What situation makes periodontal disease more severe?

Missing proximal contacts contribute to the severity of periodontal disease as they create spaces that are more difficult to clean effectively. When teeth do not have proper proximal contacts, it leads to food impaction and plaque accumulation in these areas, making it easier for bacteria to thrive. This accumulation can establish a more significant inflammatory response in the surrounding periodontal tissues, resulting in more severe periodontal disease. Additionally, the absence of proximal contacts can also disrupt the normal forces exerted on teeth during function, potentially affecting their stability and health.

The other scenarios listed do not necessarily exacerbate periodontal disease to the same extent. For instance, having enough proximal surface or a too wide bucco-lingual embrasure may not directly lead to increased severity in the disease compared to the impact of missing proximal contacts. Also, maintained usual oral hygiene typically helps prevent the development and progression of periodontal issues, counteracting potential problems rather than worsening them.