Aetiology of Periodontal Disease: Local Factors

• What are the secondary local factors of periodontal diseases?

  Plaque retentive factors:

  Dental calculusLack of salivaOther plaque retentive featuresMost local factors particularly affect gingivitis
• What is dental calculus?

  Mineralised dental plaque covering the enamel or root surface, consisting of calcium & phosphate crystals

  
• Where is dental calculus found?

  Supragingivally: found in sites of saliva pooling, light coloured & frosted

  
  

  Subgingivally: found in periodontal pockets, hard & dark, difficult to remove

  
• What does dental calculus act as?

  A plaque trap
• What are some other plaque retentive features?

  Tooth position

  Gingival anatomy

  Tooth shape/abnormalities

  Root anatomy

  Carious cavities

  Overhanging restorations

  Removable prostheses/appliances
• How is tooth position a plaque retentive factor?

  Malalignment & crowding would increase plaque accumulation

  
  

  Open contacts which would lead to food packing

  
• How are gingival anatomy & tooth abnormalities plaque retentive factors?

  Gingival overgrowth can cover surface of tooth, making it difficult for patients to remove plaque from there

  
  

  Tooth abnormalities like enamel projections will lead to increased plaque accumulations around that area

  
• How is root anatomy & its abnormalities a plaque retentive factor?

  Furcations of molars/premolars and bone loss in that area will lead to an exposed area so it's an additional surface that plaque can attach to

  
  

  Root depression e.g. if there's been bone loss in that area as well due to periodontitis, then the area becomes exposed and so more plaque being retained

  
  

  Root grooves- unevenness in the tooth surface=plaque retentive factor
• Furcation


  Area between two or more root branches
• How are caries & restorative margins plaque retentive factors?

  Overhanging restorations can lead to plaque accumulation in the area, resulting in plaque-induced gingivitis

  
  

  Carious cavities lead to plaque retention

  
• How is removable prostheses & appliances a plaque retentive factor?

  Removable partial dentures & fixed or removable orthodontic appliances increase the risk of plaque retention because patients might not be brushing their teeth properly as a result
• How is lack of saliva a plaque retentive factor?

  Xerostomia (dry mouth) is a factor because it means there's a lack of salivary antibacterial factors present to protect against the plaque
• What can xerostomia be a feature of?

  Mouth breathers

  Incompetent lips

  Drying of labial tissues

  Patients taking polypharmacy

  Patients with certain conditions e.g. Sjogren's syndrome

  Salivary gland disease

  Medications such as beta blockers, antidepressants
• What is untreated gingivitis a risk factor for?

  Periodontitis