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101 Cards in this Set
- Front
- Back
When are probing depths equal to CAL?
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When the gingival margin coincides with the CEJ, then CAL and probe score are equal
If GM=CEJ, then PD=CAL |
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Gingival Margin is a above the CEJ, how do you calculate CAL?
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When the GM is above the CEJ, the clinician must subtract the distance from the CEJ to the GM from the probe score.
CAL: PD-(GM to CEJ) PD>CAL |
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Gingival Margin is a below the CEJ, how do you calculate CAL?
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Recession!
When the gingival margin is below to the CEJ. CAL = PD + Recession CAL> PD |
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AAP Periodontal Classification:
slight: moderate: severe: |
AAP Periodontal Classification:
1-2 mm CAL = slight 3-4 mm CAL = moderate > or equal to 5 = severe |
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What does AAP stand for?
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American Academy of Periodontology
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What is PSR?
What kind of probe is used? |
PSR
This is frequently used in private practice for unassisted dental hygienists, to monitor probing at every visit. Periodontal Screening and Recording System: -0.5mm ball tip -Color-coded band extending 3.5-5.5mm from tip |
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How is PSR calculated?
0= 1= 2= 3= 4= |
PSR
MOUTH IS DIVIDED INTO SEXTANTS 0 = Colored area is completely visible, no calculus or defective margin, no bleeding 1 = Same as above except bleeding is present 2 = Similar to zero & one except calculus or defective margin is present 3 Colored area of probe is partly visible 4 = Colored area of probe is NOT visible (>5.5mm) |
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Tooth Mobility
- Pathologic Migration of Teeth Grade I: |
Tooth Mobility
- Pathologic Migration of Teeth Grade I: Slight pathologic mobility, app. 1 mm buccolingually |
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Tooth Mobility
- Pathologic Migration of Teeth Grade II: |
Tooth Mobility
- Pathologic Migration of Teeth Grade II: Moderate pathologic mobility, app. 2mm buccolingually, no vertical displacement |
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Tooth Mobility
- Pathologic Migration of Teeth Grade III: |
Tooth Mobility
- Pathologic Migration of Teeth Grade III: Sever pathologic mobility, >2mm buccolingually or mesiodistally, combined with vertical displacement. -- puss and suppuration might be present |
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What is Tooth Migration?
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What is Tooth Migration?
Physical movement of tooth |
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What is Mobility?
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What is Mobility?
Movement within the socket |
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Furcation Identification and Measurement
Grade I: |
Furcation Identification and Measurement
Grade I: Pocket formation into the flute of the fruca, but the interradicular bone is intact |
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Furcation Identification and Measurement
Grade II: |
Furcation Identification and Measurement
Grade II: Loss of interradicular bone, with pocket formation of varying depths into the fruca but not completely through to the opposite side of the tooth. |
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Furcation Identification and Measurement
Grade III: |
Furcation Identification and Measurement
Grade III: Complete loss of interradicular bone, with pocket formation that is completely probable to the opposite side |
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Furcation Identification and Measurement
Grade IV: |
Furcation Identification and Measurement
Grade IV: Loss of attachment and gingival recession making the furca clearly visible |
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Periodontal Implications of Implants
Define Perimucositis: |
Periodontal Implications of Implants
Define Perimucositis: Inflammation of the mucus membrane around the implant |
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Periodontal Implications of Implants
Define Peri-implantitis: |
Periodontal Implications of Implants
Define Peri-implantitis: Failure of implant |
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Why probing should be avoided right after implant placement?
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Probing should be avoided for the first three months after abutment connection.
After implant is placed osseointegration has to occur to be successful |
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What are considered healthy pockets around implants?
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What are considered healthy pockets around implants?
4-5mm |
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What is an indication of implant failure?
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What is an indication of implant failure?
radiographic bone loss and mobility |
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What can be the reason for implant failure?
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What can be the reason for implant failure?
Occlusal trauma causes implant failure |
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What's an example of "parafunctional" habits?
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What's an example of "parafunctional" habits?
granding, biting nails, bruxism |
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Define Hypersensitivity?
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Define Hypersensitivity?
Allergic reaction |
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G.V. Black Cavity Classification
Class I |
G.V. Black Cavity Classification
Class I: Pit and Fissures - occlusal surface of premolars and molars - occlusal 2/3 of facial and linguals on molars - lingual surface of max. incisors |
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G.V. Black Cavity Classification
Class II |
G.V. Black Cavity Classification
Class II: Proximal cavities in premolars and molars |
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G.V. Black Cavity Classification
Class III |
G.V. Black Cavity Classification
Class III Proximal cavities in incisors and canines (does not involve incisal edges) |
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G.V. Black Cavity Classification
Class IV |
G.V. Black Cavity Classification
Class IV: Proximal cavities in incisors and canines (involve incisal edges) |
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G.V. Black Cavity Classification
Class V |
G.V. Black Cavity Classification
Class V: Gingival third cavities (does not include pits and fissures) --> root exposure, root caries |
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G.V. Black Cavity Classification
Class VI |
G.V. Black Cavity Classification
Class VI Incisal edge and cusp tip cavities |
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What toothpaste was specially formulated for erosion?
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What toothpaste was specially formulated for erosion?
Sensodyne ProNamel Toothpaste |
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Define Abrasion:
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Abrasion – wearing away of tooth structures (buccal, incisal, & occlusal) resulting from excessive abrasive forces by a foreign object.
- mostly cervical third of tooth below the CEJ |
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So, if abrasion is recession caused by excessive abrasion from a foreign object, can recession occur without abrasion? What causes it?
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Yes, bacteria & inflammation can cause recession
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How does Abrasion looks like?
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How does abrasion looks like?
-"V" or wedge-shaped defects or notches - ditches, notches, or indentations |
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What causes Abrasion?
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Mechanical process of foreign objects:
toothbrush, personal habits |
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What is the precess leading to abfraction?
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Abrasion may lead to recession and then to abfraction
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Does alveolar bone regenerate after assault?
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Does alveolar bone regenerate after assault?
Alveolar bone re-mineralizes and re-intergrates but DOES NOT regenerate - you may stop the progression of disease/ bone loss but you can not regain bone --> periodontal disease |
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Define Abfraction:
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Abfraction – cervical V- or wedge shaped lesions (apical to the CEJ) caused by occlusal forces such as bruxism.
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How do you address abfraction?
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How do you address abfraction?
-Night guard - helps in distribution of uneven occlusal forces -Fluoride treatement |
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Can abrasion occur below the gum line?
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Abfraction can occur below the gum line! Abrasion can not!
Because recession must occur for abrasion to occur |
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What other evidence can you find in the mouth to support the etiology of bruxism? What other symptoms would you see?
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Linea Alba, scalloped tongue, sensitivity, cracked teeth, pitted molars, craze lines, attrition, cheek biting, clicking TMJ, tight cheeks
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Define Attrition:
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Attrition – wear from tooth-to-tooth contact (occlusal and incisal).
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What causes Attrition?
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Tooth-to-tooth contact resulting from deep overbite, crossbite, or other functional contact
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How would you describe Attrition?
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How would you describe Attrition?
-Flatening or well-defined facets (incisal or occlual) - Facet and ledges (buccal and lingual surface) |
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Define Erosion:
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Erosion – loss of enamel and dentin (any surface) resulting form chemical action of acids.
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What could cause erosion, OTHER than an eating disorder?
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What could cause erosion, OTHER than an eating disorder?
Sodas, Orange Juice, Lemons, GERD -> dietary and gastric acids |
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Aggressive and Localized Periodontitis cause bone loss? Which?
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Aggressive and Localized Periodontitis cause bone loss? Which?
- rapid bone loss - vertical bone loss |
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Abrasion & Abfraction cause bone loss? Which?
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Abrasion & Abfraction cause bone loss? Which?
- slow progression for a long time - horizontal bone loss |
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How does assaulted lamina dura looks like on a radiograph?
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How does assaulted lamina dura looks like on a radiograph?
It is widen and radiopaque due to occlusal forces |
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PDL space is ...
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PDL space is radiolucent
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Radiolucency around alveolar crest indicates what?
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Radiolucency around alveolar crest indicates what active bone disease.
- the alveolar crest (interdental septa) often look indistinct - lamina dura looks fuzzy |
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Limitations of Radiographic Assessment of Periodontal Disease:
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Limitations of Radiographic Assessment of Periodontal Disease:
1. Minor changes in bone mass are not detectable 2. Interdental Craters - Internal morphologic features or depth of crater-like defects not shown - Extent of involvement on buccal and lingual not shown |
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Digital subtraction radiography (DSR)
Pros: |
Digital subtraction radiography (DSR)
-More efficient -More accurate -Image can be digitally enhanced for better detail and detection -Image can be superimposed on the original radiograph |
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Treatment Planning
Sequence of Periodontal Procedures |
Treatment Planning
Sequence of Periodontal Procedures Preliminary Phase Phase I Therapy (Etiologic Phase) Phase II Therapy (Surgical Phase) Phase III Therapy Phase IV Therapy(Maintenance Phase) |
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Preliminary Phase
Goal: |
GOAL: bring all emergency and critical situations under control.
Treatment of emergencies Extraction of hopeless teeth and provisional replacement if needed |
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What constitutes an emergency or critical situation?
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What constitutes an emergency or critical situation?
Pain, Abcess --> can kill Mouth is very close to lymph nodes and the brain |
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Why would extraction of hopeless teeth need to happen first? What makes them hopeless?
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Why would extraction of hopeless teeth need to happen first? What makes them hopeless?
cracked tooth --> all down to the root tip - caries that is concave from clinical point of view - root is cavitated and pulp infected - the crown is gone |
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Phase I Therapy (Etiologic Phase)
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Phase I Therapy (Etiologic Phase)
GOAL: control or eliminate etiologic factors of disease - Plaque biofilm control - Diet control (for patients at high caries risk) - Scaling and root planing - Antimicrobial therapy (local or systemic) -Correction of contributing restorative and prosthetic factors -Removal of caries and restoration of teeth -Occlusal therapy. Why? -Minor orthodontic movement -Provisional splinting. What problems can arise from splinting? -Evaluation of response to Phase I (occurs 1 month or longer after completion) -Reassess gingival condition -Pocket depth, attachment loss, and gingival inflammation -Plaque biofilm, calculus, caries -Stain removal |
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What is the term used to describe restorations that are harmful to the surrounding tissues?
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Foostige
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Phase IV Therapy(Maintenance Phase)
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Phase IV Therapy(Maintenance Phase)
Plaque biofilm and calculus removal -Monitoring -Periodontal condition (pockets, CAL, inflammation) -Occlusion and tooth mobility -Other pathologic changes |
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Role of the Dental Hygienist
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Role of the Dental Hygienist
Provide treatment during Phase I (nonsurgical or etiologic phase) and Phase IV (maintenance phase). |
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Do you feel, as a clinician, that you provide more than just treatment to your patients?
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Do you feel, as a clinician, that you provide more than just treatment to your patients?
- we control bacteria - we maintain care |
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Considerations for Determining the Dental Hygiene Care Plan
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Patient ‘s general health and tolerance of treatment
-Number of teeth present -Amount of supragingival & subgingival calculus -Probing pocket depths -Furcation involvement -Alignment of teeth -Margins and restorations -Caries -Developmental anomalies |
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Considerations for Determining the Dental Hygiene Care Plan
Related to Patient: |
Physical barriers to access
Patient cooperation Patient prevention education needs Patient sensitivity |
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Treatment Planning for Periodontal Disease
Classifications: |
Treatment Planning for Periodontal Disease:
Classifications: 1.Gingival diseases 2.Slight periodontitis 3.Moderate periodontitis 4.Severe periodontitis 5.Aggressive periodontitis |
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Treatment Plan: Gingival diseases
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Treatment plan: Gingival diseases
- No Clinical Attachment Loss (LIMITED TO GINGIVA) - Often completed in 1 visit Treatment Plan: 1. Assessments 2. Patient education and plaque biofilm control instruction 3. Scaling and periodontal debridement 4. Establish appropriate maintenance interval 5. Re-evaluation at subsequent appointment or first maintenance visit |
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Treatment Plan: Slight periodontitis
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Treatment Plan: Slight periodontitis
- 1-2 mm Loss (does that mean 1-2mm pockets?) - Often requires more than one treatment visit Treatment Plan: 1. Assessments 2. Patient education and plaque biofilm control instruction; probably more complex , requiring augmentation and reinforcement at subsequent visits 3. Scaling, root planning, and periodontal debridement by quadrant, often requiring anesthetics and analgesics 4. Establish appropriate maintenance interval. How is this determined? 5. Re-evaluation by dental hygienist and dentist |
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Treatment Plan: Moderate periodontitis
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Treatment Plan: Moderate periodontitis
- 3-4 mm Loss - Often treated by quadrants, requiring several treatment visits. Treatment Plan: 1. Assessments, consider referral to periodontist 2. Patient education and plaque biofilm control instruction; probably more complex , requiring augmentation and reinforcement at subsequent visits 3. Scaling, root planning, and periodontal debridement by quadrant, often requiring anesthetic use 4. Establish appropriate maintenance interval 5. Re-evaluation by dental hygienist and dentist |
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Treatment Plan: Severe periodontitis
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Treatment Plan: Severe periodontitis
->5 mm Loss -Often treated by quadrants but may require therapy by sextants; requires several visits. Treatment Plan: 1. Assessments, strongly consider referral to periodontist 2. Patient education and plaque biofilm control instruction; probably more complex , requiring augmentation and reinforcement at subsequent visits 3. Scaling, root planning, and periodontal debridement by quadrant or sextant 4. Establish appropriate maintenance interval |
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Aggressive periodontitis
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Aggressive periodontitis
- Presents with a variety of signs and symptoms; may be treated in single or multiple treatment visits. Treatment Plan: 1. Assessments, will require referral to periodontist 2. Patient education and plaque biofilm control instruction Scaling, root planning, and periodontal debridement 3. More frequent recalls often required 4. Courses of antibiotics and microbiologic diagnostic monitoring may be required 5. Establish appropriate maintenance interval 6. Re-evaluation by dental hygienist and dentist |
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What is Root planing?
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Root planing: goal was to remove surface layer of cementum/dentin on the root surface (associated with a perio pocket) and leave a hard almost glassy surface. Remove lipopolysaccharides (endotoxins) or embedded calculus. No evidence to support that root planed teeth are easier to maintain or less likely to be associated with perio disease than those who have had calculus/plaque biofilm removed.
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Scaling
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“instrumentation of the crown and root surfaces of the teeth to remove plaque, calculus, and stains from these surfaces.” (AAP)
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Scaling and Root Planing
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Scaling and root planing are not separate procedures; all the principles of scaling apply equally to root planing. The difference between scaling and root planing is only a matter of degree. The nature of the tooth surface determines the degree to which the surface must be scaled or planed.
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Root Planing
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Root Planing
“a treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms.” (AAP) Root planing, like scaling, may be successfully performed by hand instrumentation or powered scaling devices. |
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Difference between scaling and root planing?
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Difference between scaling and root planing?
Longer, lighter root-planing strokes are then activated with less lateral pressure until the root surface is completely smooth and hard. The instrument handle must be rolled carefully between the thumb and fingers to keep the blade adapted closely to the tooth surface as line angles, developmental depressions, and other changes in tooth contour are followed. Scaling and rootplaning strokes should be confined to the portion of the tooth where calculus or altered cementum is found; this area is known as the instrumentation zone. Sweeping the instrument over the crown where it is not needed wastes operating time, dulls the instrument, and causes loss of control. |
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Periodontal Debridement
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Periodontal Debridement
Involves supragingival and subgingival scaling and root planing and disruption or removal of plaque biofilm with a minimum of tooth structure removal. Removal of plaque biofilm, plaque retentive features, and calculus, both above and below the gingival margin. The goal of periodontal debridement is to restore the periodontium to health, not to produce glassy, hard root surfaces that are free of various deposits. |
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Prophylaxis
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Prophylaxis
Procedure to remove local irritants to the gingiva and includes complete calculus removal followed by root planing. It also includes polishing. Prophylaxis is basically a preventive and maintenance procedure for periodontal patients. |
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Coronal Polishing
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Coronal Polishing
The removal of stain and plaque biofilm from the teeth. Polishing has no proven therapeutic value. |
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Gingival Curettage
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Gingival Curettage
“scraping or cleaning the walls of a cavity or surface by means of a curette” (AAP) The removal of the inflamed soft tissue lateral to the pocket wall. It provides little therapeutic value. |
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Rationale For Nonsurgical Periodontal Therapy
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Rationale For Nonsurgical Periodontal Therapy
To remove the etiologic agent of disease, bacterial plaque biofilm, and its associated factors. Eliminate and control infection to prevent reinfection. Scaling and root planing is the standard of care for nonsurgical and nonpharmacologic treatment of chronic periodontal diseases. |
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Removal of the Cause
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Removal of the Cause
Plaque Biofilm Calculus |
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Toxins on Tooth Surface
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Toxins on Tooth Surface
Endotoxins do not penetrate deeply Retained toxins are associated with missed calculus and plaque rather than “diseased” cementum. Toxins are superficially located on root surfaces and easily removed. |
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Soft Tissue Healing After Periodontal Debridement
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Soft Tissue Healing After Periodontal Debridement
Healing occurs in approximately 1 week. Healing of inflamed connective tissue is complex, requiring many cells and mediators. May take up to several months |
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When do we probe after Periodontal Debridement?
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New connective tissue fiber attachment to the tooth surface is not predictable.
Rather, the development of an elongated junctional epithelial attachment may result. Probing after treatment should be avoided for 4 weeks. |
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Healing of epithelial lining:
Healing of CT: |
Healing of epithelial lining can be expected to take 5 to 12 days.
The underlying connective tissue takes at least 3 to 4 weeks to heal. Avoid probing for at least 4 weeks. |
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Repopulation of Micro-Organisms After Therapy
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Repopulation of Micro-Organisms After Therapy
Number of organisms are reduced dramatically. Plaque shifts from gram-negative to gram-positive. New flora similar to what you find in periodontally healthy sites |
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Bacteria repopulate in a specific order:
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Bacteria repopulate in a specific order:
1. Streptococcus and Actinobacillus species 2. Veillonella, Bacteroides, Porphyromonas, Prevotella, and Fusobacterium species 3. Capnocytophaga species and spirochetes |
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Clinical Response
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Clinical Response
-Shallower pockets show less improvement -Redness and bleeding are reduced dramatically -Healing is greatest 3 to 6 weeks after nonsurgical periodontal therapy. (Greenstein, 1992) -Changes continue to occur up to 12 months after treatment, when the situation stabilizes. |
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Clinical Response
Re-evaluation: |
Re-evaluation:
Expect to see changes in the following: -Periodontal probes penetrate the epithelial attachment by 1 mm or more, especially in inflamed tissue. -The periodontal probe is less likely to penetrate healed junctional epithelium and intact CT 4 weeks after SRP. |
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ULTRASONICS:
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ULTRASONICS:
Vibrations range from 20,000 to 45,000 cycles per second. Units use magnetostrictive or piezoelectric systems to generate ultrahigh frequencies of scaling tip movement. |
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SONIC:
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SONIC:
3,000 to 8,000 cycles per second |
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Ultrasonic and Sonic Devices
How do you use it? |
Ultrasonic and Sonic Devices
How do you use it? Tip must be moved rapidly (constant motion). Do not use lateral pressure – can lead to root damage. |
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Ultrasonic and Sonic Devices
Which is better? |
Sonic scalers were at least as effective as ultrasonic scalers for calculus removal, if not slightly better.
Ultrasonic instruments caused slightly less trauma to the roots than sonic instruments. |
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Endotoxin Removal
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Endotoxin Removal
Endotoxins (lipopolysaccharides) embedded in the root surface are removed by ultrasonic scaling with overlapping, light strokes of approximately 50 g, which is about the same pressure as light probing. |
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Calculus Removal
Thin Tip: |
Calculus Removal
Thin Tip: The thinner ultrasonic tips were 16% to 27% more effective in calculus removal (in deeper areas) than hand curettes and 27% to 46% better than standard ultrasonic tips. |
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Lasers
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Lasers
♦ Diagnosis of pit and fissure caries ♦ Soft tissue incision and excision ♦ Gingival curettage ♦ Caries removal ♦ Cavity preparation |
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Irrigation with Antimicrobial Agents
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0.12% chlorhexidine
0.4% stannous fluoride 0.05% povidone-iodine Mechanical scaling and root planing is the primary antimicrobial treatment Irrigation is not reliable in augmenting its effects. |
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CHX
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CHX
Strength: 0.12% Excellent Effectiveness Delivery: -ultrasonic -cannula -handpiece long-lasting Negatives: taste, inhibits fl, stain |
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Stannous Fluoride
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Stannous Fluoride
Strength: 1.6% Excellent Effectiveness Delivery: -cannula -moderate lasting Negatives:taste, short shelf life, stain |
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Povidone Iodine
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Povidone Iodine
Strength:2.5% Excellent Delivery: -ultrasonic -cannula -handpiece short Negatives: taste, allergic reaction,stain |
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Local Delivery
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Local Delivery
♦ Advanced chronic periodontitis ♦ Refractory periodontitis ♦ Recurrent periodontal disease ♦ Indicated for isolated pockets of 5-7mm with bleeding |