Prevention of Periodontal Disease

Prevention of Periodontal Disease

Erupted teeth adjacent to impacted teeth are predisposed to periodontal disease (Figs. 9-1 and 9-2). The mere presence of an impacted mandibular third molar decreases the amount of bone on the distal aspect ofan adjacent second molar (see Fig.’ 9-1). Because the most difficult tooth  urface to keep clean is the distal aspect of the last tooth in the arch, the patient may have gingival inflammation with apical migration of the ingival attachment  on the distal aspect of the second molar. Wjth even minor gingivitis the causative bacteria have access to a large portion of the root surface, which results in the early formation of severe periodontitis (see Fig. 9-2). Patients with impacted mandibular third molars often have deep periodontal pockets on the distal aspect of the secondmolars but have normal sulcular depth in the remainder of themouth. . The accelerated periodontal problem resulting from an impacted third molar is especially serious in the maxilla. As a periodontal pocket expands apically, i~ becomes involved with the distalfurcation of the maxillary second molar relatively early, which makes advancement of the periodontal disease more rapid and severe: In addition, treatment of the· localized periodontal disease around the maxillary second molar is more difficult because of the
distal furcation involvement. By removing the impacted third molars early, periodontal disease can be prevented and the likelihood of bonv bealing and bone fill into the area previously occupied by the crown of the third molar is increased.!”

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