1. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periodontics and Coronal Polish Chapter 29

2. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periodontal Team Periodontist –Screens patient and coordinates with dentist Dental assistants –Room preparation –Chairside assisting Dental hygienists –Cleaning –Examinations Business office staff

3. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Assistant’s Role Periodontal dressing placement and removal Sutures removal Coronal polish Radiographs Impressions Fluoride treatments Patient education

4. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periodontal Disease Symptoms: –Bleeding or inflamed gums –Periodontal pockets –Malocclusion –Halitosis –Tissue recession –Abnormal contour –Pain, tenderness, and discoloration

5. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Causes of Periodontal Disease Local irritants Poor oral hygiene Improper nutrition Malocclusion Stress Systemic factors –Hormonal imbalance –Diseases –Medications

6. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Classification of Periodontal Disease Gingivitis –Plaque-induced –Non-plaque-induced

7. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Classification of Periodontal Disease Periodontitis –Chronic Necrotizing ulcerative gingivitis (NUG) –Inflamed gingiva, metallic taste, bad breath, pain, and tissue hemorrhage

8. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Classifications of Periodontal Disease Unhealthy tissueSublingual calculus © Cengage Learning 2013

9. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check What is the condition of recession of periodontal fibers and resulting inflammation and destruction of bone? –Periodontitis

10. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periodontal Diagnostic Procedures Medical dental history –Questionnaire should include: Chief complaints Medical history Oral history Oral habits

11. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Extraoral Examination © Cengage Learning 2013

12. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Intraoral Examination © Cengage Learning 2013

13. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periodontal Examination Plaque Periodontal probes Tooth mobility Furcation involvement

14. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periodontal Examination Appearance of gingiva Bleeding/suppuration Recession Gingival cleft Occlusion

15. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periodontal Screening and Recording Indicates need for partial or full periodontal evaluation –Early detection –Timely screening –Patient education

16. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Radiograph Interpretation Vertical bone loss Horizontal bone loss © Cengage Learning 2013

17. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chemotherapeutic Agents To aid patients who do not respond well to removal of dental deposits or aggressive form of periodontitis –Antibiotics Penicillin, Tetracycline, Erythromycin, or Clindamycin –Anti-inflammatory Ibuprofen, Acetylsalicylic acid (aspirin)

18. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Presentation of Treatment Plan Form treatment plan Schedule appointment Educate patient Make financial arrangements

19. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periodontal Instruments Instrument sharpening –Manual and mechanical methods Periodontal probes –Calibration needed © Cengage Learning 2013

20. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periodontal Instruments Explorers –Adapt to curves and tooth surfaces Curettes –Universal –Gracey © Cengage Learning 2013

21. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periodontal Instruments Scalers remove hard deposits –Sickle –Jacquette –Chisel –Hoe © Cengage Learning 2013

22. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periodontal Instruments Files remove calculus Ultrasonic instrument –High-powered vibrations with water © Cengage Learning 2013

23. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periodontal Instruments Air polishing systems –Remove extrinsic stain, plaque, and small debris –Fine powder abrasive air delivered under pressure through nozzle Fine powdered sodium bicarbonate

24. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periodontal Instruments Periodontal knives Interdental knives Peritomes Surgical scalpel Electrosurgery Courtesy of Hu-Friedy Mfg., Co., Inc.

25. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periodontal Instruments Pocket marking pliers Periosteal elevators Periodontal scissors, rongeurs, and forceps © Cengage Learning 2013

26. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Instrumentation Techniques SupragingivalSubgingival © Cengage Learning 2013

27. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Lasers Precise beam of concentrated light energy Efficiency based upon absorption rate of wavelengths Dentist must be trained and qualified to use

28. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Lasers Uses: –Debridement and curettage –Gingivectomy –Gingivoplasty –Frenectomy –Tumor and lesion removal –Implant exposure –Aphthous ulcer treatment

29. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Lasers Uses: –Tissue fusion –Elimination of granulation tissue –Biopsy –Crown lengthening –Control bleeding –Osseous procedures

30. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Lasers Benefits: –Bloodless operating field Improves vision –Minimal to no anesthesia –Minimal swelling and discomfort –Improved coagulation © Cengage Learning 2013

31. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Lasers Benefits: –Minimal healing time –Reduction of tissue damage and infection –Accuracy –Less time © Cengage Learning 2013

32. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check For what are periotomes used? –To sever the peridontal ligament prior to atraumatic extractions and to prepare tissue for dental implants

33. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Nonsurgical Procedures Occlusal adjustments –Teeth occlude evenly Scaling and polishing –Removal of plaque

34. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Instrument Placement for Scaling © Cengage Learning 2013

35. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Nonsurgical Procedures Root planing –Scraping of root surfaces Gingival curettage –Soft-tissue curettage scraping

36. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Preoperative Instruction Confirm patient understands procedure Explain procedure and answer questions Confirm patient has prepared as instructed Instructions if patient is to receive intravenous (IV) sedation

37. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Surgical Periodontal Procedures Gingivectomy –Surgical removal of diseased gingival tissue Gingivoplasty –Reshaping of gingival tissues

38. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Gingivectomy Procedure © Cengage Learning 2013

39. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Surgical Periodontal Procedures Periodontal flap surgery –Separation of gingiva and underlying tissue Both images courtesy of Dr. Gary Shellerud

40. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Surgical Periodontal Procedures Osseous surgery –Reshaping of bone Mucogingival surgery –Reconstructive surgery on gingiva and mucosal tissues –Covers exposed roots

41. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Surgical Periodontal Procedures Gingival grafting –Tissue graft from palate –Donor site dressed Frenectomy –Complete removal of frenum Courtesy of Dr. Gary Shellerud

42. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Surgical Periodontal Procedures Guided tissue regeneration –Uses barrier membranes to maintain space between gingival flap and root surface –Prevents interference of cells forming new structures

43. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periodontal Dressing Types: –Zinc oxide eugenol –Noneugenol –Light-cured –Gelatin-base

44. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Periodontal Maintenance Procedures Patient must be committed to ongoing therapy Maintain plaque control

45. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Advanced Chairside Functions Coronal polish –Removal of soft deposits and extrinsic stains Rubber prophy cup Prophy brush Abrasives

46. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Coronal Polish Rationale Easier to keep teeth clean Motivates patient to maintain Slows accumulation of new deposits Better absorption of fluoride Prepares tooth for other procedures

47. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Contraindications and Modifications Orthodontic appliances Hypersensitive teeth Green chromogenic bacterial stain Minor oral irritations

48. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Deposits Soft deposits Calculus Stains © Cengage Learning 2013

49. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Intrinsic Stains Dental fluorosis Pulp damaged or non-vital tooth stain Tetracycline stain Metallic stain

50. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Extrinsic Stain Yellow and brown stains Tobacco stain Green stain Black line stain Orange stain Chlorhexidine stain

51. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Abrasives and Polishing Agents Abrasives –Powders or pastes used to remove soft deposits on teeth –Many varieties

52. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Equipment and Supplies Handpiece Abrasives Rubber prophy cup Prophy brush Dental tape or floss

53. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Maintaining the Operating Field Free of saliva and debris Maximum light Maintain patient comfort Maintain proper positioning

54. ©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Auxiliary Polishing Aids Bridge threaders Abrasive polishing strips Soft wood points Interproximal brushes