prevention of periodontal diseases


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Preventive Dentistry
Third Year

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prevention of periodontal diseases

  1. 1. Prevention of Periodontal Diseases Khalid S Hassan Assist . Prof . PDS, Periodontics Division
  2. 2.  Prevention is better than cure .  Prevention is cheaper than cure .  Prevention of a disease is greater good in life than its cure .
  3. 3. Periodontal Disease   Periodontal diseases: diseases which affect periodontium. Periodontium : tissues which surround and support the teeth.
  4. 4. Etiology of Periodontal Diseases Bacterial plaque Host response Reparative tissue capacity Factors upset the balance By Increasing aggression of bacterial plaque Local predisposing factors Systemic Factors 1- Calculus 1- Hormonal imbalance 2- Material alba 2- Nutritional deficiency 3- Food debris 4- Food impaction 5- Food retention 6- Faulty dentistry 7- Malocclusion 8- Mouth breathing 9- Trauma from occlusion Decreasing defense * Overhanging filling 3- Blood diseases * Over and under contoured crowns 4- Genetics * Occlusal disharmony 5- Immunologic * Orthodontic wires 6- Metallic intoxication * Rough fillings 7- Debilitating diseases 8- Psychologic
  5. 5. Objectives 1- Removal of soft deposits (dental plaque, materia alba and food debris) 2- Gingival massage keratinization and improve circulation protection against microorganisms 3- Prevention of calculus formation. Methods Mechanical Chemical
  6. 6. ** Tooth Brushing Methods:Bass Method: •Intrasulcular method (Professional method). •Efficient for removing dental plaque from gingival third and from shallow gingival sulcus. •Place the bristles at the gingival margin with angle of 45 degree to the long axis of the teeth and the bristles pointed to the crevice. •Exert gentle vibratory pressure using short back-and-forth motions without dislodging the bristles tips (horizontal direction). •Perform about 10-20 strokes in each position. •Use a soft brush in this method.
  7. 7. Modified Stillman Method:•A soft or medium brush can be used with this method. • Recommended for patients with gingival recession to prevent abrasive tissue destruction. •The sides of the bristles are placed against the gingiva and teeth with a 45 degrees angle to the long axis of the teeth. •Pressure is applied laterally against the gingival margin to produce blanching. •Brush is activated by short back-and-forth strokes in coronal direction.
  8. 8. Brushing Methods Modified Stillman Method
  9. 9. Charters Method • A soft or medium brush can be used. • Recommended for temporary cleaning in areas of healing after periodontal surgery. • The bristles pointed toward the crown at a 45 degree angle to the long axis of the teeth. • The bristle tips not move across the gingiva. •The brush is activated with short back-and forth strokes in coronal direction.
  10. 10. Powered Tooth Brushes • Useful for: Children, hand-capped, and patients with orthodontics treatment. • Less abrasive restoration. • Do not require application. • Place the brush head next to the tooth at the gingival margin and proceed systematically around the dentition. to tooth special surfaces techniques and of
  11. 11. Adverse effects of Toothbrushing     Improper toothbrushing. Toothbrush trauma. Excessive brushing pressure. Hard toothbrush bristles. Gingival abrasion and recession Dentin hypersensitivity
  12. 12. II- Interproximal Cleaning Aids:• 1- Dental Floss: Effective for flat or convex proximal tooth surfaces with full embrasures. • Waxed, unwaxed or tufted types. • Tufted and waxed are indicated for rough restoration and tight contact • Cut about 12-15cm and anchored around one finger of each hand. • Gentle placing at the base of gingival sulcus then moved in an up-and down along the tooth surface ,right and left.
  13. 13. 2- Interdental Brushs: •Small cone-shaped or tapered brushes. •Used in large open embrasures. •Inserted interdentally and moved back and forth in faciolingual direction. 3- Tooth Picks:•Made from soft-wood and is triangular in shape. •Used in open contact. •Tooth pick moved in-and-out or up-and down direction. •Tooth pick can be placed in special plastic handles to reach areas with limited access.
  14. 14. III- Oral Irrigation:•With water and antiseptic mouth rinses. •Supra or sub-gingival irrigation. •Hand or mechanized irrigation.
  15. 15. Chemical Plaque Control (Mouth-rinsing)
  16. 16. Chlorhexidine:* The most effective antimicrobial agent in gingivitis plaque and •Mechanism of action:pellicle formation, alteration of bacterial cell wall lysis of bacteria and bacterial adhesion to tooth surfaces. • Has not produced any resistance of oral microorganisms. •Substantivity: high Substantivity. •Side effects:- Staining of teeth , tongue and resin restorations, - Alter taste sensation (temporary). •Dose: 0.2%- 0.12% mouth washes Twice/day.
  17. 17. 2- Essential Oils ** Contains:Thymol •Can Menthol Eucolyptal Methyl Salicylate plaque and gingivitis. •Mechanism of action: alter bacterial cell wall & tooth surface. adherence to •Substantivity low substantivity. •Adverse effects Burning sensation, Bitter taste. •Used twice daily.
  18. 18. Other Products H2 O 2 Stannous fluoride - Anticarious more than antiplaque formation Sanguinarine - Derived from bl. Root plant - 0.01% mouthwashes and dentifrices -No benefits on plaque, used in NUG or periocoronal abscess.
  19. 19. Dentifrices •Abrasive agent e.g. calcium carbonate, calcium oxide or/silicate. •Detergent agent e.g. sodium lauryl sulfate. •Thickening agent: carboxymethyl cellulose and amylase. •Coloring agents. •Humidifier and water. •Fluoride. •Anticalculus agents e.g. zinc citrate, soluble pyrophosphates. •Antiplaque agents e.g. chlorhexidine and triclosan. •Antibiotics eg. Pinicillin.
  20. 20. Triclosan      Active ingredient agent of dentifrices. Is a synthetic phenol derivative in a nonionic form. Compatible with other components of toothpaste. The formulation used in toothpaste contains 0.3% triclosan with 2% copolymer(added to substantivity of antimicrobial). Antiplaque activity for at least 12 hours.
  21. 21. Professional Care   Necessary to control the Subginigival biofilm. Is an example of secondary prevention.
  22. 22. Mechanical Nonsurgical Periodontal Therapy    Scaling: removal of hard deposits on the tooth. Root planing: removal of necrotic cementum. Curettage: removal of necrotic soft tissues.
  23. 23. Antimicrobial Adjunct Therapy  Systemic Delivery of Antibiotics.  Local Delivery of Antibiotics.
  24. 24. POLISHING (Oral Prophylaxis) •Upon the completion of Scaling & root planing, you should polish the teeth when it is necessary
  25. 25. GOAL OF POLISHING  To remove soft deposits and extrinsic stain with minimal trauma to hard and soft tissues and minimal discomfort for patient
  26. 26. Disclosing Agents •Used to stain the teeth for patient education and motivation for oral home care. •Used to locate areas with plaque accumulation. •Available in tablets and liquid forms. •Produce, blue, purple or red stains when attached to plaque on tooth surface. •Examples: Bismark Brown solution, erythrosine and sodium fluorescein dye.