classified as local or general. Local factors, for example, an instanding lateral incisor,
may serve to compromise local plaque control by hindering effective cleaning and
resulting in dental plaque accumulation. On the other hand, general risk factors, such
as an inherited disorder may predispose an individual to periodontal disease despite a
good level of plaque control.
It is important to understand that if a child possesses a risk factor for periodontal
disease, it does not necessarily follow that the child will develop the condition.
Conversely, a patient may appear to have no risk factors, but the disease may develop
subsequently. Bearing this in mind, risk factors (both local and general) should be
considered when assessing, diagnosing, treating, and maintaining child patients with
periodontal disease.
11.9.1 Local risk factors
These can be grouped simply into four areas. There may be overlap between these
areas.
- Malocclusions.
- Following traumatic dental injuries.
- Plaque retentive factors.
- Ectopic eruption
Malocclusions
An instanding or rotated tooth may be difficult to clean and can cause increased
plaque retention. A traumatic occlusion may result in direct damage to the periodontal
support. Angle's Class II division ii malocclusions with increased and complete
overbites may predispose to damage of the gingiva palatal to the upper incisor teeth.
Similarly, severely retroclined upper incisor teeth may damage the labial gingiva of
the lower teeth.
Following a traumatic dental injury
Luxation, intrusion and avulsion injuries all result in varying degrees of damage to the
periodontal ligament and if severe, alveolar bone. This results in increased tooth
mobility which is managed by providing the affected teeth with a splint. If a
traumatised tooth is left in a severely mobile state or in traumatic occlusion, the
periodontal ligament fibres will not heal and further damage may ensue.
Plaque retentive factors
There is a multitude of plaque retentive factors which may serve to compromise the
health of the periodontium. They may be naturally occurring (in the case of a dental
anomaly) or be iatrogenic.
Examples of dental anomalies include:
- Erupted supernumerary teeth (localized malocclusion).
- Invaginated odontomes.