Lecture 10 Flashcards
biologic equilibrium
a state of balance in the body between the bacterial plaque and the host
what happens if an individual’s immune system can effectively deal with a mouthful of periodontal pathogens
no destruction will occur
nature’s balancing act
the situation can be thought of as a balance scale, with disease-promoting factors on one side of the scale and health-promoting factors on the other side
periodontal disease results when
the balance tips between pathogenic bacteria and the hosts inflammatory and immune responses
the balance of periodontal disease can be affected by
differences in host response
risk factors: local/systemic risk factors, systemic illness, medications, smoking, poor diet, stress
risk assessment involves identifying elements that either
predispose a patient to developing periodontal disease or influence the progression of disease that already exists
in addition to an evaluation of the risk factors…
educate patients concerning their risk
implement suitable intervention strategies
eliminate/minimize the impact of contributing/risk factors
restoring balance: inadequate self-care
many patients are unable or unwilling
patient education/oral hygiene instruction
more frequent perio instrumentation
is it possible to eliminate local contributing factors to help restore balance
faulty restorations
ill-fitting dentures
caries
it is possible to compensate for local factors that cannot be eliminated
root concavities
palatal grooves
good home care around crowded teeth or anatomical challenges
systemic contributing factors
patients can work to eliminate systemic risk factors to restore balance
diabetes: control blood glucose
quit smoking: TDE for all smokers
genetic risk factors
at the present time, there are some risk factors that cannot be eliminated or controlled, such as genetic risk factors
frequent professional care can help to slow disease progression
why is it important to be aware of your patient’s risk factors
as a dental professional you want to: eliminate/minimize the impact of contributing factors to maximize the success of nonsurgical periodontal therapy
nonsurgical periodontal therapy
describes the many nonsurgical steps used to eliminate inflammation in the periodontium of a patient with periodontal disease and return the periodontium to a healthy state
nonsurgical periodontal therapy (NSPT) consists of a combination of both
professional care and patient self-care
types of procedures included in NSPT
patient education/individualized self-care instructions
home care recommendations
instrumentation of tooth surfaces
correction of local/systemic risk factors
evaluation of treatment
treatment plans for NSPT
a list of procedures or interventions that addresses a patient’s periodontal health needs as identified during the periodontal assessment
patient education/individualized self-care instructions
addressing all key concepts for patient education
individualized oral hygiene instruction/goals
home care recommendations
antimicrobial agents/xerostomia products
specific interdental/brushing aids
instrumentation of tooth surfaces
2 units of scaling: ultrasonic, hand instrumentation
select polishing
correction of local/systemic risk factors
defective restorations, food impaction, patient habits
smokers? (TDE)
caries risk? nutritional counseling/FL TX (varnish/gel)
evaluation in axium: diagnostic summary tab
are the outcomes met and goals obtained?
is a re-evaluation appointment necessary?
biofilm-induced gingivitis
NSPT primary type of care
periodontal surgery may be needed to correct other existing problems (gingival recession, gingival overgrowth)
stage 1 and stage 2 periodontitis
NSPT can bring many cases under control
may require periodontal surgery to correct damage done by the disease
stage 3 and stage 4 periodontitis
will require thorough NSPT as well as more advanced perio procedures such as perio surgery as severity of disease increases
document the possible need for more advanced treatment and inform patient when the need for such treatment appears likely
surgery is indicated for patients with more advanced periodontitis after NSPT is completed
NSPT may minimize the extent of surgery that is needed
instrumentation during NSPT objective
physical removal of microorganisms and their products (calculus/biofilm) to prevent and treat periodontal infections
why do we instrument during NSPT
physical removal/disruption is the most effective mechanism of control
rationale for instrumentation
to eliminate inflammation in the periodontium
to arrest progress of periodontal disease
to induce positive changes in subgingival bacterial flora
to increase effectiveness of patient self-care
to prevent recurrence of periodontal disease during periodontal maintenance
power instrumentation vs hand instrumentation for periodontal debridement
very effective in deplaquing tooth surfaces
more effective treatment of furcations
slim tips reach deeper into periodontal pockets
low/medium power setting less root surface damage
water irrigation removes toxins
reduced instrumentation time
scaling
instrumentation of the crowns and root surfaces to remove plaque biofilm and calculus
dental prophylaxis
includes scaling and polishing to remove coronal plaque biofilm, calculus and stain
root planing
removes rough cementum or surface dentin and the associated calculus, toxins or microorganisms
periodontal instrumentation/periodontal debridement
the removal or disruption of plaque biofilm, its by-products and calculus from coronal and root surfaces to the extent needed to reestablish periodontal health and restore a balance between the bacterial flora and the host’s immune responses
periodontal instrumentation/periodontal debridement involves
thorough biofilm and calculus removal but does not include the deliberate, aggressive removal of cementum
root surfaces should be instrumented only to a level that results in resolution of tissue inflammation
end point for instrumentation during NSPT
to return the periodontium to a state of soft tissue health that is free of inflammation
the primary type of healing in a site of attachment loss after periodontal instrumentation is through the formation of
long junctional epithelium
long junctional epithelium
as inflammation resolves, epithelial cells may readapt to the tooth surface
this adaptation of the epithelial cells to the root surface is referred to as the long junctional epithelium
following periodontal instrumentation there is no formation of
new alveolar bone
cementum
periodontal ligament
tissues responses to instrumentation
shrinkage of the soft tissue/resolution of inflammation resulting in a shallow pocket depth/reduction in probing depth
forming a long junctional epithelium: readaptation of the tissue to the root resulting in a shallow pocket depth/reduction in probing depth
little change in the level of soft tissues resulting in a residual periodontal pocket
the re-evaluation appointment
occurs after the completion of NSPT
ideally 4-6 weeks after completion of NSPT (true tissue response will not occur for at least 1 month)
allows time for complete tissue healing
steps in re-evaluation
medical status update
thorough periodontal assessment
compare results with initial assessment
decide on the next step in therapy
additional nonsurgical therapy
periodontal maintenance
possible referral for periodontal surgery
options for treatment following re-evaluation
additional NSPT: revisit unresponsive sites
establish maintenance program
recognize the need for periodontal surgery/referral
initial therapy
reduce the number of bacteria
remove calculus and biofilm accumulation
patient education: critical with perio patients
maintenance therapy
Q 3 months
debridement
review patient education and goals: reinforce home care strategies
periodontitis and its treatment may involve both
non-surgical therapy and surgical approaches
goal of treating all of the periodontium’s problems
try to reduce the number of harmful bacteria, create architecture easier for the patient and hygienist to maintain
