How Factors Related to Dentition Affect Periodontal Disease

Many dentition-related factors, including teeth that naturally grow in crowded, occur for unavoidable genetic reasons, but they may also occur as a result of modifiable behavior. For example, certain habits in childhood are considered risk factors: using a pacifier or sucking on the thumb or fingers past the age of three can increase risk of crooked teeth and misaligned jawbones. 

Modifiable adult behavior can also cause teeth to shift. For example, sleep bruxism (or teeth grinding), which occurs in approximately 13% of adults, can cause damage to both the teeth and jaw that can lead to dentition shifting over time. Bruxism may also lead to masticatory muscle hypertrophy, tooth surface loss, fracture of restorations or teeth, hypersensitive or painful teeth and loss of periodontal support.

Traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting. 

Many dentition-related factors that could increase risk of periodontal disease also occur as a result of face, jaw, or mouth injury. Stress to patients that even appear as minor injuries around the jaw, mouth, and face can drastically affect how the teeth fit together, so any patients that suffer these injuries should see a dentist as soon as possible. It is also possible that old injuries that were never treated may have altered the growth or positioning of a patient’s teeth in the past.

Improper installation or shifting

Improper placement of restorations, such as overhanging or over-contouring of restorations, or their shifting in time may promote dental biofilm retention and localized periodontal lesions.

Gaps between teeth, or other dentition-related irregularities such as tooth anatomy, cervical enamel projections, root concavity, fractures, cross-bite, tooth rotation, and root proximity may create open contacts that are difficult for patients to reach and clean properly, allowing bacteria to accumulate and affect surrounding periodontal tissues.

The natural reaction of the body to the presence of bacteria in the mouth is inflammation, possibly leading to gingivitis. The longer the pathogenic bacteria can adhere and proliferate without interruption, the greater the risk that gingivitis will advance to periodontitis.

The degree to which dentition-related irregularities such as crowding will affect a patient’s susceptibility to periodontal disease varies widely. In general, however, it is accurate to advise that the more dentition-related irregularities a patient has, the more they will contribute to that patient’s susceptibility to periodontal diseases.

Likewise, infringement of restorative margins within the supracrestal connective tissue attachment can be associated with inflammation or loss of periodontal supporting tissue if they are not properly installed or cared for.

An adequate emergence profile of restorations is key for avoiding plaque accumulation and plaque-induced gingival inflammation and allowing appropriate self-performed plaque control. 

Anatomy and position of teeth

Orthodontic treatment can be recommended for patients with dentition-related factors significant enough to increase risk of periodontal disease. In such cases, orthodontia is not only an effective measure for reducing risk of periodontal disease, but it will often also improve the patient’s jaw and overall oral health in the long term by improving the occlusion and jaw functions.

Prostheses

Any fixed or removable prostheses that retain plaque or do not allow patients to clean correctly should be corrected, readapted, or reinstalled. Patients wearing protheses that are optimally placed should be encouraged to ensure they keep their protheses clean and schedule regular maintenance appointments to ensure continued optimal placement.

Traumatic occlusal force

Although literature shows mitigated impact of the occlusal factor, traumatic occlusal forces need to be addressed to avoid further risk of loss of periodontal support. In the case of bruxism, mouthguards can help relieve the clenching and grinding of the teeth that could otherwise cause tooth fracture, tooth wear and tooth mobility.

Patients should be encouraged to take steps to avoid tooth and jaw damage whenever partaking in activities that could potentially damage either.

Though many dentition-related factors may be out of patients’ hands, such as their genetic predisposition to crowding or anatomy, there are many factors patients and dentists can and should control. Oral hygiene and the possibility to allow it always remain at the top of this list.