Prevention of Periodontal Disease PDF

PREVENTION OF PERIODONTAL DISEASE Dr. Rabab M. Abd El Hakam Researcher at the National Research Centre Orthodontics and Pediatric Dentistry Department Lecturer at Ahram Canadian University Member of the Egyptian Society for Pediatric...

PREVENTION OF PERIODONTAL DISEASE Dr. Rabab M. Abd El Hakam Researcher at the National Research Centre Orthodontics and Pediatric Dentistry Department Lecturer at Ahram Canadian University Member of the Egyptian Society for Pediatric Dentistry and Children with Special Needs (ESPSN) MEMBER OF CENTER FOR ORAL DENTAL AND HEALTH PROMOTION (CODE HP) Outline Levels of Prevention Definition Causes of Periodontal Disease Preventive Measures Conclusion  Levels of Prevention  DEFINITION Periodontal diseases a term used to describe disease involving the periodontium which is the supportive apparatus surrounding a tooth, which includes the gingival tissue, alveolar bone, cementum, and periodontal ligament Gingivitis is the localized inflammation of the gingiva Periodontitis is the inflammation of the gingiva and the deeper tissues of the periodontium. Characterized by pocket formation and destruction of the supporting alveolar bone The deep periodontal ‘Pocket’ is a hallmark of the disease and can eventually lead to tooth loss :Patients with periodontitis has shown Inflammatory destruction of the supporting tissues -1 around the teeth Loss of connective tissue -2 Loss of periodontal ligament and bone resorption -3 Roots become exposed to the oral environment -4 Cementum are colonized with a bacterial biofilm, which can -5 calcify to form dental calculus Three areas to be distinguished in gingiva: 1- Interdental Papilla 2- Free or marginal Gingiva 3- Attached Gingiva  Causes of Periodontal Disease Local factors Systematic factors 1-Diet 1- Endocrinal disorder 2-Calclus 3-Shedding of primary teeth and 2- Drugs eruption of permanent teeth 4- Untreated Caries 3- During Acute Fever 5- Occlusal abnormalities 6- Poorly fitted or incorrectly designed 4- Heamatological disorder prosthetic and orthodontic appliances 5- Avitaminosis Local Factors 1-Diet Consistency of diet and the functional stimulation derived from mastication which is essential for normal metabolic activity of gingiva and underlying structure Soft food is determinantal to the periodontium as it doesn’t afford functional stimulation and it also causes faster accumulation of food debris at the gingival margin which leads to bacterial activity and subsequently cause gingivitis 2-Calclus It’s hardly an etiological factor in children 3-Shedding of primary teeth and eruption of permanent teeth Causes gingivitis during mixed dentition period Child avoids eating on loose or painful teeth allowing food deposits to be accumulated on the affected side 4- Untreated Caries Cervical and interproximal cavities cause food impaction and gingival inflammation, while occlusal cavities cause decreased function and food accumulation on the affected side Poorly contoured restoration and overhanging cervical margins can cause periodontal disease 5- Occlusal abnormalities Crowding, open bite, proclined maxillary incisor, and incompetent lips are common causes of gingivitis as they interfere with normal function and allow food stagnation Early extraction of first permanent molar prevent cleansing effect of mastication and allow food stagnation around the tooth opposite to the space 6- Poorly fitted or incorrectly designed prosthetic and orthodontic appliances Systematic Factors 1- Endocrinal Disorders Diabetic patients suffer from gingival diseases particularly those with bad oral hygiene At puberty due to hormonal changes which alter the gingival conditions where it become swollen and hemorrhagic 2- Drugs Anticonvulsant drugs like Dilantin (Phenytoin) cause characteristic gingival hyperplasia start at the interdental papilla spreading over other areas and completely cover the teeth 3- During acute fever Such as typhoid and measles where deterioration of gingiva may occur due to concomitant poor oral hygiene but subsides on recovery 4- hematological Disorder Such as leukemia where gingival changes occur 5- Avitaminosis Such as vitamin c deficiency which lead to scorbutic gingivitis Preventive Measures  Preventive Measures 1- Professional maintenance & 5- Early diagnosis of occlusal Oral hygiene measures disorder 2- Diet 6- Correction of mouth breathing 3- Fluoride use 7- Prosthetic or orthodontic appliance measures 4- Early treatment of carious cavities 8- Systematic disease measures  Professional Maintenance & Oral hygiene measures -1 Professional maintenance at regular intervals, patient should receive scaling and root planning every 3-6 months  Control of Dental Plaque Dental plaque is defined clinically as a structured, resilient, yellow-grayish substance that adheres tenaciously to the intraoral hard surfaces Dental Plaque Causes of Dental Plaque Bad Oral Hygiene-1 High Sugar Foods and Drinks-2  Antimicrobial Therapy Antimicrobial therapy usually begins with a deep oral cleaning that includes scaling and root planning. This process removes plaque build-up from “pockets” caused by periodontal disease These “pockets” contain a huge amount of bacteria, and must be cleaned for antimicrobial treatments to be effective, for example : antiseptic and/or antibacterial :Antimicrobial agent for prevention of periodontitis disease Chlorhexidine-1 Triclosan-2 Essential oils-3 )Cinnamon, peppermint, spearmint, and tea tree(  Oral hygiene The self-care recommended uses 3 step daily regimen: brushing 2- flossing 3- rinsing -1  Brushing methods Charter’s method A soft/medium multi-tufted tooth brush taken Bristles are placed 45 to the gingiva with bristles directed coronally. Mild vibratory strokes required with bristles ends lying interproximally Stillman’s method End of bristles rest on the attached gingivae and cervical areas of the teeth (part of the bristles on the cervical part of the tooth & the other on the adjacent gingiva) directed apically Short back & forth strokes are used and brush head is moved occlusally with slight pressure  Other devices Dental floss Effective for flat or convex proximal tooth surfaces with full embrasures Waxed, unwaxed or tufted types Tufted and waxed are indicated for rough restoration and tight contact Oral irrigation With water and antiseptic mouth rinses Supra or sub-gingival irrigation Toothpicks Made from soft-wood and is triangular in shape. Used in open contact Tooth pick can be placed in special plastic  Diet and Prevention of Periodontal disease - 2 :Dietary elements affect healthy periodontium Iron, copper and Zinc -1 Vit E mainly from vegetable oils, some -2 oil-seeds and nuts Vitamin E supplements had a protective -3 effect on bone loss Vitamin C -4 Vitamin D -5 Omega-3s 6 Fluoride Use -3 Stannous fluoride It has anti-plaque and anti-gingivitis effects It reduces bacteria and spirochetes in subgingival areas; thus can help to promote gingival health 4-Early treatment of carious cavities Old restoration should be checked for overhanging and defect at tooth restoration interphase 5- Early diagnosis of occlusal disorder treatment by preventive or interceptive measures 6- Correction of mouth breathing By clearing oronasal passage surgically or orthodontically 7- Prosthetic or orthodontic appliance measures Perform good oral hygiene, clean removable appliances outside the mouth, be sure the appliance is well-fitted 8- Systematic disease measures Refer the patient to a specialist, remove local irritants, give dietary recommendations in case of vitamin deficiency, stress on oral hygiene measures  Conclusion Although periodontal disease is the most prevalent infectious oral condition but is treatable and preventable The reduction in the incidence and prevalence of periodontal disease can result in lowering its associated systemic diseases and complications Decreased periodontal disease burden can minimize treatment needs and can reduce financial impact on healthcare systems High prevalence of periodontal disease also necessitates the establishment of a surveillance system for oral diseases in the community Perio-systemic link should be concerned with diagnosing and referring the patients to specialized dental or periodontal care to improve the quality of life of their patients