Every periodontal surgical procedure has its own indications. With proper knowledge of the etiology of the disease, correct diagnosis and treatment planning, the clinician is able to draw predictable success with periodontal flap surgery.
Bone loss and patterns of bone destructionvidushiKhanna1
- introduction
- bone resorption
- factors causing bone destruction in periodontal disease
-- destruction by extension of gingival inflammation
--- histopathology
--- pathways of spread of inflammation
--- radius of action
--- periods of destruction
---- mechanism of destruction
-- bone destruction caused by TFO
-- bone destruction caused by systemic disorders
- factors determining bone morphology in periodontal disease
-- normal variation of alveolar bone
-- exostosis
-- butressing bone formation
-- food impaction
-- agressive periodontitis
- patterns of bone destruction
-- horizontal bone loss
-- vertical or angular defects
-- osseous craters
-- bulbous bone contours
-- reversed architecture
-- ledges
- furcation involvement
-- classification
-conclusion
Periodontitis is a complex infection initiated by bacteria –tissue destruction.
Host: the organism from which a parasite obtains its nourishment/ an individual who receives a graft
Modulation: the alteration of function or status of something in response to a stimulus or an altered physical or chemical environment
Definition of periodontal pocket, classification, Histopathology of periodontal pocket, microflora involved, pathogenesis, periodontal pocket as a healing lesion, microtopography of root surface, treatment of periodontal pocket
A brief description of all topics to recent advances,SDD, host modulation and diabetes, host modulation in smokers, chemically modified tetracyclines, bisphosphonates
Carranza 2015, 12th edition, Chapter 20, The Periodontal PocketMostafa Montazeri
Carranza's Clinical Periodontology, 12th edition, Chapter 20, The Periodontal Pocket
The periodontal pocket, which is defined as a pathologically deepened gingival sulcus, is one of the most important clinical features of periodontal disease. ....
The defense mechanism of gingiva includes GCF, Saliva, epithelial barrier and connective tissue cells. All these protect the periodontium from bacterial invasion.
Every periodontal surgical procedure has its own indications. With proper knowledge of the etiology of the disease, correct diagnosis and treatment planning, the clinician is able to draw predictable success with periodontal flap surgery.
Bone loss and patterns of bone destructionvidushiKhanna1
- introduction
- bone resorption
- factors causing bone destruction in periodontal disease
-- destruction by extension of gingival inflammation
--- histopathology
--- pathways of spread of inflammation
--- radius of action
--- periods of destruction
---- mechanism of destruction
-- bone destruction caused by TFO
-- bone destruction caused by systemic disorders
- factors determining bone morphology in periodontal disease
-- normal variation of alveolar bone
-- exostosis
-- butressing bone formation
-- food impaction
-- agressive periodontitis
- patterns of bone destruction
-- horizontal bone loss
-- vertical or angular defects
-- osseous craters
-- bulbous bone contours
-- reversed architecture
-- ledges
- furcation involvement
-- classification
-conclusion
Periodontitis is a complex infection initiated by bacteria –tissue destruction.
Host: the organism from which a parasite obtains its nourishment/ an individual who receives a graft
Modulation: the alteration of function or status of something in response to a stimulus or an altered physical or chemical environment
Definition of periodontal pocket, classification, Histopathology of periodontal pocket, microflora involved, pathogenesis, periodontal pocket as a healing lesion, microtopography of root surface, treatment of periodontal pocket
A brief description of all topics to recent advances,SDD, host modulation and diabetes, host modulation in smokers, chemically modified tetracyclines, bisphosphonates
Carranza 2015, 12th edition, Chapter 20, The Periodontal PocketMostafa Montazeri
Carranza's Clinical Periodontology, 12th edition, Chapter 20, The Periodontal Pocket
The periodontal pocket, which is defined as a pathologically deepened gingival sulcus, is one of the most important clinical features of periodontal disease. ....
The defense mechanism of gingiva includes GCF, Saliva, epithelial barrier and connective tissue cells. All these protect the periodontium from bacterial invasion.
The presentation three main topics :
- The clinical features of gingivitis.
- Extension of inflammation from the gingiva in the supporting perodontal tissue.
- Chronic periodontitis
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
8. • According to location & distribution:
Localized: limited to gingiva adjacent to single tooth
or group of teeth.
Generalized: involving gingiva throughout mouth
Marginal: confined to marginal gingiva
Papillary: confined to interdental papilla
Diffuse: involving marginal, attached & papillae
Discrete: an isolated sessile or pedunculated tumor
like enlargement
9.
10. • According to degree of gingival
enlargement:
Grade 0: no signs of gingival enlargement
Grade I: enlargement confined to inderdental
papilla
Grade II: enlargement involves papilla & marginal
gingiva
Grade III: enlargement covers three quarters or
more of the crown
11.
12. Chronic inflammatory enlargement:
• Clinical features:
• Originates as a slight ballooning of interdental papilla &
marginal gingiva
• Produces bulge around involved teeth
• Bulge increases in size until it covers part of
crown
• Painless
• Occasionally occurs as discrete sessile or
pedunculated mass resembling a tumor
• May be interproximal, marginal or attached
gingiva
• Slow growing mass
• Painful ulceration sometimes occur
14. • Etiology:
Prolonged exposure to dental plaque. Factors that
favor plaque accumulation & retention include poor
oral hygiene, Irritation by anatomic abnormalities &
improper restortative & orthodontic appliances.
15. Acute inflammatory enlargement:
• Gingival abscess:
o Clinical features:
• Localized, painful, rapidly expanding lesion that
usually has a sudden onset.
• Generally limited to marginal or interdental gingiva
• In early stage, appears as red swelling with smooth,
shiny surface
• Within 24-48 hrs, lesion becomes fluctuant &
pointed with surface orifice from which purulent
exudates may be expressed.
• Adjacent teeth is often sensitive to percussion
• If permitted to progress, lesion generally ruptures
spontaneously
16. Gingival abscess on facial gingival surface, in space
between cuspid & lateral incisor,unrelated to gingival
sulcus area.
17. o Etiology:
Bacteria carried deep into the tissues when a foreign
substance( e.g. toothbrush bristle, piece of apple core
etc) is forcefully embedded into gingiva
19. Drug induced gingival
enlargement:
• Clinical features:
Growth starts as a painless, bead like enlargement of
interdental papilla & extends to the facial and lingual
gingival margins
Marginal & papillary enlargements unite and may
develop into a massive tissue fold covering
considerable portion of the crowns
20.
21. • When uncomplicated by inflammation, the lesion is
mulberry shaped, firm, pale pink and resilient with a
minutely lobulated surface and no tendency to bleed
• Appears to project from beneath gingival margin
• Usually generalized but more severe in maxillary &
mandibular anterior teeth
• Occurs in areas in which teeth are present, not in
edentulous spaces
• Drug induced enlargement may occur in mouths with
little or no plaque & may be absent in mouths with
abundant deposits.
23. • Idiopathic gingival enlargement:
• Designated by such terms as gingivostomatitis,
elephantiasis, idiopathic fibromatosis, hereditary
gingival hyperplasia
• Clinical features:
• Affects attached gingiva as well as gingival margin &
interdental papillae
• Facial & lingual surfaces of mandible & maxilla are
generally affected
• Enlarged gingiva is pink, firm & almost leathery in
consistency
• Has a characteristic minutely pebbled surface
24. Idiopathic gingival enlargement in 14 year old white male pt.
A,facial view;gingiva is firm with nodular,pebbled surface &
partially covers crowns of teeth.B, occulual view
25. • Enlargement associated with systemic
disease or conditions:
• These disease and conditions affect the
periodontium by two different mechanisms:
• Magnification of an existing inflammation initiated
by dental plaque (conditioned enlargement)
• Manifestation of systemic disease independently of
the inflammatory status of gingiva (neoplastic
enlargement)
26. • Conditioned enlargement:
• Bacterial plaque is necessary for the initiation of this
type of enlargement.
• Three types of conditioned enlargements are
Hormonal (pregnancy, puberty)
Nutritional (associated with Vitamin C deficiency)
Allergic
27. • Enlargement in pregnancy:
• May be marginal & generalized or may occur as a
single or multiple tumor like masses
• During pregnancy, there is increase in levels of
progesterone & estrogen.
• These hormonal changes induce changes in vascular
permeability, leading to gingival edema & increased
inflammatory response to dental plaque.
28. • Marginal enlargement:
• Clinical features:
• Results from aggravation of previous inflammation
• Usually generalized
• More prominent interproximally than on facial
&lingual surfaces
• Enlarged gingiva is bright red or mageneta, soft &
friable & has smooth, shiny surface
• Bleeding occurs spontaneously or on slight
provocation
29. • Tumor like gingival enlargement:
o Clinical features:
• Also called pregnancy tumor
• Inflammatory response to bacterial plaque
• Appears after 3rd month of pregnancy, may occur
earlier
• Appears as mushroom like, flattened spherical
mass that protudes from gingival margin
• Dusky red, smooth, glistening surface
• Usually painless
30. Enlargement in puberty:
o Clinical features:
• Appears in areas of plaque accumulation
• Occurs both in male & female adolescents
• It is marginal & inter-dental
• Characterized by prominent bulbous inter-
proximal papillae
• Often, only facial gingiva are enlarged
• Has all c/f associated with chronic inflammatory
gingival disease with distinction degree of
enlargement & recurrence in presence of relatively
scant plaque deposits
31. Enlargement in vitamin C deficiency:
o Clinical features:
• Generally included in classic description of scurvy
• Enlargement is marginal
• Gingiva is bluish red, soft& friable & has a smooth
shiny surface
• Hemorrhage occur either spontaneously or on slight
provocation
• Surface necrosis with pseudo membrane formation
32.
33. • Plasma cell gingivitis:
• Referred to as atypical gingivitis and plasma cell
gingivostomatitis
• Gingiva appears red, friable, sometimes granular &
bleeds easily;usually it does not induce a loss of
attachment
• Mild marginal gingival enlargement that extends to
attached gingiva
• An associated cheilitis & glossitis have been
reported.
• Thought to be allergic in origin, possibly related to
components of chewing gum, dentrifices or various
diet components.
34.
35. • Non-specific conditioned enlargement
(pyogenic granuloma)
Tumor like gingival enlargement that is
exaggerated in response to minor trauma
Similar to conditioned gingival enlargement seen
in pregnancy
Treatment consists of removal of the lesions plus
the elimination of irritating local factors.
Recurrence is about 15%
37. • Systemic diseases causing gingival
enlargement:
Leukemia:
o Clinical features:
• May be diffuse or marginal & localized or generalized
Gingiva is generally bluish red, has shiny surface,
friable , hemorrhagic
• Acute painful necrotizing ulcerative inflammatory
involvement may occur
• Pt may have simple chronic inflammation without
involvement of leukemic cells
• True leukemic enlargement occurs in acute leukemia,
sub-acute leukemia but seldom occurs in chronic
leukemia
39. • Neoplastic enlargement(gingival tumors):
Benign tumors of the gingiva:
o Fibroma:
arise from the gingival CT or from the periodontal
ligament.
Slow growing, spherical tumors that tend to be
firm & nodular, may be soft & vascular
Usually pedunculated
40. • The so-called giant cell fibroma contains
multinucleated fibroblasts
• In another variant, mineralized tissue(bone,
cementum like material) may be found called as
peripheral ossifying fibroma.
41. • Papilloma:
Benign proliferations of surface epithelium
Not all cases associated with HPV
Appear as solitary wart like or cauliflower like
protuberances
Small & discrete or broad, hard elevations with
minutely irregular surfaces
43. • Peripheral giant cell granuloma:
• Arise interdentally or from gingival margin
• Occur most frequently on labial surface, may be
sessile or pedunculated
• Smooth, regularly outlined masses to irregularly
shaped, multilobulated protuberances with surface
indentations
• Ulcerations of margin occasionally seen
• Painless,vary in size, may cover several teeth
• Firm or spongy,color varies from pink to deep red
or purplish blue
45. • Central giant cell granuloma:
Giant cell lesions arise within the jaws and
produce central cavitation
They occasionally create a deformity of jaws that
makes the gingiva appear enlarged
• Leukoplakia:
A white patch or plaque that does not rub off &
cannot be diagnosed as any other disease –WHO
Associated with use of tobacco. Other factors are
Candida albicans,HPV-16 & HPV-18 & trauma
Leukoplakia of gingiva varies in apperance from
grayish white, flattened, scaly lesion to thick
irregularly shaped keratinous plaque
46. Most leukplakias (80%) are benign; the remaining
20% aremalignant or pre-malignant
47. • Gingival cyst:
• Appear as localized enlargement that may involve
marginal & attached gingiva.
• Cysts occur in mandibular canine & premolar areas,
most often on lingual surface
• Painless
• Should be differentiated from lateral periodontal cyst
which arises within alveolar bone, adjacent to root &
is devepmental in origin.
49. • Malignant tumors of the gingiva:
o Carcinoma:
• Gingiva is not a frequent site of oral malignancy(6%
of oral cancers)
• Squamous cell Ca is the most common malignant
tumor of the gingiva
• May be exophytic, presenting as irregular
outgrowth, ulcerative, apperaing as flat erosive
lesions
50. • Malignant melanoma:
• Rare oral tumor that tends to occur in hard palate &
maxillary gingiva of older persons
• Usually darkly pigmented
• May be flat or nodular & characterized by rapid
growth & early metastasis
51. • Sarcoma:
• Fibrosarcoma, lymphosarcoma & reticulum cell
sarcoma of gingiva are rare
• Kaposi’s sarcoma occurs often occurs in oral cavity
of pts with AIDS, particularly in palate & gingiva
52. • False enlargement:
• Are not true enlargements of gingival tissues
• May appear as such as a result of increase in size of
underlying osseous or dental tissues
• Gingiva usually presents no abnormal clinical
features except massive increase in size of the area
o Underlying osseous lesions:
o Enlargement of bone sub adjacent to gingival area
occurs most often in tori & exostoses, can occur in
pagets disease, fibrous dysplasia, cherubism,
osteoma etc
o Gingival tissues can appear normal or may have
unrelated inflammatory changes
53. o Underlying dental tissues:
During various stage of eruption, particularly of
primary dentition, labial gingiva may show a
bulbous marginal distortion caused by
superimposition of bulk of gingiva on normal
prominence of enamel in gingival half of crown.
This enlargement called as developmental
enlargement.
This enlargement is physiologic & usually present
no problems
55. Introduction
• Treatment of gingival enlargement is based on
understanding of the cause and underlying
pathology changes.
56. Chronic inflammatory enlargement
• Chronic inflammatory enlargement, which are
soft and erythematous and are caused
principally by edema and cellular infiltration are
treated by scaling and root planning, provided
the size of enlargement doesnot interfere with
complete removal of deposit from the involved
tooth surfaces.
• When these inflammatory enlargement include
a fibrotic component ,surgical removal is the
treatment of choice.
57. Periodontal and gingival abscess
• Treatment options are:
1. Drainage through pocket retraction or
incision.
2. Scaling and root planning.
3. Periodontal surgery.
4. Systemic antibiotics.
5. tooth removal.
58. Drug induced gingival enlargement
• Treatment of drug induced gingival enlargement
should be based on the medication being used and
the clinical features of the case.
• First, discontinuing the drug of changing the
medication:
It is important to allow for 6-12 months to elapse
between discontinuation of the offending drug and
the possible resolution of gingival enlargement
before surgical intervention.
Alternative medications.
59. Contd.
Phenytoin-carbamazepine and valproic acid.
Nifedipine-44%, diltiazem-20%, and verapamil-4%
and other hypertensive.
Cyclosporin-tacrolimus.
Antibiotic azithromycin may aid in decreasing the
severity of cyclosporin induced gingival
enlargement.
60. Contd.
• Second, non-surgical treatment options:
Plaque control
Good oral hygiene and frequent professional
removal of plaque decreases the degree of
the gingival enlargement present.
• Third, surgical treatment:
Gingivectomy
Periodontal flap
62. Gingivectomy
• A surgical procedure in which gingival
pockets are eliminated by removal of
gingiva.
Principle of operation:
1. Continuous incision at 45 degree angle at
the base of the pocket
2. Sharp dissection of tissues in the inter-
dental areas
3. Smoothing of the incisal edge
4. Contouring of the gingival surface
63. 5. Scaling and root planning
6. Wound coverage
Instruments:
1. Mouth mirror and probe
2. Pocket Marker
3. Kirkland and Orban inter-dental
gingivectomy knife
4. Surgical blade
5. BP handle
67. STEPS IN SURGICAL
GINGIVECTOMY
• Start apical to point marking of the course
of periodontal pocket and is directed
coronally to a point between the base of
the pocket and the crest of the bone.
• The incision should be beveled at
approximately 45 degree to the tooth
surface to follow the normal festooned
pattern of the gingiva.
• Should not leave diseased pocket wall.
• The incision should pass completely
68. REMOVE RESECTED-GINGIVA
• Remove the marginal and inter-dental
gingiva starting from distal surface of last
tooth,detach gingiva at the line of incision
with the help of surgical hoes and scalers.
• Remove the granulation tissue
• The curettes are used for this purpose.
The curette is guided along the tooth
surface and under the granulation tissue.
69. • Remove calculus:
The remaining calculus and necrotic cementum
are to be removed using scalers and
curettes.Check each surface of every tooth for
calculus and soft tissue remnants.
Wash area several times with saline and cover
with gauze sponge.
• Place periodontal pack
After the bleeding is control and hemostatis
achieved,the gingivectomy wound is covered
with periodontal pack.
70. Periodontal flap
• A section of gingiva and/or mucosa
surgically separated from the underlying
tissue to provide visibility and access to
the bone and root surface.
71. Leukemic gingival
enlargement
• Bleeding and clotting times and platelet count of
the patient should be checked and the
hematologist consulted before the periodontal
treatment.
• The enlargement is treated by scaling and root
planning carried out in stages under topical
anesthesia.
• The initial treatment consists of gently removing
all loose accumulation with cotton pellets.
72. Contd.
• Progressively deeper scaling are carried
out at subsequent visits.
• Antibiotics are administered systemically
the evening before and for 48 hrs after
each treatment to reduce the risk of
infection.
73. Gingival enlargement in
pregnancy
• Treatment requires elimination of all local
irritants responsible for precipitating the
gingival changes in pregnancy.
• Marginal and interdental gingival
inflammation and enlargement are treated
by scaling and curettage.
• Treatment of tumor like gingival
enlargement consists of surgical excision
74. Contd.
• In pregnancy, the emphasis should be on :
1. Preventing gingival disease before it
occurs.
2. Treating existing gingival disease before
it worsens
75. Gingival enlargement in
puberty
• Gingival enlargement in puberty is treated
by performing scaling and curettage,
removing all sources.
• The use of escharotic drugs has been
recommended in the past for the removal
of gingival enlargement of irritation and
controlling plaque.
76. CONCLUSION
• Gingival enlargement are multi-factorial
and complex in nature,which may be in
response to various interaction between
host and environment.
• Gingival overgrowth considerably reduce
the quality of life and may result in serious
emotional and social problems hence the
prevention and treatment based on the
underlying the cause and underlying
pathologic changes.
77. • The treatment of gingival enlargement
depends on the type of clinical
enlargement encountered.
• In recent years, flap surgery have been
used more often to treat gingival
enlargement than gingivectomy.