Iatrogenic Factors In Periodontal Diseases

Iatrogenic Factors In Periodontal Diseases

Write short note on periodontal disease and iatrogenic factors.
Answer. Iatrogenic factors are any dental procedures that contribute to the deterioration of the periodontal tissues, e.g. quality of dental restoration or prosthesis.

Conservative Dentistry Factors

• Use of the rubber dam clamps, copper bands, matrix bands and disks in such a manner as to lacerate the gingiva. This results in varying degree of inflmmation.
• Restorative materials: It remains rough, unpolished the restoration surfaces favor plaque accumulation and contributes to periodontal diseases.
• GIC and porcelain seems to retain less plaque and are more acceptable from the periodontal point of view.
• Highly polished surfaces of porcelain inhibit plaque accumulation and permit its rapid removal.
• Fluoride constantly leaking from GIC prevents the attachment of the bacteria to the pellicle and it also interferes with the metabolism and growth of the bacteria.
• Subgingival restorations are plaque retentive areas that are inaccessible to scaling instruments, hence greater chance of severe gingivitis and deeper pockets.
• Overhanging dental restorations has been considered to be a contributing factor to gingivitis and possible periodontal attachment loss. Overhanging dental restorations not only increase plaque mass but also increases the specific periodontal pathogens in the plaque.
• Over-contoured or improperly contoured restorations tend to accumulate plaque and possibly prevents the selfcleansing mechanisms of adjacent cheek, lips and tongue.
• Poorly constructed restorations will cause occlusal disturbances that may be injurious to the supporting normal periodontal tissues. This type of tissue injury is called as ’primary trauma from occlusion.

Prosthodontic Factors

• Failure to replace the extracted teeth initiates a series of changes that produce various degrees of periodontal diseases.
• Insertion of prosthesis, replacement that creates excessive forces on the abutment or antagonist teeth.
• Excessive forces on the abutment results in increased mobility of abutment with gingival inflammation and periodontal pocket formation.
• Presence of RPD accentuates increased plaque formation and predisposes to gingival inflammation. Presence of RPD not only induces quantitative changes in plaque, but also qualitative changes by promoting development of most pathogenic bacteria.

Orthodontic Factors

Miller has listed 8 possibilities for periodontal breakdown brought about by the orthodontic treatment.

• Too rapid movement
• Too vigorous pressure
• Not allowing sufficient resting time between application of pressure
• Moving the teeth into traumatic occlusion.
• Unusual tissue responses
• Endocrine factors
• Nutritional deficiencies
• Undue displacement of the apex.