• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
The helper!. (1)
 

The helper!. (1)

on

  • 358 views

 

Statistics

Views

Total Views
358
Views on SlideShare
358
Embed Views
0

Actions

Likes
0
Downloads
7
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    The helper!. (1) The helper!. (1) Document Transcript

    • ‫ |كلية الفارابي لطب األسنان والتمريض‬Alfarabi college | The helper in periodontics 2013 level 7 & 8 some basic info. Help you in the clinic and the general knowledge in the periodontology ✌My Friends ,I made these papers to Facilitates you , To access the information quickly And remember main info, in our course I hope it benefit youOsama almasry , level 8 28 / 2 / 2013 ☂ Pepared by : Osama a. almasry Course coordinator : Dr . khalid Azouni
    • Presenting the patient :Mr| miss ( ) from Saudi arabia , and he she is 21 years oldHe | she is a smoker , non smokerThe C.C " Chief complaint " is ….His| her medical history :: Diabetes , hypertention , breathless , blooddisorder , medications , allergy , any abnormalities , etc ..His | her Dental history :: last visit , oral hygiene , Bleeding , plaque , bad taste ,Resto , ortho , scaling , etcHis | her habits are . . . .The Diagnosis is :: Generalized marginal chronic gingivitis ,Localized severe chronic periodontitis , etc ..The G. prognosis is : Excellent , Fair , poor , Hopeless . etc ..The treatment plan will be : non surgical treatment or sugricalSupragingival scaling , or Subgingival scaling , root planning , etcOHI : oral hygiene instructionsFollow up : After 4 - 6 weeks re evaluation of the plaque , oral hygiene , codition of the gingiva , etc .. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Denti | Signs You have to tell your patient about these signs " its Facilitates your treatment "
    • ❞The instruments ::Scaling instruments :☛Sickle scaler : to remove supragingival calculus- two cutting edges " sharp pointed tip "- straight shank to anterior and premolars teeth- contra – angled shanks to posterior teeth ☛Curette : to remove subgingival calculus , root planning , removal of soft tissuelinning the pocket- two cutting edge , not sharp pointed tip- finer than scalersUniversal curette : Gracey " area specific " curette- two cutting edge , one plane - one cutting edge , two plane- blade not offset - blade offset- 90 degree angle of blade - the terminal shank 70 degree ★ Method of application of Curette : Pull stroke ( UPWARD ) ★ -------------------------------------------------------------------------------------------------Gracey 1-2 , 3-4 | for anterior teethGracey 5-6 | for anterior teeth and premolarsGracey 7-8 , 9-10 | for posterior teeth ( Facial and lingual )Gracey 11-12 | for posterior teeth ( mesial)Gracey 13- 14 | for posterior teeth (distal )--------------------------------------------------------------------------------------------------------------☛Chisel , Hoe , file scalers : to remove tenacious subgingival calculus and alteredcementum .☛Ultrasonic : for scaling and cleansing tooth surfaceand soft tissue wall of perio pocket☛Cleaning and polishing instruments : rubber cup, brushes , dental tapeAir bowder abrasive system and prophy jet . Rubber cup Prophy jet★ The most effective grasp for periodontal instruments : Modified pen grasp
    • ❞The Gingiva Normal ::- pink - firm & resielient - knife edge – stippling - sulcus " 1-3 mm " Gingivitis :: Periodontitis- change In color to bluish red - Gingival inflammation- edema - pocket - Furcation- Round tip - bone loss " in X ray "- loss of stippling - tooth mobility- Bleeding on probe ! - tooth migration★ Dental Plaque :Is complex soft non calcified microbial deposit which accumulate on teeth , dentures ,appliances★ Materia alpa " same plaque but you can remove it by water " !Lack the organized structure of plaque★ Calculus :Hard deposit form by mineralization of dental plaque and covered by un mineralizedplaque Factors ☀ Local Factors of perio Diseases ::: " important in our sheets in hospital "1 plaque and calculus2 Iatrogenic factors " defects in Resto , improber denture , improber ortho "3 Malocclusion 4 anatomical variation5 Habits " holding of nails , tooth pick biting , lip biting , thumb sucking , pipe smoke , Bruxism " 6 Food retention7 mouth breathing " unknown cause but may due to dehydration " 8 Hypofuction teeth Clenching thumb suck tooth pick malocclucion overhang hold nails Tongue thrusing pipe smoking
    • ☀ Systemic factors of perio disease :: 1 Pregnancy 4 Abnormalities of endocrine system 2 Puberty 5 Weakened immune system 3 Diabetes 6 Smoking 7 Osteoporosis 8 Heart disease 9 Obesity Medications can cause Gingival Disease :: Anticonvulsant drug Hypertensive drug Immunosuppressive drug phenytoin Nifidipine Cyclosporine ❞Pockets : Pathologically deep gingival sulcus Classifications : A - Gingival pocket " psuedo pocket " B - Periodontal pocket divided into :: " suprabony pocket : bone loss horizontal " intrabony pocket : bone loss vertical Classification accord involved tooth surface : * Simple pocket (A) * Compound Pocket (B) * Complex Pocket ( C ) ❞Gingival Recession : Is exposure of root surface by apical shifting Factors cause the Recession : age , inflammation , false brush , abnormal frenum , tooth malposition ❞Furcation involvement : BY Nabers probe Is invasion of bifurcation and trifurcation of multi rooted teeth . Grade 0 0 mm no furcation^ Grade 1 1-3 mm Grade 2 > 3 mm surpassing half of buccolingual thic of tooth , not through and through + some interradicular bone attached Grade 3 > 3 mm Encompassing entire width of tooth , through and through + no bone attached Grade 4 > 3 mm Encompassing entire width of tooth , through and through + no bone attached + Gingival recession
    • ❞ Tooth mobility : Is loosening of tooth in socket☀ Class 1Slight mobility , up to 1 mm horizontal displacement " faciolingual direction "☀ Class 2Moderate mobility , greater than 1 mm horizontal displacement " faciolingual direction "☀ Class 3Severe mobility , greater than 1 mm horizontal displacement " faciolingual direction "With vertical displacement~ Horizontal mobility " Exam it by tow dental instruments on either side "| Vertical mobility " Exam it by end of instrument handle "Factors cause the mobility :Loss of support , Trauma , inflammation , perio surgery , sometimes pregnancy , use of contraceptive ,Associated with menstrual cycle❞Gingival index :0 normal1 sign of inflamation ( mild ) without bleeding2 sign of inflamation ( moderate ) with bleeding on probing3 sign of inflamation ( severe ) with spontaneous bleeding❞ Plaque index :0 no plaque1 film of plaque detectable on probe only2 moderate plaque seen by eye and detectable by probe3 abundance of plaque | more than 2/3 of the tooth covered by plaque☉ Signs of inflammation : Dolor (pain) Calor (heat Rubor (redness) Tumor (swelling) Functio laesa (loss of function)❞ Ramfjord Teeth 16 21 24 44 41 36In the clininc we exam "Plaque or bleeding" on the ( Ramfjord teeth ) as indicator teethIf on of them missing we exam the adjacent one ..
    • ❞Clinical attachment level (CAL)Is the distance from CEJ to location of the inserted probe tip .CAL = PD + GL pd = probing depth , GL = Gingival level☉ The land mark to measure the CAL Is : CEJ cemento enamel junctionWe measure the CAL by :a) PD (the depth to probe pentrates )b ) level of gingival margin ( distance from CEJ to gingival margin )▪﹁ if there is Recession " Positive number of GL "CAL = PD + GL▪﹁ If the gingival margin cover the CEJ " negative number of GL "CAL = PD + ( - GL )CAL = PD - GL▪﹁ If the gingival margin at CEJ , GL will be = 0 mmCAL = PD + GL❞The X ray :The radiographic survey should consist of minimum of14 intraoral periapical films and four posterior bite wings filmOr panoramic to detect pathologic lesion of teeth and jaw , fractures ,severity of bone destruction ..
    • ❞The Diagnosis :: 2 Severity Distribution 1 Location 3 the disease Severity : slight , moderate , severeGeneralized or localized Chronic (periodontitis or gingivitis etc .. ) Distribution : Marginal , papillary , Diffuse Diffuse♦ Generalized : > 30 %of the teeth ♦ Localized <30% of the teeth♦ Marginal : involve margin & papillae♦ Papillary : papillae only♦ Diffuse : involve margin & papillae & attached gingiva♦ The severity :: the classification of severity is as follows: Mild: 1–2 mm Moderate: 3–4 mm Severe: ≥ 5 mm ‫ إلحدى الحاالت‬severity ‫لنحسب الـ‬ ‫مثال‬ 168 = 27 × 6 ] ‫نضرب عدد األسطح في عدد أسنان الحالة [ ال ننسى أن بعض الحاالت فقدت بعض األسنان‬ , ‫حيث 6 هو عدد األسطح لكل سن‬ ] ‫72 هو عدد األسنان الموجودة [ يوجد خمس اسنان مفقودة لدى الحالة‬ ‫ " لكل األسنان‬probind depth " PD ‫نحسب الـ‬ ‫ 5 ومافوق‬mm ‫ 4-3 أو الـ‬mm ‫ 2-1 أو‬mm ‫ونحسب كم عدد األسنان التي حصلت على‬ ‫ 2-1 هو 9 أسنان‬mm ‫لنفرض أن عدد األسنان التي حصلت على‬ ‫ 4-3 هو 12 سن‬mm ‫وعدد األسنان التي حصلت على‬ ‫ 5 ومافوق هو 6 أسنان‬mm ‫وعدد األسنان التي حصلت على‬ : ‫ للمرض نعمل اآلتي‬severity ‫لكي نحسب الـ‬ 1-2 mm = ( 9 / 168 ) × 100 = 5 % 3-4 mm = (12 / 168 ) × 100 = 7 % 5 mm = ( 6 / 168 ) × 100 = 3% 7 % ‫اذا ٌ النسبة الكبرى هي‬ moderate = ‫ للمرض‬severity ‫اذاً الـ‬
    • ❞ The Prognosis Excellent Good Fair No bone loss -Adequate remaining - less than adequate Excellent ginigiva bone support remaining bone support Good cooperation - adequate control of - Some tooth mobility No systemic factors etiological factors - Grade I furcation - Adequate cooperation - Acceptable cooperation - No systemic factors – limited systemic factors Poor Questionable Hopeless - Modrate , advanced - Advanced bone loss - Advanced bone loss bone loss - Grade II or III furcation - non maintianable areas - Tooth mobility - Tooth mobility - Extraction indication- Grade I & II furcation - in access area - presence of - doubtful cooperation - presence of systemic uncontrolled systemic- presence of systemic factors factors factorsFactors affect the prognosis : age , presence of plaque , calculus , local factors , severity , prosthetics❞
    • ❞Oral Hygiene Instructions ( OHI )A. Proper brushing Techniques and mouth rinse1. Always use a soft bristled toothbrush2. Use anti-cavity Fluoride toothpaste3. Hold toothbrush at a 45-degree angle at the gum line, brushing in acircular motion4. Brush teeth for a minimum of three minutes at least twice a day.5. Brush gums and tongue along with your teeth.6. Don’t brush too hard because this can cause gingival (gum) recession.7. Use mouthwash twice only 20 ml for thirty seconds then wash .B. Proper flossing technique and the reason for flossing1. Use an arms length (18 inches) of floss. Wrap around fingers mostly to oneside.2. Floss each tooth forming a “C” shape with the floss each time.3. A new area of floss should be introduced into each gingival pocket.4. Don’t forget to floss behind your last molar.5. Flossing removes plaque from behind your teeth that brushing misses.6. Flossing helps prevent periodontal disease by removing plaque. Types of oral disease and ways they can easily be prevented:1. Dental Caries (cavities)a) Brushing and flossingb) Fluoride rinse from your dentist if he or she recommends it for youc) Reduce your carbohydrate intake along with simple sugars2. Periodontal Disease ‫مراجعة التعليمات التي يتم إخبارها‬a) Gingivitis is the first stage of periodontal disease ‫للمريض بعد الزيارة [ حول العناية‬1. Bleeding gingival tissue while brushing teeth ‫باألسنان ] بالعربي‬2. Red puffy gingival tissue ‫- تنظيف األسنان يوميا مرتين على األقل لمدة‬3. May be sensitive to touch ‫3 – 5 دقائق وعدم التفريش بطريقة خاطئة‬ ‫وشديدة حتى ال يتم إيذاء اللثة‬4. Bad breath (Halitosis) ‫- تبديل الفرشاة كل 3 شهور‬b) Periodontal disease ‫- استعمال غسول الفم مرتين‬ ‫وإزالة الرائحة الكريهة وإزالة الكميات الكبيرة‬1. Recession of gingival tissue 12 [ .. ‫من البكتيريا والحماية من التسوس‬2. May be sensitive to hot and cold liquids or foods ‫مل ] لمدة ثالثين ثانية ثم بصق الكمية‬ ‫وغسل الفم بالماء وتجنب بلع أي كمية من‬3. Root exposed due to gingival recession ‫الغسول‬ ‫- استعمال خيط األسنان إلزالة البقايا بين‬4. Slight bone loss ‫األسنان‬5 Usually large amounts of plaque and calculus build up ‫- استعمال معجون مضاد للحساسية إذا كان‬ ‫المريض يشكو من ذلك‬6 Bone loss and periodontal ligament detachment ‫- توصيته بالمراجعة بعد شهر من الزيارة‬7 Teeth could be loose8 Puss maybe within gingival pocket9. Major bone loss along with damaged periodontal ligaments.
    • ‫بإمكانك إطالع المريض على هذا الجزء :: وإخباره بأن الوقت المناسب لتنظيف األسنان هو 3 – 5 دقائق ثالث مرات باليوم‬ ‫, وعليه أن يقوم بتغيير الفرشاة كل ثالث أو أربع شهور‬ --------------------------------------------------------------------------------------------- ❞Treatments of Periodontal Disease1. Root scaling to remove calculus and plaque below the gum line2. Surgery to reattach gingival tissue to the surface of the tooth3. Sometimes the gingival tissue may regenerate to fill the voidof the bone loss, but the bone itself will never regenerate. ☛Types of Periodontal Disease Diagnosis Case Type Treatment by Gingivitis Type I General Dentist Mild Periodontitis Type II General Dentist Moderate Periodontitis Type III General Dentist Advanced Periodontitis Type IV Periodontist --------------------------------------------------------------------------------------------- ‫☈ كيفية الكتابة في الملف الخاص بالمريض‬ Procedure ‫في خانة‬ D.h ‫ و الـ‬m.h ‫ والـ‬C.c ‫نكتب اسم المريض , و الـ‬ .. ‫ للحالة‬Tx ‫ والـ‬Dx ‫والـ‬ Mr khalid , 21 years c.c =pain in the lower gingival and bleeding m.h = NAD ( nothing abnormalities detectable) D.h = bad 0ral hygiene , bleeding on probing , Supragingival calculus X ray ? :: .. The Dx : generalized marginal chronic gingivitis The Tx : Supragingival scaling , OHI Follow up✍ The Resources : Carranza ,clininc Manual of periodontics , Wikipedia , Google picture !