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4/22/12
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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4/22/12 Overzealous use of a toothbrush may denude the gingival
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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