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ETIOLOGY OF PERIODONTAL DISEASE

Etiology
1. Dental Plaque/ Biofilm
2. Predisposing Factor
3. Host Response
4. Systemic Influence

Dental Plaque
Defintion: Plaque is clinically defined as a
Structured, Resilient, Yellowish gray substance, that
adhere tenaciously to Intraoral hard surfaces, Including
removable and fixed restorations.

Biofilm
Definition: MATRIX ENCLOSED BACTERIAL
POPULATIONS ADHERENT TO EACH OTHER AND
TO SURFACES OR INTERFACES” Clinical significance of plaque :
1. Marginal plaque – Initiation and development of
gingivitis.
2. Supragingival and tooth associated subgingival
plaque – calculus formation and caries.
3. Tissue associated subgingival plaque *More
dangerous*– tissue destruction.

How to remove plaque:


1. Toothbrushing
2. Scaling

Composition of Plaque
 1 g wet plaque : contain 10^11 bacteria.
 500 distinct microbial species have been isolated of
which one individual can have 150 species.
Types of plaque
Supragingival plaque Subgingival plaque # Non bacterial microbes in plaque:-
Found above (coronal) or Tooth associated plaque :- 1. Mycoplasma ,
at the gingival margin. - Adhere to root 2. yeasts,
Marginal plaque cementum, 3. Protozoa,
Tissue associated plaque 4. viruses.
Layer of microorganisms
facing soft tissues
Matrix:
Gram +ve cocci and rods Gram-ve anaerobes,
Organic content Inorganic content
motile spirochetes
1. Albumin - from 1. calcium,
Eg: Eg:
gingival 2. phosphorus,
Streptococcus mitis, Peptostreptococcus
crevicular fluid . 3. sodium,fluoride
Streptococcus sanguis
 micros ,
2. Lipid – from food
Phorphyromonas
Actiomycosis viscosus, and cell debris,
gingivalis,
A. naselundii, 3. Glycoproteins –
Prevotella intermedia,
Eubacterium from saliva,
T.forsythia,
4. Polysaccharide –
f. nucleatum
from bacteria.

Progression of Plaque
*root cleaning
Loc: coronal to the gingival below the crest of the
margin and therefore is marginal gingiva and
visible in the oral cavity. therefore is not visible on
routine clinical
examination.

Influence hard and dense and


Colour: frequently appears dark
contact with such brown or greenish black
substances as tobacco and while being firmly attached
food pigments. to the tooth surface.
white or whitish in color,
hard with clay-like
consistency, and easily
detached from the tooth
surface.

Blue: good bacteria (A.nase..)


Red : more troublemaker ( Fuso. Nucleatum)

IATROGENIC FACTORS

1. Margins of the restoration 


Periodontitis: bone loss

PREDESPOSING FACTOR
2. Contoursandopencontact 

• CALCULUS
 • IATROGENIC
Calculus
DEFINITION
• Is mineralized bacterial plaque, which is a hard, tenacious
mass that forms on the clinical crowns of the natural teeth 3. Designofpontic 

and on denture and other dental appliances.
* Ordinarily calculus consists of mineralized bacterial
plaque with a layer covering unmineralised dental plaque.

4. Materials 


5. Designoftheremovalpartialdenture

6. Restorativedentistryprocedure

7. Periodontalcomplicationassociatedwith orthodontic
CALCULUS therapy
SUPRAGINGIVAL SUBGINGIVAL
CALCULUS CALCULUS
8. Extractionofthirdmolar 


9. Malocclusion 


Definition:

• Inadequate dental procedures that contribute to


deterioration of the periodontal tissues are referred to as

iatrogenic
factors.1