Dental Hygiene II - Chapter 37 Non-Surgical Periodontal Instrumentation

Gingivitis and Periodontitis

Name 2 Categories of Periodontal Disease?

Plaque induced
Non-plaque induced

What are 2 Categories of Gingivitis?

Chronic
Aggressive
Other forms

What are the 3 Categories of Periodontitis?

1. To control the bacterial challenge to the patient (elimination/suppression of infectious microorganisms)
2. Control of local factors (establish environment which promotes resolution of inflammation)
3. Control of systemic factors (modifiable host facto

What are the goals of NSPT?

1. Arrest the progress of disease
2. Induce positive changes in pathogenic microflora
3. Create an environment of health (reduction of pocket probing depths, stabilization of attachment levels, eliminate bleeding)
4. Improve client self-care

What are the outcomes of Debridement?

Diseased microflora

What health category do the following fall into? anaerobic, gram negative, motile, spirochetes, motile rods, pathogenic, high total count of all microorganisms, many leukocytes

Healthy microflora

What health category do the following fall under? aerobic, gram positive, non-motile, coccoid form, nonpathogenic, lower count of all microorganisms, lower leukocytes

not usually indicated

Is surgery indicated for Plaque induced gingivitis (Case Type I?)

Slight Chronic Periodontitis (Case Type II; 1-2 mm CAL)

Surgery not usually indicated for this type of condition.

Need for surgery varies; must re-evaluate

Surgery condition for Moderate Chronic Periodontitis (Case Type III; 3-4 mm CAL?)

Surgery is usually indicated

Is surgery indicated for Severe Chronic Periodontitis (Case Type IV; 5+ mm CAL?)

Physical challenges (pocket probing depths, pocket accessibility/location, furcation involvement, tenacious deposits); Systemic factors; Local factors; Patient compliance

What are some things that affect therapy outcomes?

1. Disease acknowledgement and understanding of periodontal etiology (Pt participation in exam, Pt ID health and disease)
2. Client participation in tx (homecare)
3. Explain all possible results at initial visit

Describe Outcomes Education...

Clinician position, modified pen grasp, fulcrum, adaptation, angulation, activation

What are the Factors of Instrumentation?

Assessment

This stroke is used to evaluate the tooth surface?

Placement

The act of positioning the working end at base of pocket is known as?

Working

The act of removing deposits is known as?

Technique is different, adaptation is the same

What is the difference between Root instrumentation vs Scaling?

Channeling and Oblique

You would use these 2 Types of strokes with both scaling and Root planing

1. Type of Calculus
2. Location of Calculus
3. Attachment of Calculus
4. Accessibility

These factors affect Calculus Removal Instrumentation

Calculus

The makeup of this is 70-90% Inorganic; 10-30% Organic

Calcium and Phosphorous

What is the composition of Inorganic Calculus?

Plaque, dead epithelial cells, and dead WBCs

What is the Composition of Organic Calculus?

Enamel

This tooth component is 96% Inorganic; 4% Organic

Dentin

This tooth component is 65-70% Inorganic; 30-35% Organic

Cementum

This tooth component is 45-50% both Inorganic and Organic

Brushite, Octocalcium phosphate, Hydroxyapatite

Name the different types of calculus

Brushite

Another name for newly formed calculus; 24-48 hours or 2 weeks after plaque formation; easily removed?

Octocalcium Phosphate

Calculus that is less than 6 months old is called?

Hydroxyapatite

Mature Calculus older than 6 months is called?

1. By means of pellicle (most common-enamel surfaces; easily removed)
2. Irregularities in the tooth surface (difficult removal)
3. Direct contact of calcified components to tooth surface (deposits firmly interlocked with inorganic crystals of tooth; diff

These are the ways Calculus becomes attached.

1. Pocket anatomy (depth of pocket; narrow or open access to pocket)
2. Root surface irregularities
3. Defective restorations
4. Malpositioned teeth
5. Occlusion

Accessibility of Calculus is increased by the following factors

Ultrasonic, Scaler, Gracey, Extended Gracey, Mini Gracey, After Five Gracey

Instrumentation Selection means selecting one of the following...

Hirshchfeld Files

This item is good for burnished calculus to roughen it up or shred it

Hartzell Langers

These are similar to Graceys but have cutting edge on both sides

Younger-Good

This looks like a probe and works like an S204

1. Technique practice
2. Horizontal
3. Oblique
4. Concavities

What is the instrument sequence on multirooted teeth?

1. Most stable, secure support for hand
2. Provides leverage and power
3. Allows for excellent tactile transfer to fingers
4. Hand and instrument work together
5. Precise stroke control
6. Allows forceful stroke pressure with less stress
7. Decreases like

What are the benefits of standard intraoral fulcrum?

Plaque removal, control, sub&supragingival scaling, root planing, and the adjunctive use of chemical agents

NSPT encompasses?

Intrumentation of the crown and root to remove plaque biofilm, calculus, & stains, it is used for the treatment of patients with healthy gingiva or gingivitis

What is scaling?

A definitive procedure to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms

What is root planing?

Thoroughness of root debridement

This is the most critical element in the promotion of gingival healing and reduction in pocket depths

The removal of all subgingival plaque and its by-products as well as detectable calculus-embedded cementum to finish the root surface during periodontal instrumentation while preserving as much of the tooth as possible. This intervention blends scaling &

What is a periodontal debridement?

Dental Biofilm

This attaches to the gingiva and teeth. Calculus is formed from the mineralized version of this.

Gingival inflammation & periodontal destruction come from a pathogen found in this?

Dental Biofilm

Endotoxins

These are derived from cell walls of gram-negative microbes. This causes inflammation & destruction of periodontal attachment. These can be removed

Cementum

The goal is to end with a smooth surface so some removal of this during instrumentation for calculus in inevitable

Calculus

Since an irregular surface of this provides good plaque retention, you must remove it for tissue to heal.

to stop or interrupt the progress of disease, to create an environment for tissue to heal & decrease inflammation, positive changes in subgingival bacteria, prevent or postpone disease reoccurrence, provide initial preparation for patients with advanced d

What are the desired outcomes of NSPT?

Class I or Class II, light to moderate calculus

Which dental hygiene appointments can be completed in a single visit?

Quadrant scaling(may need anesthesia,) Tissue conditioning(pat ed,plaque control) Evaluate each visit for healing

Which dental hygiene appointments must be completed in multiple visits?

Healing at the gingival margin(due to limited access), potential for abcess formation, patient instruction, roughened calculus, patient understanding

Name some problems that could arise with incomplete scaling?

Review the patient's record & xrays, prep the patient with any needed pre-med mouthrinse, or anesthesia if indicated, complete a sub and supragingival exam.

What do you do when preparing for instrumentation?

Clock Position of clinician, chair position, good vision, light, sharp instruments(means less strokes)

What are the prerequisites for calculus removal?

1. The type of pocket, 2. Location of calculus, 3. Position of margin, 4. Level of clinical attachment

Location of instrumentation - what do you look for?

Removal of calculus and biofilm, removal of toxic materials from the root to produce a smooth surface, systematic deposit removal

Describe the scaling process?

anatomy of teeth can vary, accessibility and visability can vary and subgingival calculus can be present

What are some extra considerations when removing deposits subginigivally?

Instrument grasp, use of fulcrum/finger rest, slecting the correct cutting edge, adaptation of the cutting edge, angulation, lateral pressure, activation, channels of strokes

What are the steps for manual scaling?

Purpose: smoothing the tooth surface to lessen immediate recolonization of bacteria, Procedure: instrumentation is the same as scaling, Application: Only plane where it is needed once you have explored and found the areas that need treatment

What is the process for planing the root surface?

A lighter grasp will increase tactile sensitivity, light lateral pressure is applied, a lighter stroke should be used for final smoothing of the root surface, increased pressure is NOT needed

When root planing, what kind of touch and pressure is needed?

Use smooth, overlapping strokes, as the surface becomes smoother, longer strokes with reduced pressure help to remove small lines, scratches, or grooves without gouging the surface, vertical strokes and oblique strokes are used, horizontal strokes should

What type of stroke do you use when planing a root surface?

Ultrasonic scaling

These are electronically powered devices that produce vibratory motions to fracture deposits from tooth surfaces

Mechanical vibration

These are power driven devices that convert electrical energy into high-frequency sound waves. Sound waves produce rapid vibrations and calculus is shattered from the tooth surface when vibrations are applied to the tooth

Cavitron

This item uses water which is required to dissipate the hear that is produced by the vibrating tip. When the water and vibrating tip meet this creates minute bubbles that collapse and release energy.

Has little effect on hard deposits. It destroys bacteria and removes endotoxins from root surfaces

The Cavitron ______?

Irrigation

When the water spray reaches the base of the pocket to flush out debris, bacteria, and endotoxins it is referred to as ___?

Reduced time, improved operator comfort, comparable results to hand scaling

What are some advantages of ultrasonic scaling?

Root surfaces are not as smooth as those that are hand scaled, reduced visability due to water spray, possible damage to hard & soft tissues due to incorrect use

What are some disadvantages of ultrasonic scaling?

Removal of supragingival calculus and stains, subgingival periodontal debridement, initial debridement for patients with NUG, debridement of furcations, debridement prior to oral surgery, removal of ortho cement, removal of overhangs

What are the indications for use of ultrasonic scaling?

communicable disease, susceptibility to infection, repiratory risk, difficulty swallowing, cardiac pacemaker, demineralized areas, exposed dentinal surfaces, restorative materials, titanium implant abutments, narrow perio pockets, children

What are the contraindications for using the ultrasonic scaler?

Magnetostrictive, Pierzoelectric, & sonic

What are the 3 types of ultrasonic scalers?

Magnetostrictive

This moves in an elliptical pattern at about 18,000 to 45,000 cycles per second. This is what we use in the wcc clinic

Piezoelectric

This moves in a linear pattern at about 25,000 to 50,000 cps

Titan

This attaches directly to the handpiece & moves in an elliptical pattern at about 2500 to 7000 cps.

Review the medical history, oral exam, instrumentation plan.

How must you prepare for a patient that will need the ultrasonic scaler?

establish power & water connections, flush water lines, full ultrasonic handpiece with water, select insert, set power level, adjust water to a fine mist, use an antimicrobial solution

How do you prepare you ultrasonic unit for use?

flush water lines in a slow speed hand piece for 2 minutes, attache the sonic hand piece to the slow speed hand piece line, select and screw the sonic tip into the hand piece

How do you prepare for sonic unit usage?

review health history, explain procedures, provide protection for the patient, pre-procedural rinse, patent position and breathing, pain control, water control

How do you prepare the patient for ultrasonic scaling?

Low power: comfortable for patient but does not remove calculus completely // High to medium power: calculus can be removed more efficiently

What are the principles for technique when using an ultrasonic scaler?

Full length of tip vibrates but only the terminal few mm will transfer max energy capable of disrupting calculus

How does the transfer of energy work when using ultrasonic equipment?

Position the side of the tip against the tooth with the few mm near the end of the tip closely adapted to the tooth

How does adaptation work when using ultrasonic equipment?

the tip must always be moving

How does activation work when using ultrasonic equipment?

Grasp = modified pen, Fulcrum = required, Adaptation = keep the side of the tip closely adapted to the tooth, Stroke = very light/constant moving strokes

Ultrasonic scaling process?

Foot pedal has 2 speeds, the 1st starts the water then the 2nd runs both the cavitron and the water together

How does water control work with the cavitron?

Let the water run ofof of the mirror and use your finger to remove, when water pools on the mirror head, it gives you a clearer image

How is the mirror used when completing an ultrasonic cleaning?

Use a periodontal subgingival explorer to evaluate

After scaling with an ultrasonic and also scaling manually, what should you do next?

after 2 weeks

When can the true test of successful treatment be determined?

tissue response is the most significant measure of success in perio debridements, the essential components of successful non-surgical instrumentation are thorough subgingival debridement by the clinician and plaque control by the patient.

What are the effects of nonsurgical instrumentation?

Manual scalers and curets, ultrasonic tips, and broken instruments

What parts of ultrasonic scaling may require maintenance?

Endotoxin

This is a lipopolysaccharide complex found in the cell wall of many gram-negative microorganisms, contained superficially within periodontally involved cementum

furcation invasion

This is the pathogenic resorption of bone within a furcation.

Instrumentation zone

The area where calculus and altered cementum are located and treatment is required

Root planing

A definitive treatment procedure designed to remove altered cementum or surface dentin that is rough, impregnated with calculus or contaminated with toxins or microorganisms.

Debridement

This term also means root planing or root preparation

Scaling

Instrumentation of the crown or root surfaces to remove dental biofilm and calculus

Bactermia

This is the presence of bacteria in the blood

Galvanic pain

A sudden sharp stabbing pain upon tooth to tooth contact is known as __?

Abfraction

These are cratered areas of enamel or dentin at the CEJ in the shape of a wedge or a V-shaped notch

Dentin hypersensitivity

Thermal, muchanical, evaporative, osmotic, chemical sensitivity, sharp, sudder transient pain; these are all signs and symptoms of what condition?

Caries extending into the dentin

Pain with sweets, pain upon pressure and thermal sensitivity are signs and symptoms of what condition?

pulpitis

Severe, intermittent throbbing pain ("typical toothache") is known as ____?

Periodontal ligament inflammation

Pain upon chewing is a symptom for what condition?

Acoustic Turbulence

This is the agitation in the fluids surrounding a rapidly vibrating ultrasonic tip, this has the potential to disrupt the bacterial matrix

Cavitation

This is the action created by the formation and collapse of bubbles in the water by high frequency sound waves surrounding an ultrasonic tip

Ferromagnetic

This is a type of rod with unusually high magnetic permiability used in magnetostrictive ultrasonic inserts

Lavage

The therapeutic washing of the pocket and root surfaces to remove endotoxins and loose debris

Piezoelectric

This is an ultrasonic scaling device activated by dimensional changes in crystals housed in the handpeice?

Magnetostrictive

This is an ultrasonic scaling device that generates a magnetic field and produces tip vibrations by the expansion and contraction of a metal stack or rod