The role of local and systemic risk factors in periodontitis — Ivan Mandel Definition of a risk factor Primary etiologic factors causative factors of periodontal diseases are bacteria.
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They are necessary and sufficient to initiate an inflammation. Risk factors contribute to the process initiated by causative factors through increasing the likelihood of disease occurrence or through modifying the speed and severity of disease development.
These can be divided into two main subgroups: local and systemic factors. Local factors can be of natural origin or iatrogenic. Local factors Iatrogenic risk factors Deficiencies in the quality of dental restorations or prostheses are plaque retentive factors.
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Overhanging margins of restorations, overcontoured crowns, contact areas of inappropriate size or position, lack of contact areas, insufficient width of embrasure areas under pontics, insufficient space provision for interdental papillae between crowns and pontics, insufficient space provision between kerületi papillae nyelvkezelés attachments and the marginal gingiva and inadequate RPD design increase dental plaque accumulation and make oral hygiene procedures more difficult.
Biological width is defined as the amount of soft tissue attached to the tooth surface above the crest of the alveolar bone. It is approximately 2mm, composed of ~1mm epithelial attachment and ~1mm connective tissue attachment.
This 2 mm band of soft tissue is paraziták és buzgó tünetek maintained by the body: chronic iatrogenic irritation and the subsequent apical reposition of the epithelial attachment cause equal amount of bone resorption. Fixed orthodontic appliances are also kerületi papillae nyelvkezelés retentive factors.
Figure 3. Figure 1. Figure 2. Oral hygiene is excellent Figure 3. Figure 4.
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As epithelial attachment follows these irregularities of enamel development, gingival recession or attachment loss may occur. Pseudofurcation is a shallow groove along the buccal surface of the neck and root of maxillary incisors that often contributes to attachment loss. Mesial and distal depressions are often seen on the cervical areas of the premolar teeth.
These concave surfaces are almost impossible to clean with a toothbrush or with dental floss therefore the use of interdental brushes is recommended. In microdontia diasthemas often cause food impaction in the interdental region. Figure 5. Abnormalities in the position and number of teeth Ectopia of teeth may lead kerületi papillae nyelvkezelés dehiscence, fenestration and crowding.
Eccentric bite load can be a cause of trauma from occlusion. Resorption of the interdental septum may be seen in crowding if the distance between the roots of neighboring teeth is narrower than 1. Figure 6. It often leads to traumatic occlusion: widening of the periodontal ligament, increased mobility, drifting and migration of teeth.
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Trauma from occlusion alone does not result in attachment loss, however it may enhance the rate of progression of attachment loss around teeth with periodontitis. Furcation involvement Denuded furcation areas of teeth with attachment loss as a féregellenes étrend of periodontitis are highly plaque retentive.
Furcation involvement worsens the long term prognosis of teeth, especially that of the upper molars. Figure 7. These cervical notches are plaque retentive. Root caries, circular caries, approximal caries Carious lesions with cavitation in the cervical area of teeth are highly plaque retentive.
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Figure 8. However its irregular surface is always covered with dental plaque, which is the main causative factor of periodontal inflammation. Figure 9. Figure Aberrant frenum Aberrant frenum pull caused by a kerületi papillae nyelvkezelés attached close to the marginal gingiva often produces shallow vestibule and gingival recession.
Non-modifiable systemic risk factors Immunodeficient conditions The main cause of tissue damage in periodontal inflammation is related to host immunological reactions. Both hyper-responsiveness and decreased response of the immune system may lead to a more severe tissue loss. Decreased number familiar chronic benign neutropenia, cyclic neutropenia, Kostmann-syndrome or altered function of PMN leukocytes leukocyte adhesion deficiency type I.
Hormonal conditions Sexual hormones have an effect on capillary morphology and permeability of periodontal tissues as well as on biofilm bacteria. These hormones play a crucial role in pubertal, menstruational and pregnancy gingivitis. Diabetes Mellitus Badly managed diabetes mellitus patients have a 3.
Osmotic damage kerületi papillae nyelvkezelés cells caused by hyperglycemia and alterations in protein functions due to glycation lead to altered immune functions increased inflammatory cytokine and interleukine production and decreased regenerative capacity of tissues.
Periodontal inflammation also affects diabetes by increasing insulin resistance and by aggravating the progression of complications of DM. Therefore diabetes and periodontitis are in bi-directional relationship. Ethnicity Research has shown that localized aggressive periodontitis is significantly more common and the occurrence of pockets deeper than 5 mm is 3 times higher in the African-American population than in the Caucasian population in the USA.
On the contrary, ulcerative periodontal lesions are more frequent in Caucasian Americans. Kerületi papillae nyelvkezelés The prevalence and severity of periodontal lesions increases kerületi papillae nyelvkezelés age. Modifiable systemic risk factors Smoking Smoking is the most important behavioral risk factor of periodontitis. Tooth loss and attachment loss due to periodontitis proportionately increases with the number of years and number of cigarettes the patient has smoked.
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Smoking alters gingival blood circulation decreased BOP on the periodontal chartdecreases O2 tension in kerületi papillae nyelvkezelés red complex bacteria occur in pockets shallower than normalalters immune response, and reduces the growth potential of periodontal ligament fibroblasts.
Nutrition Decreased protein intake and vitamin C deficiency are risk factors for periodontal disease. Vitamin C supplementation is especially important for smokers.
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The use of probiotics decreases the number of pathogenic bacteria in both the supra- and subgingival flora. Socio-economic factors Lower socio-economic status is a risk factor for periodontal disease. This can be related to more stress, higher prevalence of smoking, poor oral hygiene and fewer dental visits of people living in lower socio-economic conditions.