From our previous article, you’ve learned that predisposing factors are plaque-retentive factors found in the mouth. They are physical or mechanical that, aside from encouraging plaque accumulation, also renders plaque removal more difficult. In this article, we will discuss the most common predisposing factors one by one.
Calcular deposits are the most common predisposing factor. It has a hard, porous, and irregular surface where plaque can accumulate easily. Removal of calcular deposits will be of great help in the prevention and treatment of periodontal disease.
Irregularities on Tooth Surface:
These include cavitations caused by tooth decay, non-decay cavitations, and developmental abnormalities. Irregularities located in-between the teeth and near the gum line are the ones that contributes the most to the development of periodontal disease. Non-decay cavitations, or what dentists call non-carious lesions, include abrasion, abfraction, and erosion. Abrasion pertains to loss of tooth structure by mechanical causes, usually incorrect and vigorous tooth brushing.
Abfraction, meanwhile, is loss of tooth structure near the gum line due to flexure of tooth. It is often related to bruxism, and it gets worse when combined with incorrect tooth brushing techniques.
With regards to developmental irregularities, the most common are the so-called enamel pearls. These are globules of enamel that form in the root area, more commonly in-between the roots of molars. They are about the size of a pinhead.
Tooth malpositions can present as crowding, spacing, rotations, tipping, and drifting. All of these complicate oral hygiene, leading to increased plaque accumulation. Thus, dentists prescribe orthodontic treatment to correct the malposition and make oral hygiene much more effective. They may also recommend the use of adjuncts like interdental brushes, single-tufted brushes, and wood sticks to name a few.
Much like tooth malpositions, oral appliance also promotes the development of periodontal disease by making oral hygiene more difficult. Such appliances include partial dentures, dental braces, and retainers. In partial dentures, fixed bridges are more likely to encourage plaque accumulation because they are much more difficult to clean compared to their removable counterparts.
Dental braces and retainers are challenging to clean as well. That is why adjuncts are also recommended for those who have any oral appliance in their mouth. Individuals with dental braces, in particular, are advised not to delay or miss an appointment with their orthodontist.
Erupting Wisdom Teeth:
Erupting third molars are difficult to reach given their position at the back of the mouth. If they are partially-erupted and the orientation is not upright like other teeth are, the problem is even worse. Plaque accumulation often leads to a condition called pericoronitis, where the gum tissue overlying the partially-erupted tooth, also known as operculum, gets inflamed. To get rid of it, a procedure called operculectomy is required. It is a minor surgery that involves removal of the operculum. Another treatment option, which will be more effective as it gets rid of the root cause, is the extraction of the tooth itself.
Faulty restorations pertain to poorly-constructed or poorly-fabricated restorations. These restorations are commonly characterized by having overhangs, poor contours, and subgingival margins. An overhang is the extension of the restoration beyond the confines of the tooth. In other words, it pertains to excess restorative material. More often than not, you can find it in-between teeth and at or near the gum line. The periodontal destruction caused by overhangs is a slow and painless process, causing an individual to be aware of it only when the destruction is extensive enough.
Poor contours, on the other hand, make the gum tissues less cleansable. Problematic contours may be over- or under contoured. Lastly, subgingival margins are margins placed below the gum line. These margins are difficult to reach, making plaque removal almost impossible.
As you can see, these predisposing factors have a huge role in the development of periodontal disease. Some of them may be addressed by your dentist, but most are up to you to take care of. By eliminating these factors, their harmful effects on the mouth, periodontal disease can be prevented or arrested.