Periodontics Textbook PDF

Periodontics UNIT 4  Introduction ⚫ Periodontics is the dental specialty involved with the diagnosis and treatment of diseases of the supporting tissues of the teeth.  Obj. 1 Role of the DA ⚫ DA must have a thorough understanding of periodontal diseases and the...

Periodontics UNIT 4  Introduction ⚫ Periodontics is the dental specialty involved with the diagnosis and treatment of diseases of the supporting tissues of the teeth.  Obj. 1 Role of the DA ⚫ DA must have a thorough understanding of periodontal diseases and the types of periodontal instruments and procedures. ⚫ the dental assistant will assist with periodontal charting and periodontal surgeries and provide home care instructions to the patient.  The Periodontal Practice ⚫ clients are referred by the general dentist or dental hygienist ⚫ After the periodontal treatment, the patient will return to the general dentist for routine dental care. ⚫ patients will alternate their periodontal maintenance (cleaning) appointments between the periodontist’s office and their general dentist’s office. Obj. 2 Early Signs of Periodontal Disease ⚫ Changes in the gingiva (color, size, shape, texture) ⚫ Gingival inflammation ⚫ Gingival bleeding ⚫ Evidence of exudate ⚫ Development of periodontal pockets Obj. 3 The Periodontal Examination ⚫ A periodontal examination includes: ⚪ Medical and dental histories ⚪ Radiographic evaluations ⚪ Examination of the teeth ⚪ Examination of the oral tissues ⚪ Supporting structures ⚪ Periodontal charting  1. Medical and Dental History ⚫ Medical history: gather info to detect systemic conditions that may influence periodontal treatment. Ie. AIDS, diabetes ⚫ Dental history: gather information that may indicate Periodontal disease: ie. Bleeding gums  2. Radiographic Analysis ⚫ Very valuable for evaluation of periodontal disease ⚫ Accuracy is critical ⚫ Bitewing is most valuable-shows one height along the root surface ⚫ Vertical bitewings are excellent for determining the extent of crestal bone loss Bone loss in periodontal disease. A, Molar vertical bitewing. B, Premolar vertical bitewing. A B  3. Dental Examination ⚫ Focuses on teeth for indications of periodontal disease.  4&5. Examination of the Oral Tissues and Supporting Structures ⚫ The periodontal examination includes: ✔ Assessment of the amounts of plaque and calculus ✔ Changes in the gingival health and bleeding ✔ Assessment of the level of bone ✔ Detection of periodontal pockets  Periodontal Probing ⚫ A periodontal pocket occurs when the gingival sulcus becomes deeper than normal (3 mm or less). ⚫ Periodontal pockets make it very difficult, and sometimes impossible, for the patient to clean. ⚫ The bacteria in the periodontal pockets will multiply and, if left untreated, the disease will progress until the tooth is ultimately lost. The working end of a periodontal probe The millimeter measurement indicates the distance from the gingival margin to the base of the pocket.  #6. Periodontal Charting Includes: ⚫Pocket readings ⚫Furcations ⚫Tooth mobility ⚫Exudate (pus) ⚫Gingival recession Fig. 55-1 Periodontal charting for a 40-year-old patient.  Computer programs provide computerized periodontal charting Furcations  Mobility ⚫ It is normal for teeth to have a slight amount of mobility (tooth movement) as a result of the cushioning effect of the periodontal membranes. ⚫ Excessive mobility can be an important sign of periodontal disease. Determining tooth mobility Gingival Recession  Bleeding Index ⚫ Measures severity of the gingival inflammation ⚫ Assessed during probing ⚫ Each system is based on the principal that healthy gingiva does not bleed. Obj. 4. Identify Periodontal Instruments ⚫ Periodontal therapy requires the use of specialized instruments to: 1. remove calculus 2. smooth root surfaces 3. measure periodontal pockets 4. perform periodontal surgery.  Periodontal Probes ⚫ Used to locate and measure the depth of periodontal pockets. ⚫ The periodontal probe is tapered to fit into the gingival sulcus and has a blunt or rounded tip. ⚫ Six measurements are taken and recorded for each tooth. ⚫ Periodontal probes are available in many designs, and selection depends on the personal preference of the operator. Six probing depths are taken for each tooth.  Explorers ⚫ Used to locate supragingival and subgingival calculus deposits ⚫ Explorers used in periodontics are longer and more curved than explorers used for caries detection. ⚫ The working ends of periodontal explorers are thin, fine, and easily adapted around root surfaces. ⚫ They also are long enough to be capable of reaching to the base of deep pockets and furcations. Fig. 55-10 Various styles of periodontal explorers  Scalers ⚫ Sickle scalers are used primarily to remove large deposits of supragingival calculus. ⚫ Chisel scalers are used to remove supragingival calculus in the contact area of anterior teeth. The blade on the chisel scaler is curved slightly to adapt to the tooth surfaces. ⚫ Hoe scalers are used to remove heavy supragingival calculus. Hoes are most effective when used on buccal and lingual surfaces of the posterior teeth.  Curettes ⚫ Curettes are used to remove subgingival calculus, smooth rough root surfaces (root planing), and remove the diseased soft tissue lining of the periodontal pocket (soft tissue curettage). ⚫ Curettes have a rounded end, unlike a scaler, which has a pointed end. ⚫ There are two basic designs of curettes: ⚪ Universal ⚪ Gracey Comparison of the end of the scaler (pointed) and the curette (rounded)  Types of Curettes ⚫ Universal curettes are designed so one instrument is able to adapt to all tooth surfaces. ⚪ There are two cutting edges, one on each side of the blade. Universal curettes resemble the spoon excavators used in restorative dentistry. ⚫ Gracey curettes have only one cutting edge and are area-specific; this means that they are designed to adapt to specific tooth surfaces (mesial or distal). ⚪ Treatment of the entire dentition requires the use of several curettes Universal curette. Note the cutting edge on each side of the blade. Assorted Gracey curettes  Periodontal Surgical Instruments ⚫ Periodontal knives ⚪ Kirkland knives are one of the most common types of knives used in periodontal surgery. These instruments are usually double-ended with kidney-shaped blades.  Orban knives ⚪ are used to remove tissue from the interdental areas. These knives are shaped like spears and have cutting edges on both sides of the blades. Kirkland and Orban interdental knives  Pocket Markers ⚫ Pocket markers are similar in appearance to cotton pliers; however, one tip is smooth and straight, and the other tip is sharp and bent at a right angle. ⚫ The smooth tip of the pocket marker is inserted at the base of the pocket, and when the instrument is pressed together, the sharp tip makes small perforations in the gingivae. ⚫ These perforations, which are referred to as bleeding points, are used to outline the area for an incision on the gingivae. Periodontal pocket marker makes pinpoint perforations that indicate the line for the surgical incision.  The Ultrasonic Scaler ⚫ The ultrasonic scaler provides rapid calculus removal and reduces hand fatigue for the operator. ⚫ converts very high frequency sound waves into mechanical energy in the form of very rapid vibrations. ⚫ A spray of water at the tip prevents the buildup of heat and provides a continuous flushing of debris and bacteria from the base of the pocket. ⚫ Because of the spray of water at the tip, there is a large amount of potentially contaminated aerosol spray. Fig. 55-17 A series of ultrasonic tips designed to reach every area of the mouth (Courtesy Dentsply, York, PA) Fig. 55-18 A, Positioning of the ultrasonic scaler. B, Ultrasonic scaler with water source turned on. (Courtesy Hu-Friedy Manufacturing, Chicago, IL.) Obj. 5 Indications for Use of the Ultrasonic Scaler ⚫ Removal of supragingival calculus and difficult stains. ⚫ Removal of subgingival calculus, attached plaque, and endotoxins from the root surface. ⚫ Cleaning of furcation areas. ⚫ Removal of deposits before periodontal surgery. ⚫ Removal of orthodontic cements; debonding. ⚫ Removal of overhanging margins of restorations.  Contraindications and Precautions ⚫ Communicable disease: A patient with a known communicable disease that can be transmitted by aerosols, such as tuberculosis. ⚫ Patient who is susceptible to infection: A compromised patient who is open to infection. ⚫ Respiratory problems: Materials can be aspirated into the lungs of these patients. ⚫ Swallowing difficulty: A patient with a swallowing problem or severe gag reflex. ⚫ Cardiac pacemaker: Consultation with the patient’s cardiologist is necessary. The newer models of ultrasonic scalers have protective coatings. Oral Conditions That Contraindicate Ultrasonic Use ⚫ Demineralized areas: The vibrations of the ultrasonic can remove the areas of remineralization that begin to cover the demineralization. ⚫ Exposed dentinal surfaces: Tooth structure can be removed and cause tooth sensitivity. ⚫ Restorative materials: Some restorative materials, such as porcelain, amalgam, composite resins, and laminate veneers, can be damaged by ultrasonics. ⚫ Titanium implant abutments: Unless a special plastic sheath is used to cover the tip, the ultrasonic will damage titanium surfaces.  Obj. 8 Goals & types of Non Surgical Periodontal Treatment Dental Prophylaxis ⚫Scaling and Root planing ⚫Gingival Curettage ⚫Antimicrobial and Antibiotic Agents ⚫Locally Delivered Antibiotics  The Dental Prophylaxis ⚫ Commonly referred to as prophy or cleaning, prophylaxis ⚫ complete removal of calculus, soft deposits, plaque, and stains from all supragingival and unattached subgingival tooth surfaces. ⚫ Only done by dentist and dental hygienist ⚫ A prophylaxis is indicated for patients with healthy gingiva as a preventive measure and is most commonly performed during recall appointments. ⚫ A dental prophylaxis also is the primary treatment for gingivitis.  Scaling, Root Planing, and Gingival Curettage ⚫ Scaling and root planing are nonsurgical treatments ⚫ Goal is to remove deposits on tooth and reduce bioburden. ⚫ In some cases, gingival curettage, a nonsurgical technique, may also be indicated. ⚫ A local anesthetic is usually administered before performing these procedures. Scaling, root planing, and curettage  Scaling ⚫ Scalers are used to remove supragingival calculus from the tooth surface. ⚫ Curettes are used to remove supragingival and subgingival calculus. ⚫ There may be areas on the root surface that remain rough after calculus removal. ⚫ This is because the cementum has become necrotic (dead) or because the scaling has produced grooves and scratches in the cementum.  Root Planing ⚫ Root planing follows scaling procedures to remove any remaining particles of calculus and necrotic cementum embedded in the root surface. ⚫ After root planing, the surfaces of the root are smooth and glasslike. ⚫ Smooth root surfaces resist new calculus formation and are easier for the patient to keep clean.  Gingival Curettage ⚫ Curettage means scraping or cleaning with a curette. ⚫ Some patients also require gingival curettage in addition to scaling and root planing. ⚫ Gingival curettage, also referred to as subgingival curettage, is the scraping of the gingival lining of a periodontal pocket. This is performed to remove necrotic (dead) tissue from the pocket wall. ⚫ This is not surgery Scaling, root planing, and curettage  Antimicrobial and Antibiotic Agents ⚫ Tetracycline is an antibiotic that is particularly useful for the treatment of periodontitis, early onset periodontitis, and rapidly destructive periodontitis. An important side effect of tetracycline is that it interferes with the effectiveness of birth control pills. ⚫ Fluoride mouth rinses have been shown to reduce bleeding by delaying bacterial growth in the periodontal pockets. ⚫ A chlorhexidine rinse twice daily is the most effective agent available to reduce plaque and gingivitis. Chlorhexidine can cause some temporary brown staining of the teeth, tongue, and resin restorations.  Locally Delivered Antibiotics ⚫ Method used to deliver antibiotics directly into pocket ⚫ Fiber containing tetracycline is packed into pocket ⚫ Similar to placing retraction cord ⚫ Also syringe method