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Local contributing factors are
oral conditions that increase a person’s susceptibility to periodontal disease in specific sites
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What are some LOCAL FACTORS CONTRIBUTING TO PERIODONTAL DISEASE
- –Increase plaque pathogenicity due to Calculus
- –Increase plaque biofilm retention due to Faulty restoration
- –Cause direct damage to the periodontium due to Food impaction, poorly fitting appliance
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The cause of gingival inflammation is
bacterial plaque biofilm
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The primary effect of calculus is not __________ but is due to ___________
- (as was originally thought) mechanical irritation
- its always being covered with a layer of living bacterial plaque biofilm
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__________ makes up 70 to 90% of supragingival calculus and consist of
- Inorganic mineral content
- Primarily calcium phosphate
- Calcium carbonate
- Magnesium phosphate
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Organic portion of calculus makes up ___ to ___% and consist of
- 10 to 30%
- Plaque biofilm – living bacteria
- Dead epithelial cells and white blood cells
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As calculus ages the inorganic components
change through different crystalline forms
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Newly formed calculus contains what inorganic component
–brushite
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calculus less than 6 months old contain what inorganic component
–octacalcium phosphate
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Mature calculus contain what kind of inorganic component
–primarily hydroxyapatite
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supragingival calculus appearance is ______ due to _______
- yellowish-white
- proteins in saliva
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supragingival calculusCan be found on any tooth surface BUT, most abundant on
- –the buccal surfaces of maxillary molars opposite Stenson’s duct, and
- –on the lingual surfaces of mandibular anterior teeth opposite Wharton’s duct
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SUBGINGIVAL CALCULUS shape is _______ and the appearance is
- –most often flattened guided by the pocket wall
- –Usually dark brown to black in color due to deposition of proteins located in blood in the gingival crevicular fluid
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What are the MODES OF ATTACHMENT OF CALCULUS
- 1. Attachment by means of the organic pellicle
- Most commonly on enamel surfacesEasily removed because the calculus is on the surface of the pellicle and not locked into the tooth surface
- 2. Attachment to irregularities in the tooth surface
- Irregularities include cracks, tiny openings where Sharpey fibers were detached, grooves in cementum, scratches from previous instrumentation
- Complete calculus removal is difficult because calculus is embedded in defects
- 3.Attachment by direct contact of the calculus and the tooth surface
- Matrix of calculus deposit is interlocked with the inorganic crystals of the tooth
- Deposits are difficult to remove
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Mineralization of calculus can begin within ______ hours with maturation occurring in about ___days
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The morphology (surface features) of a tooth that can increase biofilm retention, include
- –Poorly contoured restoration
- –Untreated tooth decay
- –Grooves or concavities in the tooth surface
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What is Pathogenicity
the ability of the bacteria in a biofilm to produce periodontal disease
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What are some FACTORS THAT CAUSE DIRECT DAMAGE TO THE PERIODONTIUM
- Food impaction
- Patient habits
- Faulty restorations
- Occlusal forces
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What are some patient habits that contribute to periodontal disease
- Mouth Breathing: Localized inflammation and gingival enlargement usually affecting anterior teeth due to drying effect
- Toothbrush Abrasion
- Acute – scuffing of epithelium
- Chronic – gingival recession with loss of tooth structure
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The biologic width is the ____ and atleast ___ mm
space on the tooth surface occupied by the junctional epithelium (the most apical part of the gingival sulcus and the alveolar crest) and the connective tissue fibers
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Crown Margins should be ____ not ______
intracrevicular not subgingival
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Describe First molar loss syndrome
- 2nd and 3rd molars drift mesially and tilt resulting in spaces and loss of vertical dimension
- Mandibular premolars may drift distally
- Maxillary 1st molar extrudes into space on mandibular arch
- Anterior overbite is increased with resultant pathologic migration
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What are Functional occlusal forces
normal forces produced during the act of chewing food
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Parafunctional occlusal forces result from _________ and what are two examples
- tooth to tooth contact when not in the act of eating
- Clenching
- Bruxism
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Signs of occlusal trauma
- –Tooth mobility
- –Sensitivity to pressure
- –Migration of teeth
- –Enlarged, funnel-shaped PDL space
- –Alveolar bone resorption
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Acute Trauma from Occlusion results from abrupt change in occlusal force such as ________ and can cause _________
- Biting hard object
- Restorations
- Prosthetics
- Tooth Pain, Sensitivity to Percussion, Increased tooth Mobility
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Referred Pain
pain referred from periodontal injury may be felt in the area of the maxillary sinuses or spread elsewhere in the facial area
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Chronic Trauma from Occlusion is _______ than acute trauma occlusion has greater clinical significance and develops from gradual occlusal changes such as ______
- –Tooth wear
- –Drifting of teeth
- –Extrusion of teeth
- –Bruxism
- –Clenching
- –No tooth Pain
- –No sensitivity to percussion
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Primary occlusal trauma is
injury to a normal periodontium resulting from excessive occlusal forces
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Secondary occlusal trauma is __________ and may result in ________
- injury to the periodontium from normal occlusal forces applied to a periodontium previously damaged by periodontitis
- more rapid bone loss and pocket formation
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