Predisposing Factors for Periodontal Disease

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:

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 Gum 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 Gum disease. Non-decay cavitations, or what dentists call non-carious lesions, include abrasion, ab fraction, 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:

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.

Periodontal Gum Disease

Oral Appliances:

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:

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 Gum 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.

Wisdom Tooth Surgery – What to Expect After?

One of the reasons that makes going to the dentist a dreadful thought is tooth extraction. And we’re only talking about a simple extraction procedure here.

What if what it is your wisdom tooth that has to be extracted? As you might probably know, it is a way more extensive procedure because it involves a lot of pretty complicated steps.

But you don’t have to worry about undergoing it if you know what to expect after the operation and what you can do about it.

Bleeding

Bleeding is a common complication of any type of surgery, including simple extraction and wisdom tooth surgery.

Some bleeding may occur for up to a few minutes after surgery, but it’s nothing that cannot be stopped by applying pressure on the surgical area.

Do this by biting firmly on a piece of gauze for half an hour at least to allow for the formation of a blood clot that will plug the tooth socket.

Apply a new piece of gauze as needed. If the bleeding becomes profuse and persistent, you must contact your dentist immediately.

Aside from pressure application, you will also be given other instructions to keep bleeding to minimum. Basically, any activity that generates negative pressure like smoking, spitting, and using straws should be avoided.

Negative pressure creates a suction effect that can dislodge the clot and start bleeding again. It is also advised to refrain from doing any activity that causes blood pressure to rise.

You will also be instructed to be on a soft, cold diet for the first 24 hours. Cold promotes narrowing of the blood vessels on the extraction site, thereby preventing further bleeding.

Pain and Discomfort

You may also start to feel pain and some other discomfort a couple of hours after the operation, as anesthesia start wears off.

The degree of discomfort depends on your tolerance and the extent of the surgery. Needless to say, in a more extensive and traumatic surgery, the discomfort will be greater.

It will be mild to moderate in nature, but painkillers such as ibuprofen and mefenamic acid should be enough to get rid of them, otherwise, contact your dentist for further instructions because you might be experiencing the so-called dry socket.

With regards to your oral hygiene, you can avoid further discomfort by not brushing the area for the first 24 hours. You can clean it by rinsing it with a warm saline solution or an alcohol-free mouthwash. After a day, you should be able to go back to your normal oral hygiene routine.

Swelling

Swelling is another definite complication of surgery, and it will greatest for 48 to 72 hours after the operation.

To minimize swelling during this period, you may apply cold compress on intermittently on the area. Cold relieves swelling by causing the blood vessels to constrict.

Also, be sure to keep your head slightly above the heart level when lying down.

Infection

Infection should not be much of a problem if the operation is completed in the fastest possible time, although antibiotics may be given prior to and after the operation.

One way to determine if infection has occurred is the presence of foul odor. To combat infection, take your antibiotics exactly as prescribed by your dentist. Typically, you have to be on antibiotics thrice a day for seven to ten days.

Follow-up visits

After your surgery, you will be asked to come back to your dentist’s clinic for a follow-up visit, the purpose of which is to monitor healing. This follow-up visit should be done a week after the operation, or earlier if the depending on the complications you are experiencing.

Most Common Complications of Impacted Wisdom Teeth

The wisdom teeth, or the third molars, are the last teeth to emerge in the mouth.

Some people won’t have any problem with these teeth but most of the time, there is no enough space for them to erupt properly or develop normally.

In such case, these teeth get trapped, or in a more scientific term, become impacted.

An impacted wisdom tooth may be partially- or fully-impacted. Partial impaction is when some of parts of the crown have erupted, while full impaction is when the entire tooth is completely covered by gums and/or bone.

In both cases, surgical removal of the impacted tooth is necessary. The problem is, not all patients are willing to go through surgery.

However, retention of an impacted tooth can also be a problem, as it will lead to one or more of the following complications:

Tooth Decay:
Partial impaction allows bacteria to have access to the tooth, making it more likely to develop tooth decay.

Add to that the fact that its location makes it difficult to clean through brushing and flossing.

Tooth decay may result to pain, swelling, and in worst cases, difficulty opening the mouth. And if the impacted tooth is inclined towards the second molar, destruction of that tooth by decay or resorption is also very likely.

Damage to the Adjacent Teeth:
Sometimes, the impacted tooth may push against the tooth next to it, causing the latter to resorb.

Tooth resorption refers to the destruction or breakdown of the tooth structure, most especially the roots.

Severe resorption is usually very difficult to treat and may often lead to the extraction of the tooth involved.

Misalignment of Teeth:
The pressure exerted by the impacted teeth to against the nearby teeth may sometimes be enough to cause crowding, especially of the anterior teeth.

To correct crowding and bring the teeth back to their normal alignment, extraction of the impacted tooth is required along with orthodontic treatment.

If orthodontic treatment is done without extracting the impacted tooth, then crowding will recur once the orthodontic appliance is removed.

Pericoronitis:
Pericoronitis, otherwise called operculitis, is the inflammation of the gum tissue that surrounds the crown of a partially-impacted tooth.

The inflammation is usually caused by the accumulation and entrapment of debris underneath the gums, or it can also be brought about by repeated trauma when biting or chewing.

Pericoronitis can be mild or severe in nature.

Mild pericoronitis is characterized by localized redness and swelling of the gum tissue, whereas severe pericoronitis leads to difficulty opening the mouth in addition to the inflammation.

Cysts:
The crown of an unerupted tooth is enclosed in a so-called follicular sac.

This sac has the potential to become a cyst, which can grow larger by destroying the bone around it.

Unless the tooth and its sac are removed, the jawbone will get weaker and weaker over time, ultimately resulting to fracture.

All impacted teeth, unless contraindicated, should be considered for extraction. But of course, being a surgical procedure, it is important to have it done by a skilled and experienced dentist that you trust.