1. Supramarginal cal
2. Salivary cal

 Continuous or intermittent forceful closure of the maxillary teeth against the mandibular teeth

parafunctional habit

Forceful grinding of the teeth

parafunctional

The process of primarily breathing through the mouth rather than the nose

Appliance used to replace missing teeth

2 local risk factors can contribute to the initiation and progression of periodontal disease.

• Mineralized plaque that is covered on the external surface by nonmineralized, living plaque.
• The channels which are nonmineralized contain bacteria

• 1st max premolar
• Lower ant
• Always check and see if pt has palatogingival groove

70-90% inorganic

primarily-calcium phosphate

trace amounts- calcium carbonate,magnesium, sodium, potassium, fluoride,zinc, strontium

10-30% organic

materials derived from plaque, dead epithelial cells, dead WCB

• 25 -27%
• Smooth with instrument
• Talk to Dr about using hand piece to adj

• Create niches
• increase amount of plaque pathogenicity
• prevent effective plaque control

• increase bacteria
• prevent cleansing
• increase pathogenicity

What is the value of performing a periodontal risk assessment?

• Predicting an oral disease
• Help identify individuals and groups who would benefit from targeted interventions
• Increase clinician awareness
• Provide a foundation for early recognition which identifies correct disease management technologies.

Five step process in oral risk assessment

1.      Gather and review assessment data.

2.      assess and analyze

3.      Plan. 

4.      Recommend. 

5.      Evaluate or re-evaluate.

occlusal forces

food impaction

habots

faulty restorations

Mobility

Sensitivity to pressure

Migration

• enlarged, funnel shaped PDL
• Alveolar bone resorption

Primary-excessive force on healthy tissue

Secondary- excessive force on unhealthy tissue

Parafunctional occlusal forces

• widened PDL
• mobility
• pain
• Reversible once occlusion is corrected

• abnormal forces on unhealthy periodontium
• pt already has migration of JE and loss of attachment
• tooth will experience rapid bone loss and increased pocket formation

• Functional: normal forces applied during mastication
• Parafunctional: tooth to tooth contact when not masticating. (ie clenching, bruxism) 

•       Be able to give examples of local risk factors and how each affects the risk of periodontal disease. 

•       Tooth morphology

•       Max. 1^st premolars have a mesial concavity and max lateral incisors (palatogingival)

•       Poorly contoured restorations

•       Undercut or overcontoured restorations prevent cleansing and increase plaque retention

•       Calculus

•       Porous niches for bacteria

 Know how a dental hygienist can assist in diagnosing and planning for intervention for each risk factor identified.

• Tooth morology- Explore areas that we know retain plaque ( max 1^st premolars)
• Poorly contoured restoration- Examine RADS, explore, discuss with Dr
• Calculus-Remove calculus

Know the different modes of attachment for calculus and level of difficulty of removal for each one.

1.       Pellicle

                                                                                                               i.       Attaches on the pellicle versus the tooth. 

2.       Irregularities on the tooth surface

                                                                                                               i.      Cracks, openings from detached PDL fibers, over instrumentation grooves

3.       Direct contact of the calcified calculus and tooth

                                                                                                               i.      Calculus matrix interlocked with the inorganic crystals of the tooth