Plaque control for the
prevention of oral diseases
Libyan International Medical University
2nd Year First Semester
D Caroline Piske de A. Mohamed
Objectives
• At the end of this topic you should be able to
explain and describe:
• Plaque retentive factors.
Dental Plaque retentive factors.
• Margins of
restoration
• Contours and
open contact
• Materials
• Design of
RFD
• Maloclusion and
Periodontal
complications
associated with
therapy
• Extraction of
impacted 3 rd
molar
• Radiation therapy
1.
IATROGEN
IC
FACTORS
3.HABITS
AND SELF
INFLICTED
INJURIES
2.
ASSOCIATE
D WITH
CLINICAL
PROCEDUR
ES
4.ANATOMIC
CONTRIBUT
ING
FACTORS
• Toothbrush
trauma
• Chemical
irritation
• Mouth breathing
• Tongue thrusting
• Tobacco use
• Others
• Proximal contact
relation
• Enamel pearls
and CEP
• Root anatomy
cemental tears
• Accesory canals
• Adjacent teeth
1. IATROGENIC FACTORS
• Inadequate dental procedures that
contribute to the deterioration of the
periodontal tissues are referred as iatrogenic
factors.
a. Margins of restoration
b. Contours and open contact
c. Materials
d. Design of RFD
a) Margins of restoration
• Overhanging
margins
of
dental
contribute to the development of
disease:
1. Shift on gingival sulcus flora
2. No access to remove plaque
restoration
periodontal
Subgingival margins = large amount of plaque = more
severe gingivites and deep pocket
b) Contours and open contacts
• Over contoured crowns and restoration tend to accumulate
plaque and possibly prevent the selfcleaning mechanism of the
cheek, lips and tongue.
• Contour of the occlusal surface as stablished by marginal
ridges and related developmental grooves serves to deflect food
away from the interproximal spaces.
• The integrity and location of the proximal contacts along with
the contour of the marginal ridges and developmental grooves
prevent interproximal food impactation.
• As the teeth wear down their originally convex
proximally surfaces become flattened and the wedging
effect of the opposing cusp is exaggerated. ( plunger
cusps)
• Not replaced missing teeth may also act as plunger
cusps as the relationship between proximal contacts is
altered.
• The presence of abnormalities does not necessarily
lead to food impaction and periodontal disease.
• Ecxessive anterior overbite is a common
cause of food impaction on the lingual surfacs of
the opposing mandibular teeth.
c) Materials
• Plaque that forms at the margins of the
restoration ( all types of restorative
material – silicate) is similar to that
found on the adjacent non restored
tooth surfaces.
• Hygiene Pontic gives access for oral
hygiene.
d) Design of Removal Partial
Dentures.
• After the insertion of partial dentures, the mobility of
the abutment teeth, gingival inflammation and
periodontal pocket formation increases because
partial dentures favor the accumulation of plaque
particularly if they cover the gingival tissue.
• Take off PRD at night.
2. Associated with clinical
procedure malocclusion
• A maloccusion is a irregular alignment of
teeth that may make plaque control more
difficult.
2 ASSOCIATED WITH CLINICAL
PROCEDURES
• Maloclusion and Periodontal complications
associated with therapy
• Extraction of impacted 3 rd molar
• Radiation therapy
Periodontal complication associated with
the orthodontic therapy
• Ortho. Therapy may affect the periodontium by favoring
the plaque retention or by directly injuring the gingiva as a
result of overextended bands and by creating excessive force
on tooth and supporting structures.
• Ortho. Appliances can modify the gingival ecosystem.
Gingival trauma and alveolar bone height
• Ortho. Treatment is often started soon after
eruption of the permanent teeth, when
junctional epithelium is still adherent to the
enamel surface.
• Ortho. Bands should not be forcefully placed
beyond the level of attachment because this will
detach the gingiva from the tooth and result in
apical proliferation of the junctional ep., with
increased incidence of gingiva recession.
• It is important to avoid excessive force and too
rapid movement in ortho. Treatment.
Associated with clinical procedures
• Extraction of impacted third molars
Numerous studies reported that the
extraction of impacted 3rd molars often results
in the creation of vertical defects distal to the
second molars.
Associated with clinical procedures
• Radiation therapy
• Citotoxic effects on both normal cells and malignant
cells.
• Periodontal attachment loss and tooth loss were
greater on the radiated side in cancer patients treated
with high dose unilateral radiation compared with non
radiated control side of dentition.
• Radiation therapy induces
• Obliterative end arterites result in soft tissue
ischemia and fibrosis
• Irradiated bone becomes hypo vascular and
hypoxic
• Saliva production is permanentely impaired
• Xerostomia results in greater plaque
accumulation and a reduced buffering capacity
from the remaining saliva
3. HABITS AND SELF INFLICTED INJURIES
•
•
•
•
•
•
Toothbrush trauma
Chemical irritation
Mouth breathing
Tongue thrusting
Tobacco use
Others
3. Habits and self inflicted injuries
• Toothbrush trauma
• Abrasion of the gingiva as well as alterations in
tooth structure may result from aggressive brushing
in a horizontal or rotary fashion.
• Highly abrasive dentifrice.
• Scuffing of epithelial surface, denudation of
underlying connective tissue – gingival ulcer
gingival recession.
• Improper use of dental floss may result in
lacerations of interdental papilla.
• Interproximal attachment loss is generally a
consequence
of
bacteria
induced
periodontitis, where as buccal and linghal
attachment loss is frequently result of
toothbrush abrasion.
Tobacco use
• Smoking is one of the most significant risk
factors currently available to predict the
development
and
progression
of
periodontitis.
• A diminished response to non surgical
therapy has been reported for smokers.
Habits and self inflicted injuries
• Chemical irritation
• Acute gingival inflammation may be caused by
chemical irritation resulting from either sensitivity or
non specific injury.
• Chemicals- Strong mouthwashes, topical application
of corrosive drugs as aspirin, and accidental contact
with phenol or silver nitrate, bleaching.
Mouth Breathing
• Can dehydrate the gingival tissue and
increase suscetibility to inflammation.
• These patients may or may not have
increased levels of dental plaque.
• Tongue thrust
• Tongue thrusting is often associated with an anterior
open bite. During swallowing tongue is thrusted forward
against the teeth instead of being placed against the
palate.
• When the amount of pressure against the teeth is
great it can lead to tooth mobility and cause
increased spacing of ant. Teeth.
Habits and self inflicted injuries
• Fingernail biting
• Using toothpicks
• Trauma associated with oral
jewelry
(tongue and lip piercing)
• Trauma associated with drug abuse
4. Anatomic contributing factors
a. Proximal contact relation
b. Cervical enamel projections and enamel
pearls
c. Intermediate bifurcation ridge
d. Root anatomy
e. Cemental tears
f. Accessory canals
g. Root proximity
h. Adjacent teeth
a) Proximal contact relation
• Open interproximal contacts or uneven marginal
ridge relations are factors that may predispose to food
impaction.
• It can lead to inflammation, bone los, and attachment
loss.
• Open interproximal contacts that are easily
cleansable may be as healthy as those with a proper
contact relation.
b) Cervical enamel projections and
enamel pearls
• CEP appear as narrow wedge shaped extensions of
enamel pointing from the CEJ towards furcation
area.
• Most frequently in molars.
• Plaque retentive and can predispose to furcation
involvement.
c) Intermediate bifurcation ridge
Bifurcation ridges are one of the contributing anatomical
factors in the etiology and compromised prognosis of
furcation involved teeth.
d) Root anatomy
•
•
•
•
•
Palatogingival groove
Attachment area
Root trunk lengh
Interroot separation
Root fusion
• Root grooves are developmental anomalies in which
an infolding of the inner enamel epithelium and
Hertwigs epithelial root sheath (HERS) creates a
groove on the tooth surface.
• Such morphological features compromise patient's
self care, favour accumulation of plaque, calculus
and food debris.
• They facilitate plaque growth and later provide
anaerobic condition for bacterial selection and
proliferation. They cause patients inaccessibility to
routine oral hygiene procedures and they also
complicate restorative procedures.
• Root trunk length is defined as area of the tooth
extending from CEJ to the furcation. Therefore
horizontal attachment loss leading to furcation invasion
compromises the root trunk, resulting in the loss of one
third of the total periodontal support.
• The significance of root trunk is related to both prognosis
and treatment of tooth.
• A molar with a short root trunk is more vulnerable to
furcation involvement but has a better prognosis
after treatment since less periodontal destruction
has presumably occurred.
• Alternatively a furcation involved molar with a long
root trunk and short roots may not be a candidate for
root resection, since these teeth lose more periodontal
support with furcation invasion.
e) Cemental tears
• A Cemental tear is a piece of detached cementum,
often with some dentin, that may remain attached to
periodontal ligamental fibers.
• It can lead to rapid periodontal bone loss and
produce bony defect.
f) Accessory canals
• Accessory
canals
may
furnish
a
communication between canal and the PDL.
• Pulpal necrosis could contribute to formation
of periodontal defect through an accessory
canal.
g) Root proximity
• Close approximation of tooth roots, with an
accompanying thin interproximal septum, leads to an
increased risk of periodontal destruction.
• Crowns of these teeth especially anterior teeth are
very closely approximated and may have long
interproximal contacts, and minimal embrasure
space, which makes plaque removal difficult.
h) Adjacent teeth
• Retention of periodontally compromised tooth
may have a detrimental effect on a adjacent
periodontally healthy tooth.
• Adjacent third molars are of particular
concern in patients with periodontites
Recommended
• Mouth Care for Patients Receiving
Chemotherapy and
Radiation Therapy In.
http://www.cancerlearning.gov.au/docs/Mout
h_cares.pdf
Activity
• Please buy and use 3 different types of tooth
pastes.
• Next class you should provide a report
comparing the advantages and disadvantages of
the different characteristics of each tooth paste
regarding taste, smell, appearance, ease of use,
feeling of freshness after brushing, effectiveness,
prices and general satisfaction with it.
References
•
•
•
•
•
•
Marya CM. A Textbook of Public Health Dentistry. JaypeenBrothers Medical Publishers, 2011.
Harris. N.O.Primary Preventive Dentistry. Ed.Apleton& lange. 4 ed. 1991.
Leknes KN. The influence of anatomic and iatrogenic root surface characteristics on bacterial and periodontal destruction: A Review. J periodontal 1997; 68(6) :507-516.
2. Matthews DC, Tabesh M. Detection of localized tooth -related factors that predispose to periodontal infections. Periodontol 2000; 2004;34:136-50
3. Blieden T M. Tooth related issues. Ann periodontal 1999;4(1): 91-7
4. Buckley LA. The relationship between malocclusion and periodontal disease. J Periodontol 1972; 43(7): 415-7.
5. Wasserman B H, Thompson RH Jr, Geiger AM, Goodman SF, Pomerantz J, Tyugeon LR, BeubeFE. Relationship of occlusion and periodontal disease. II. Periodontal status of study
population. J Periodontol. 1971;42(6): 371-8.
6. Silness J, Roynstrand T, Relationship between alignment conditions of teeth in anterior segments and dental health. J Clin Periodontol 1985; 12(4): 312-20.
7. Kornman KS, Loe H. The role of local factors in the etiology of periodontal diseases. Periodontol 2000 1993 2; 83-97
8. Jernberg GR., Bakdash MB, Keenan KM. Relationship between proximal tooth open contacts and periodontal disease. J Periodontol 1983; 54(9): 529-33.
9. Koral SM, Howell T.H, Jeffcoat MK. Alveolar bone loss due to open interproximal contacts in periodontal disease. J Periodontol 1981 ;52(8): 447-50.
10. Geiger A M, Wasserman B H, Turgeon L R . Relationship of occlusion and periodontal disease. 8. - Relationship of crowding and spacing to periodontal destruction and gingival
inflammation. J Periodontol 1974; 45(1):43-49.
11. Woofler C. The prevalence and etiology of gingival recession. Periodontal Abstr. 1969; 17(2): 45-50
12. Grant, Stern , Listgarten. Treatment of periodontal trauma. Periodontics , sixth edition. C.V Mosby company 1988.
13. Kepic TJ, O'Leary TJ. Role of marginal ridge relationship as an etiologic factor in periodontal disease. J Periodontol 1978; 49(11): 570-5.
14. Haney JM, Leknes KN, Lie T, Selvig KA, Wikesjo UM. Cemental tear related to rapid periodontal breakdown: A case report. J Periodontol 1992; 63(3):220-4.
15. Ishikawa I, Oda S., Hayashi J., Arakawa S. Cervical cemental tears in older patients with adult Periodontitis. Case reports. J Periodontol 1996; 67(1) :15-20.
16. Gher ME, Vernino AR. Root morphology - clinical significance in the pathogenesis and treatment of periodontal disease. J Am Dent Asoc 1980 ;101(4): 627-33.
17. Gher MW Jr, Dunlap RW . Linear variation in root surface area of maxillary first molar. J Periodontol 1985; 56(1): 39-43.
18. Mass E, Aharoni K, Vardimon AD. Labial-cervical-vertical groove in maxillary permanent incisors- prevalence, severity and affected soft tissue. Quintessence Int 2005 ;36(4) :281-6.
19. AL-Shammari KF, Kazor CE, Wang HL.Molar root anatomy and management of furcation defects. J Clin Periodontol 2001:28(8):730-40.
20. Leknes KN, Lie T, Selvig KA. Root grooves: A risk factor in periodontal attachment loss . J Periodontol 1994;65(9):859-63.
21. Hou GL, Tsai CC. Relationship between palato-radicular grooves and localized periodontitis. J Periodontol 1993;20(9) :678-82.
22. Hou GL, Chen YM, Tsai CC, Weisgold AS. A new classification of molar furcation involvement based on the root trunk and horizontal and vertical bone loss. Int J Periodontics
Restorative Dent 1998; 18(3): 257-65.
23. Svardstrom G, Wennstrom JL. Furcation topography of the maxillary and mandibular first molars. J Clin Periodontol 1988; 15(5) :271-5.
24. Santana RB, Uzel MI, Gusman H, Gunaydin Y, Jones JA, Leone CW. Morphometric analysis of the furcation anatomy of mandibular molars. J Periodontol 2004; 75(6): 824-9.
25. Hou GL, Tsai CC. Cervical enamel projection and intermediate bifurcational ridge correlated with molar furcation involvements. J Periodontol 1997; 68(7): 687-93.
26. Swan RH, Hurt WC. Cervical enamel projections as an etiologic factor in furcation involvement . J Am Dent Assoc 1976; 93(2) :342-5.
27. Bissada NF, Abdelmalek RG. Incidence of cervical enamel projections and its relationship to furcation involvement in Egyptian skull. J Periodontol 1973; 44(9) :583-5.
28. Leib AM, Berdon JK. Furcation involvements correlated with enamel projections from the cementoenamel junction. J Periodontol 1967; 38(4): 330-4.
29. Shiloh J, Kopezyk R. Developmental variations of tooth morphology and periodontal disease. J Am Dent Assoc 1979;99(4): 627-630.
30. Bower RC. Furcation morphology relative to periodontal treatment. Furcation root surface morphology. J Periodontol 1979; 50(7):366-74.
31. Booker BW 3rd, Loughlin DM. A morphologic study of the mesial root surface of the adolescent maxillary first bicuspid. J Periodontol 1985; 56(11) :666-70.
1. Löe H, Schiött CR, Karring G, Karring T. Two years oral use of
chlorhexidine in man. I. General design and clinical effects. J Periodontal
Res. 1976 Jun;11(3):135-44.