ETIOLOGY OF PERIODONTAL
DISEASES
Dr. Emrah Türkmen
emrahturkmen@medipol.edu.tr
The etiology of periodontal diseases includes:
• Microbial factors
• Accumulations on the Teeth
• Malocclusions
• Food impaction
• Improper use of oral hygiene tools
• Occlusal trauma
• Bruxism
• Iatrogenic factors
• Chemical, Physical, Radial applications
• Systemic factors
• Various habits
• Stress
• Nutrition
1- Microbial Factors
Microbial factors are the most important
factor that plays a role in the etiology of
periodontal diseases.
2- Accumulations on the Teeth
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Pellicle
Materia alba
Plaque
Calculus
Dental stains
Food debris
PellicIe:
 It is a homogeneous, membranous, cell-free film layer formed after
tooth eruption.
 It is a structure composed of salivary glycoproteins and is observed
between plaque and teeth.
 It is removed by polishing, but re-forms in a short time.
Materia Alba:
 It is soft accumulation of microorganisms, desquamated epithelial cells, leukocytes, salivary
proteins that the lack of organized structure of dental plaque
 It is somewhat less adherent than dental plaque.
 Easily displaced with a water sprey
Plaque:
 It is a mass firmly adhered to the tooth, consisting of
microorganisms, leukocytes, desquamated epithelial cells,
salivary glycoproteins.
 Impossible to remove by rinsing or the use of sprays
Calculus:
 Hard deposits that forms mineralization of dental plaque
 Generally covered by a layer of unmineralized plaque
Dental Stains:
 Pigmented deposits on the tooth surface are called dental stains.
 Stains are primarily an aesthetic problem and do not cause inflammation
of the gingiva
 The use of tobacco products, coffee, tea, mouthrinses, and pigments in
foods can contribute to stain formation
Food Debris:
 Most food debris is rapidly liquefied by bacterial enzymes and
cleared from the oral cavity by salivary flow and the mechanical
action of the tongue, cheeks, and lips
 Dental plaque is not a derivative of food debris, and food debris is
not an important cause of gingivitis.
3- Malocclusions
 The irregular alignment of teeth may make plaque control more
difficult
 Marginal and papillary gingivitis is frequently encountered in the
maxillary anterior sextant in cases that involve an anterior open bite
with mouth breathing.
4- Food Impaction
It is forceful wedging of food into the periodontium by occlusal forces.
Hirschfeld classification of factors causing food impaction:
 1- Occlusal wear
 2- Loss of proximal contact
 3- Extrusion beyond the occlusal plane
 4- Congenital morphological abnormalites
 5- Improperly constructed restorations
5- Improper use of oral hygiene tools
 Abrasions of the gingiva as well as alterations in tooth
structure may result from aggressive brushing in a
horizontal or rotary fashion. The gingival changes that
are attributable to toothbrush trauma may be acute or
chronic.
 The acute changes vary with regard to their
appearance and duration, from scuffing of the
epithelial surface to denudation of the underlying
connective tissue with the formation of a painful
gingival ulcer.
 Chronic toothbrush trauma results in gingival
recession with exposure of the root surface.
• The improper use of dental floss may result in
lacerations of the interdental papilla
6- Occlusal Trauma
 It is refers to injury to the periodontium caused by
excessive occlusal forces. More force comes into the
periodontium than it can tolerate
 The most common clinical findings are widening of
periodontal ligament space and increased mobility.
7- Bruxism
 Bruxism is a movement disorder characterized by grinding and
clenching of teeth.
 It has devastating effects on teeth, soft tissues and alveolar
bone.
 Periodontal destruction is inevitable in teeth that have lost
periodontal support.
8- Iatrogenic Factors
 Inadequate dental procedures that contribute to the deterioration of the periodontal tissues are
referred to as iatrogenic factors.
 Overfilled fillings
 Destruction of the gingiva by fillings and crowns
 Destruction by various filling materials and tools
 Destruction caused by faulty planning of partial dentures
 Complications during orthodontic treatment
 Destruction of bone and gingiva while teeth are being extracted
9- Chemical, Physical, Radial Applications
 Pressing aspirin, cologne or alcohol on the gums
 Side effects of various drugs (alendronate, nifedipine,
dilantin, overused mouthwashes)
 Consumption of excessive hot food/liquid
 Matrices bands used in dental fillings
 Effects of radiotherapy and chemotherapy (mucositis,
osteoradionecrosis)
Aspirin burn
10- Systemic Factors
 Hormonal, puberty, pregnancy, menopause,
 Various hematological problems,
 Various sytemic diseases and drugs used in their treatment
11- Various Habits
 Occupational habits: Shoemakers
with taking nails in their mouths,
tailors tearing threads with teeth,
acrobats lifting weights with their
teeth etc.
 Personal habits: Tongue and lip
piercing, nail biting, pen biting etc
Tongue piercing
12- Stress
 It can increase susceptibility to
periodontal disease by
weakening the immune
system.
 The most typical example is
acute necrotizing ulcerative
gingivitis.(ANUG).
13-Nutrition
 Proteins, carbohydrates, vitamins,
minerals and lipids, the frequency and
timing of the daily diet play an
important role in susceptibility to
periodontal disease.
 Scurvy, which develops due to vitamin
C deficiency, is the most typical
example.