Periodontics
is the dental specialty involved in the diagnosis and treatment of diseases of the supporting tissues.
In a periodontal practice, the dental assistant assists with _______ _________ and __________ _________ and provides ______ _____ _______ to the patient.
periodontal charting and periodontal surgeries and provides home care instructions to the patient.
Depending on the particular state's dental practice act, the dental assistant also may
place and remove periodontal dressings,
remove sutures,
perform coronal polishes,
take impressions for study models,
and administer topical fluoride applications.
A periodontal examination includes
the patient's medical and dental history,
radiographic evaluation,
examination of the teeth,
examination of the oral tissues and supporting structures, and periodontal charting.
Periodontal charting includes _______ _____,______,______ ______, _______, and ______ ________. Clinical findings of the periodontal examination are recorded on the ______ _____
pocket readings, furcations, tooth mobility, exudate (pus), and gingival recession.
periodontal chart
The periodontist reviews the medical history to detect any systemic conditions that may influence periodontal treatment. What are some Systemic diseases? , Lowered resistance makes periodontal disease more severe and more difficult to treat.
such as acquired immunodeficiency syndrome (AIDS),
human immunodeficiency virus (HIV) infection, or diabetes, can lower resistance of the tissue to infection.
What is the dental history used for?
The dental history is used to gather information about conditions that could indicate periodontal disease
What conditions could indicate periodontal disease?
patients with periodontal disease often complain of bleeding gums, loose teeth, or a bad taste. They may describe a dull pain after eating or a burning sensation in the gingival tissue
Dental Examination what is included
teeth mobility
Oral Tissues and Supporting Structures examination
Periodontal Probing
Bleeding Index
Occlusal Adjustment
Radiographic Analysis
Tooth Mobility
detected with the blunt ends of two instruments.
excessive mobility can be an important sign of periodontal disease
examination of _____ _____ and ______ ________ includes an assessment of amounts of plaque and calculus, changes in gingival health and bleeding, and level of bone, as well as detection of periodontal pockets
Oral Tissues and Supporting Structures
Periodontal probing
A normal sulcus measures 3 mm or less
The purpose of periodontal probing is to measure how much epithelial attachment has been lost to disease. The greater the depth of the periodontal pocket, the greater is the loss of epithelial attachment and bone, and
A periodontal pocket occurs when
disease causes the gingival sulcus to become deeper than normal.
which one (A or B) shows a periodontal pocket?
Dental Conditions That Contribute to Periodontal Disease
Pathologic migration
Clenching or grinding
Defective restorations or bridgework
Mobility
Occlusal interferences
A shift in the position of the teeth is caused by loss of periodontal support.
Pathologic migration
places excessive biting forces on the teeth and may accelerate bone loss.
Clenching or grinding (bruxism)
may retain plaque and increase the risk of periodontal disease
Defective restorations or bridgework
is recorded with the following scale: 0, normal; 1, slight mobility; 2, moderate mobility; 3, extreme mobility.
Mobility
Certain tooth areas can prevent the teeth from occluding properly.
do not directly cause periodontal disease but can contribute to mobility, migration, and temporomandibular joint pain.
Occlusal interferences
What is the primary cause of gingival inflammation and most other forms of periodontal disease.
Plaque
is hard mineralized plaque.
may be supragingival (above the gingivae) or subgingival (below the gingivae).
adheres to the surfaces of natural teeth, crowns, bridges, and dentures.
is a contributing factor in periodontal disease because it is always covere
Calculus
may recede, leaving portions of the roots of the teeth exposed below the cementoenamel junction.
levels can be visualized on the chart by drawing a dotted or colored line to indicate the gingival margin
Gingival recession
Severity of gingival inflammation is measured by the amount of bleeding observed during probing. Several different indices are used to measure bleeding. Each system is based on the principle that healthy gingivae do not bleed.
Bleeding index
What are the early signs of periodontal disease
� Changes in the gingiva (color, size, shape, texture)
� Gingival inflammation
� Gingival bleeding
� Evidence of exudates
� Development of periodontal pockets
.
How many probing depths are taken for each tooth?
Six
B, Buccal; DB, distobuccal; DL, distolingual; L, lingual; MB, mesiobuccal; ML, mesiolingual.
In the radiograph indicate what A,B,C,D
Vertical bone defect.
Crestal ridge at near-normal height.
Alveolar crest.
Severe vertical defect
a, Vertical bone defect.
b, Crestal ridge at near-normal height.
c, Alveolar crest.
d, Severe vertical defect.
The operator of an ultrasonic scaler should have the dental assistant use the _____ ____ _____ to minimize aerosol contamination.
high-volume evacuator (HVE)
Indications for use of an ultrasonic scaler include the following:
�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, o
Contraindications to use of the ultrasonic scaler include the following general health considerations:
�Communicable disease.
�Patients susceptible to infection..
�Respiratory problems.
�Swallowing difficulty.
�Cardiac pacemaker.
�Communicable disease
Patients with a known communicable disease, such as tuberculosis, can transmit contaminated aerosols. It is important to use an HVE to remove these aerosols.
.�Patients susceptible to infection
Medically compromised patients, such as those receiving chemotherapy or with HIV infection, uncontrolled diabetes, debilitation, or organ transplants, are more susceptible to infection.
.�Respiratory problems.
Materials can be aspirated into the lungs of patients with chronic pulmonary disease, including asthma or other breathing problems, emphysema, and cystic fibrosis.
�Swallowing difficulty.
Patients with muscular dystrophy, multiple sclerosis, paralysis, or amyotrophic lateral sclerosis may have swallowing problems or may have a severe gag reflex. The water flow and spray can be very uncomfortable for some patients.
�Cardiac pacemaker.
Consultation with the patient's cardiologist is necessary because theoretically an ultrasonic scaler can disrupt a pacemaker, although no actual cases have been reported. The newer models of ultrasonic scalers have protective coatings to prevent this.
Oral conditions also may be contraindications to the ultrasonic scalers:
Demineralized areas.
�Exposed dentinal surfaces.
�Restorative materials.
�Titanium implant abutments. .
�Narrow periodontal pockets.
Demineralized areas.
The vibrations of the ultrasonic scaler may remove the areas of remineralization that begin to cover the demineralization.
�Exposed dentinal surfaces.
Tooth structure may be removed, and this may cause tooth sensitivity.
�Restorative materials.
Some restorative materials, including esthetic restorations such as porcelains, composite resins, and laminate veneers, may be damaged by ultrasonic scalers.
�Titanium implant abutments.
Unless a special plastic sheath is used to cover the tip, ultrasonic scalers will damage titanium surfaces.
�Narrow periodontal pockets.
The tip of the ultrasonic scaler will not fit into very narrow subgingival pockets without interfering with proper angulation of the tip and limiting visibility.
the use of ultrasonic scalers is contraindicated on primary and newly erupted permanent teeth. Why?
Young tissues are very sensitive to ultrasonic vibrations. These vibrations and heat may damage the pulp tissue of primary and newly erupted permanent teeth, which have large pulp chambers.
Nonsurgical Periodontal Treatment
Dental Prophylaxis
A dental prophylaxis procedure, commonly referred to as prophy or cleaning, is the complete removal of The dentist and the dental hygienist are the only dental health team members licensed to perform a prophylaxis.
calculus, soft deposits, plaque, and stain from all supragingival and unattached subgingival tooth surfaces.
Assisting With a Dental Prophylaxis= Equipment and Supplies
? Mouth mirror
? Explorer
? Anterior scaler
? Universal curette
? Disposable prophy angle with rubber cup
? Disposable prophy angle with bristle brush
? Prophy paste
? Saliva ejector and/or high-volume evacuator (HVE)
? 2 � 2 gauze
? Dental floss or tape
Assisting with a dental prophylaxis=Procedural Steps
1 Assist with transfers as the operator uses an explorer to locate interproximal and subgingival calculus.
2 Use the HVE as necessary and retract the lips, tongue, and cheeks to improve visibility and access as the operator uses scalers and curettes to re
are done as part of a periodontal debridement.
The goal of debridement is to remove deposits on the tooth and reduce the bioburden within the pocket. This procedure will help return the tissues to a healthy state. A local anesthetic is usually administere
Scaling and Root Planing
The periodontist may prescribe antimicrobial agents and antibiotics for use with periodontal treatment which are:
Tetracycline
Penicillin
Fluoride mouth rinses
Chlorhexidine rinse
is a particularly useful antibiotic for the treatment of early-onset periodontitis, as well as for rapidly destructive periodontitis. An important adverse effect of is that it interferes with the effectiveness of birth control pills (i.e., oral contracept
Tetracycline
is less effective against periodontal disease infection because many periodontal pathogens are resistant to it.
Penicillin
have been shown to reduce bleeding by delaying bacterial growth within the periodontal pockets.
Fluoride mouth rinses
is a highly effective antimicrobial therapy available to reduce plaque and gingivitis
can cause temporary brown staining of the teeth, tongue, and resin restorations. This stain can be removed by polishing.
Chlorhexidine rinse (twice daily)
a fiber that contains tetracycline is packed into periodontal pockets that have not responded to other methods. This procedure is similar to placing a retraction cord before an impression. These fibers must be removed and are most effective in pockets lar
Locally Delivered Antibiotics
Advantages of Periodontal surgery
it allows one to gain access to the root surface by removing or lifting the gingival tissues.
When root surfaces are exposed, they can be scaled and root-planed more easily and thoroughly.
Surgery also improves access for the patient in cleaning areas tha
Disadvantages and contradictions of periodontal surgery
patient's health status and age, as well as limitations of the procedures.
From the patient's point of view, the disadvantages of surgery usually include time, cost, esthetics, and discomfort.
Prognosis based on amount of bone loss.
A, When some bone is present, it may be safe to postpone surgery and take a wait-and-see approach. An additional bone loss of 2 mm may not alter the prognosis of the tooth.
B, When half the bone has been lost, an ad
is a type of surgery that removes the excess tissue. It is the most rapid method for reduction of periodontal pockets. Gingivectomy and gingivoplasty are common types of excisional surgery.
Excisional periodontal surgery
is the surgical removal of diseased gingival tissue.
is performed when it is necessary to reduce the depth of the periodontal pocket, and when fibrous gingival tissue must be removed.
involves making bleeding points with pocket markers and removing gingiv
Gingivectomy
involves the surgical reshaping and contouring of gingival tissues.
The presence of deep periodontal pockets with fibrous tissue is the main indication for both gingivectomy and gingivoplasty. Often, the two procedures are performed simultaneously
Gingivoplasty
Assisting With Gingivectomy and Gingivoplasty= equipment and supplies
A) Mirrors, explorer, probe, series of curettes, needle holder, rongeurs, and scissors.
B)Series of chisels, Kirkland knife, Orban knife, scalpel handles with surgical blades (#15C, #15, #12D), periosteal elevators, spatula, tissue forceps, cheek retracto
Assisting With Gingivectomy and Gingivoplasty= Role of the Dental Assistant
1 Set out the patient's health history, radiographs, and periodontal chart.
.2 Assist in the administration of local anesthetic.
3 Anticipate the dentist's needs, and be prepared to transfer and retrieve surgical instruments when needed.
4 Have gauze read
post operative instructions for periodontal surgery
-Limit your activities for the next few days to those requiring minimal exertion.
-Do not rinse your mouth for 24 hours.
-Some slight bleeding may occur during the first 4 or 5 hours after the operation. This bleeding is not unusual. If bleeding continues
- bone is contoured and reshaped. In addition, bone may be added through bone grafting (taking bone from one area and placing it in another) or placement of artificial bone-substitute materials through a procedure called bone augmentation. This procedure
osteoplasty, or additive bone surgery
, bone is removed. This procedure is necessary when the patient has large exostoses (bony growths).
is performed if a patient needs a full denture and the bony growth would interfere with the comfort and fit of the denture.
In ostectomy, or subtractive bone surgery
is a surgical procedure that is designed to expose more tooth structure for the placement of a restoration such as a crown.
is becoming a very common procedure for esthetic anterior restorations.
may involve the removal of soft tissue or of soft tissue an
Crown Lengthening
also known as periodontal flap surgery or simply flap surgery, is performed when excisional surgery is not indicated.
the tissues are not removed but are pushed away from underlying tooth roots and alveolar bone, similar to the flap of an envelope.
When t
Incisional surgery,
is periodontal surgery that involves modification of the supporting bone. It is performed to eliminate pockets, remove defects, and restore normal contours in the bone. Types of periodontal surgeries that involve bone include osteoplasty and ostectomy. Ea
Osseous surgery
Gingivectomy surgery to treat gingival enlargement. A, Enlarged gingivae.
B, Initial incision with a Kirkland knife.
C, Interproximal tissue removed with an Orban knife. D and E, Gingivoplasty performed with tissue nippers and a round diamond bur.
F, Surg
Soft Tissue Grafts
Pedicle Graft
free Gingival Soft Tissue Graft
is used to move gingivae from an adjacent tooth or edentulous area to a recipient site on another tooth. is "freed" on three sides but remains attached on one side and thus retains its blood supply.
best used for single-site recession for root coverage an
Pedicle Graft
In contrast to the pedicle graft, _______ _____ ____ _____ _____has a donor site that is located away from the grafted site.
the blood supply is not attached to the graft and depends on the recipient site. The most common site for donor tissue is the pati
Free Gingival Soft Tissue Graft
Postsurgical Patient Instructions
After periodontal surgery, the periodontist most likely will prescribe an analgesic (pain medication) and possibly an antibiotic. Many periodontists recommend the use of an antibacterial rinse twice daily to help with plaque control. A chlorhexidine mouth
A periodontal dressing (Perio Pak) serves as a bandage over the surgical site. Periodontal dressings, also known as periopacks, are used for the following purposes:
�To hold the flaps in place
�To protect newly forming tissues
�To minimize postoperative pain, infection, and hemorrhage
�To protect the surgical site from trauma during eating and drinking
�To support mobile teeth during the healing process
A variety of materials are available on the market for periodontal dressings. The dressings most often used are those made with ______ _____ ____ and those made without ______
zinc oxide-eugenol (ZOE) and those made without eugenol.
is supplied as a powder and a liquid that are mixed before use.
can be mixed beforehand, wrapped in wax paper, and frozen for future use
has a slow set, which allows for a longer working time.
It sets to a firm and heavy consistency and provides good supp
The ZOE dressing
Signs if a patient is allergic to eugenol
Some patients are allergic to the eugenol and will experience redness and burning pain in the area of the dressing.
the most widely used type of periodontal dressing. This material is supplied in two tubes�one for the base material and the other for the accelerator.
is easy to mix and place and has a smooth surface for patient comfort. This material has a rapid setting
Noneugenol Dressing
The use of lasers offers a promising new technology for dentistry. Research is continuing that may lead to more widespread uses of lasers in clinical dentistry. Periodontal applications of lasers on soft tissue include the following:
� Removal of tumors and lesions
� Vaporization of excess tissues, as in gingivoplasty gingivectomy, and frenectomy
� Removal of or reduction in hyperplastic tissues
� Control of bleeding in vascular lesions
Lasers offer the following advantages over conventional surgical techniques:
�Laser incisions heal faster than incisions made with electrosurgery. (However, incisions made with scalpels heal faster than those made with lasers.)
�Hemostasis (control of bleeding) is rapid.
�The surgical field is relatively dry.
�The risk of blood-bo