caninethat require surgical

exposure andorthodontic assistance


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Extraction of impacted thirdmolars Creation of vertical defects distal to

the second molar . Individual older than 25 years.

Visible plaque, bleeding on probing,

root resorption in the contact area,presence of a pathologically widenedfollicle, inclination of the third molar

and the proximity of the third molar


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Habits and self-inflictedinjuries

Gingival recession on a maxillary caninecaused by self-inflicted trauma from thepatients fingernail.


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Trauma associated with oral

jewelry Piercing jewelry in the lip or

tongue

Mostly teenagers and youngadults

lingual recession with pocketformation

Bone loss


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Fig a) Priced tongue withoral jewelry

Fig b)Probing depth of8mm with 10 mm of

clinical attachment loss onlingual surface of lowercental incisor adjacent tooral jewelry in pricing

tongue.

Fig c)Radiograph of lowerincisor in fig b, depicting bone

loss associated with pierced


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Toothbrush trauma

Acute:

Gingival ulcer

Diffuse erythema and denudation

due to overzealous brushing

Chronic:

Gingival recession with denudation ofthe root surface

Interproximal attachment loss


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epithelial surface and expose the underlying connectivetissue as a ainful ulcer


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Chemical irritation

Sensitivity or nonspecific tissue injury

Simple erythema to painful vesicle

formation and ulceration. strong mouthwashes,

topical application of corrosive drugs

(asprin or cocaine), accidental contact with drugs such as

phenol or silver nitrate


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Fig a) Chemical burnscaused by aspirin, withsloughing of gingival

tissue andaccompanyingrecession.

Fig b) Biopsy of aspirin-induced chemical burns.Note intraepithelialvesicles(V) and

inflammatory infiltrate (I)


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Tobacco use

Smokers are 2.6 to 6 times more likely to

develop periodontal disease

They harbor more pathogenic subgingival

microfloraTheir flora might be more virulent

more difficult to suppress certain bacteria

such as A.a, P.g, B.f depressed numbers of helper T

lymphocytes

reducing serum levels of IgG


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Gingival recession and hyperkeratosis ofthe vestibular mucosa that developed

following the use of chewing tobacco.


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Radiation therapy

Total dose of radiation for head and necktumors is in the range of 5000 to 8000centigrays

fractionation: 100 to 1000 cGy per week Mucositis: avoid irritation such as

smoking, alcohol, and spicy foods

Precautions:

prophylatic antibiotics,


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THANKYOU

Other Predisposing Factors of Dental Calculus

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