Khalid S Hassan
Assist . Prof .
Prevention is better than cure .
Prevention is cheaper than cure .
Prevention of a disease is greater
good in life than its cure .
Periodontal diseases: diseases
which affect periodontium.
Periodontium : tissues which
surround and support the
Etiology of Periodontal Diseases
Reparative tissue capacity
Factors upset the balance By
Increasing aggression of bacterial plaque
Local predisposing factors
1- Hormonal imbalance
2- Material alba
2- Nutritional deficiency
3- Food debris
4- Food impaction
5- Food retention
6- Faulty dentistry
8- Mouth breathing
9- Trauma from occlusion
* Overhanging filling
3- Blood diseases
* Over and under contoured crowns
* Occlusal disharmony
* Orthodontic wires
6- Metallic intoxication
* Rough fillings
7- Debilitating diseases
1- Removal of soft deposits (dental plaque, materia alba and
2- Gingival massage
keratinization and improve
protection against microorganisms
3- Prevention of calculus formation.
** 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
•Exert gentle vibratory pressure using short back-and-forth
motions without dislodging the bristles tips (horizontal
•Perform about 10-20 strokes in each position.
•Use a soft brush in this method.
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
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.
Powered Tooth Brushes
Useful for: Children, hand-capped, and patients
with orthodontics treatment.
Do not require
Place the brush head next to the tooth at the
gingival margin and proceed systematically
around the dentition.
Adverse effects of
Excessive brushing pressure.
Hard toothbrush bristles.
Gingival abrasion and recession
II- Interproximal Cleaning Aids:• 1- Dental Floss:
Effective for flat or convex proximal tooth surfaces with full
• 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.
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.
III- Oral Irrigation:•With water and antiseptic mouth rinses.
•Supra or sub-gingival irrigation.
•Hand or mechanized irrigation.
Chlorhexidine:* The most effective antimicrobial agent in
•Mechanism of action:pellicle formation, alteration of
bacterial cell wall
lysis of bacteria and
adhesion to tooth surfaces.
• Has not produced any resistance of oral microorganisms.
•Substantivity: high Substantivity.
•Side effects:- Staining of teeth , tongue and resin
- Alter taste sensation (temporary).
•Dose: 0.2%- 0.12% mouth washes Twice/day.
2- Essential Oils
plaque and gingivitis.
•Mechanism of action: alter bacterial cell wall &
Burning sensation, Bitter taste.
•Used twice daily.
H2 O 2
- Anticarious more than
- Derived from bl. Root
- 0.01% mouthwashes and
-No benefits on
plaque, used in
•Abrasive agent e.g. calcium carbonate, calcium oxide
•Detergent agent e.g. sodium lauryl sulfate.
•Thickening agent: carboxymethyl cellulose and amylase.
•Humidifier and water.
•Anticalculus agents e.g. zinc citrate, soluble pyrophosphates.
•Antiplaque agents e.g. chlorhexidine and triclosan.
•Antibiotics eg. Pinicillin.
Active ingredient agent of dentifrices.
Is a synthetic phenol derivative in a nonionic
Compatible with other components of
The formulation used in toothpaste contains
0.3% triclosan with 2% copolymer(added to
substantivity of antimicrobial).
Antiplaque activity for at least 12 hours.
Necessary to control the
Is an example of secondary
Scaling: removal of hard deposits
on the tooth.
Root planing: removal of necrotic
Curettage: removal of necrotic
Antimicrobial Adjunct Therapy
Systemic Delivery of Antibiotics.
Local Delivery of Antibiotics.
POLISHING (Oral Prophylaxis)
•Upon the completion of Scaling & root
planing, you should polish the teeth when it
GOAL OF POLISHING
To remove soft
extrinsic stain with
minimal trauma to
hard and soft
tissues and minimal
•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.