There are a number of smoking-related mechanisms pertaining to smoking as a risk
factor for periodontal disease. These include:
- Increased prevalence of some periodontal pathogens;
- Reduction in the levels of salivary IgA;
- Reduction in effective phagocytosis;
- Alterations in the numbers of certain T cell populations.
If an individual stops smoking this will allow an improved response to the
management of periodontal disease, but the time taken for this 'recovery' to occur is
unclear.
The underlying defect associated with general risk factors is compromised
phagocytosis and or chemotaxis. The importance of polymorphonuclear leucocyte
(neutrophil) function to the host response is also demonstrated in less common
conditions such as the neutropaenias (see page 252).
11.10 PERIODONTAL COMPLICATIONS OF ORTHODONTIC
TREATMENT
11.10.0 Introduction
Orthodontic treatment in adolescents, particularly with fixed appliances, can pre-
dispose to a deterioration in periodontal health and a number of well-recognized
complications.
11.10.1 Gingivitis
Access for interproximal toothbrushing is reduced considerably during fixed
appliance therapy and the accumulation of plaque induces gingivitis (625HFig. 11.9). The
problem is compounded when teeth are banded rather than bonded as periodontal
health is more easily maintained when the gingival sulcus is not encroached upon by
metal bands.
When supragingival plaque deposits are present on teeth that are being repositioned
orthodontically, the type of movement used may play an important part in the
development of periodontal problems. Supragingival plaque deposits are shifted into a
subgingival location by tipping movements. Conversely, bodily movements are less
likely to induce a relocation of supragingival plaque.