IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 19, Issue 6 Ser.8 (June. 2020), PP 48-52 www.iosrjournals.org DOI: 10.9790/0853-1906084852 www.iosrjournal.org 48 | Page Assessment of the impact of some local risk factors on periodontal health - case report Petra Surlin 1 , Dora Maria Popescu 1 , Alexandra Maria Martu 2 , Luminita Lazar 3 , Dorin Nicolae Gheorghe 1 1 Department of Periodontology, University of Medicine and Pharmacy of Craiova, Romania 2 Department of Periodontology, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, Romania 3 Department of Periodontology, University of Medicine, Pharmacy, Sciences and Technology of Tg. Mures, Romania Corresponding author: Dorin Nicolae Gheorghe, Abstract: The constant interaction between the subgingival bacterial biofilm and the host immune response leads to the clinical onset of a variety of signs and symptoms of periodontal disease. However, the disease can manifest differently from individual to individual, in terms of severity and rate of progression. This can be explained by the predisposing activity of certain local risk factors. These local risk factors can facilitate bacterial biofilm accumulation, complicate good oral hygiene methods, increase the mechanical stress on teeth or inflict physical damage to the periodontal tissues. In all, their combined action can have a significant predisposing and facilitating effect on the onset and evolution of periodontal disease. If left unmodified and uncorrected, such local risk factors can contribute decisively to the triggering of severe and rapidly progressive forms of periodontal disease, as depicted in the exhibited case report. Key Word: Periodontal Disease, Local Risk Factor --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 01-06-2020 Date of Acceptance: 16-06-2020 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Periodontal disease (PD) is an inflammatory disease that affects the supporting tissues of the teeth being caused by the subgingival accumulation of bacteria, taking the form of bacterial biofilm attached to the tooth surface or floats within the gingival sulcus. [1] The clinical manifestations and progression of periodontal disease may vary from individual to individual, being primarily influenced by the microbial composition of the subgingival biofilm and the type and intensity of the host immune response, and secondarily, by a series of local and systemic risk/predisposing factors. [2] Thus, the clinical features of periodontal disease can range from a slight inflammation of the marginal gingiva (gingivitis) to the severe resorption of the alveolar bone and consequent loss of teeth (periodontitis). [2] In general, local risk factors act as bacterial biofilm retentors or prevent the patient from efficiently and thoroughly removing plaque deposits. [3,4] These local risk factors include morphological abnormalities, such as crowded teeth and malocclusions, dental treatments, such as orthodontic and prosthodontic appliances and mineralized biofilm deposits (dental calculus). [5] However, certain local risk factors act as direct influencers on the biological and mechanical status of teeth, as they induce significant mechanical stress. These stressful circumstances are represented by the violation of the biological width by the subgingival margins of dental crowns and by the generating of exceeding, over-threshold, occlusal forces. [6] Such supraliminal occlusal forces can be generated either by patient’s malocclusions or by improperly designed prosthetic appliances. In any situation, the adaptive capabilities of the tooth and its supporting tissues (periodontal ligament and alveolar bone) are over-whelmed, resulting in their increasing damage and consequent extraction. [7] Fortunately, most local risk factors are modifiable and correctable so as to offer the practitioner a favorable status for perfect plaque control, resolution of inflammation and regeneration of periodontal tissues. [5] The purpose of this case-study is to illustrate a series of local risk factors that contributed to the onset of severe periodontitis and to offer a good understanding of the pathogenic processes that lead to the exhibited clinical manifestations.