All of my Lectures are based on information purposes.
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Basically for 4th BDS Professional Year.
Furcation involvement is a common sequela of severe chronic periodontal disease. Its effective management has a profound influence on the outcome of periodontal therapy.
Aberrant Frenum !!
No worries... When Frenectomy is here.
Hello Periodontists,
Here's the entire process of Frenectomy in a nutshell and various ways to encounter the same.
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Phase I periodontal therapy is the first in the chronologic sequence of procedures that constitute periodontal treatment. It is also referred to as cause related therapy or non-surgical periodontal therapy.
Furcation involvement is a common sequela of severe chronic periodontal disease. Its effective management has a profound influence on the outcome of periodontal therapy.
Aberrant Frenum !!
No worries... When Frenectomy is here.
Hello Periodontists,
Here's the entire process of Frenectomy in a nutshell and various ways to encounter the same.
Lets Shoot ...
Phase I periodontal therapy is the first in the chronologic sequence of procedures that constitute periodontal treatment. It is also referred to as cause related therapy or non-surgical periodontal therapy.
In periodontology, classifications are widely used to categorize defects due to periodontitis according to their etiology, diagnosis, treatment and prognosis.
Several classifications have been proposed in the literature in order to facilitate the diagnosis of gingival recessions.
The defense mechanism of gingiva includes GCF, Saliva, epithelial barrier and connective tissue cells. All these protect the periodontium from bacterial invasion.
Epidemiology of gingival & periodontal diseasesChetan Basnet
It is the “study of the distribution and determinants of health related states or events in a specified population, and the application of this study to control of health problems.”
-John M. Last(1988)
In periodontology, classifications are widely used to categorize defects due to periodontitis according to their etiology, diagnosis, treatment and prognosis.
Several classifications have been proposed in the literature in order to facilitate the diagnosis of gingival recessions.
The defense mechanism of gingiva includes GCF, Saliva, epithelial barrier and connective tissue cells. All these protect the periodontium from bacterial invasion.
Epidemiology of gingival & periodontal diseasesChetan Basnet
It is the “study of the distribution and determinants of health related states or events in a specified population, and the application of this study to control of health problems.”
-John M. Last(1988)
clinical assessment and treatment of oral malodour and halitosis.
includes microorganisms causing halitosis, volatile sulphur compounds and its relation to periodontal destruction.
Breath malodor has important socioeconomic consequences and can reveal important diseases. A proper diagnosis and determination of the etiology allow initiation of the proper etiologic treatment.
Halitosis is derived from a Latin word which means unpleasant breath. If not treated, it could affect your social life. Majority of the cases of halitosis have oral origin. Therefore, appropriate dental treatment eliminates the cause.
Chronic periodontitis, formerly known as “adult periodontitis” or “chronic adult periodontitis” is the most prevalent form of periodontitis.
Chronic periodontitis has been defined as “an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss”.
This definition outlines the major clinical and etiological characteristics of the disease:
Microbial plaque formation.
Periodontal inflammation.
Loss of attachment and alveolar bone.
Flap surgery, also called pocket reduction surgery. Your periodontist makes cuts in your gums to carefully fold back the tissue. This exposes the tooth roots for more effective scaling and root planning. Because periodontitis often causes bone loss, the underlying bone may be reshaped before the gum tissue is stitched back in place. After you heal, it's easier to clean the areas around your teeth and maintain healthy gum tissue.
Soft tissue grafts. When you lose gum tissue, your gumline gets lower, exposing some of your tooth roots. You may need to have some of the damaged tissue reinforced. This is usually done by removing a small amount of tissue from the roof of your mouth or using tissue from another donor source and attaching it to the affected site. This can help reduce further gum loss, cover exposed roots and give your teeth a better appearance.
Bone grafting. This procedure is performed when periodontitis destroys the bone around your tooth root. The graft may be made from small bits of your own bone, or the bone may be made of artificial material or donated. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone.
Guided tissue regeneration. This allows the regrowth of bone that was destroyed by bacteria. In one approach, your dentist places a special type of fabric between existing bone and your tooth. The material prevents unwanted tissue from growing into the healing area, allowing bone to grow back instead.
Tissue-stimulating proteins. Another approach involves applying a special gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue.
Host modulatory therapy does not shut off the normal defence mechanism of inflammation instead, they ameliorate excessive or pathologically elevated inflammatory process to enhance the opportunities for wound healing and periodontal stability.
Pharmacological agents are used to stop the progression of periodontitis by intervention of the pathogenic mechanism.
It is used as an adjunct with conventional periodontal disease treatment.
It offers the opportunity for modulating or reducing destruction by treating chronic inflammatory response.
The concept was introduced by William and Golub in 1990.
Initially adjunctive therapies were solely anti-microbial such as use of antibiotics and antiseptics.
New approaches include modulation of host response.
Host modulatory therapy is considered as a BENCH-MARK in the treatment of patients with periodontal diseases.
Also, Useful in the following patients :
Diabetes & immunocompromised situations
peri-implant dis-ease (local and systemic efficiency of host modulatory therapy are used as an adjunct to conventional local disinfection treatment)
Although the efficacy and usefulness of host modulating agents have improved the treatment in several folds still, more research is required to make treatment response faster and to increase periodontal stability.
In the 18th century CAROLUS LINNAEUS called Carl von Linné, revolutionized the field of natural history by introducing a formalized system of naming organisms, what we call a taxonomic nomenclature.
He divided the natural world into 3 kingdoms and used five ranks : Class, Order, Genus, Species & Variety.
FROM 1977 TO 1989, THE AMERICAN ACADEMY OF PERIODONTOLOGY (AAP) WENT FROM 2 MAIN PERIODONTAL DISEASE CATEGORIES TO 5.
The 1989 Classification Had It’s Short-comings Including :
Lack of a category for strictly gingival diseases
Overlap between disease categories
Difficulty in fitting certain patients into any of the existing categories.
Similarity of microbiological and host response features.
A New Periodontal Disease Classification System Was Recommended By The 1999 International Workshop For A Classification Of Periodontal Disease And Conditions.
Periodontal abscesses, combined periodontic-endodontic problems, mucogingival deformities and occlusal trauma all remain unchanged except that they have been ordered in the classification system.
NUG and NUP were combined under the category of necrotizing periodontal diseases with no changes to their definitions.
One of the most significant changes included the addition of a detailed section on gingival diseases and lesions. Another important change was the discontinuation of terms related to age of presentation and rate of progression of the diseases.
The criteria for chronic periodontitis remain similar to those used for adult periodontitis but the age-dependent terminology has been removed.
All syndromes and systemic diseases which predispose a patient to periodontal disease would be classified under the category of “PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASE”
Refractory periodontitis (low plaque scores and low responsiveness to periodontal therapy) is no longer considered a specific disease.
The 1999 classification system has been approved by the AAP, is now official terminology for that organization, and will be used in accredited graduate periodontal programs and board examinations.
The Parameters of Care approved by the AAP have adopted the new classification and future publications will use it as their standard. Since many of the 1999 workshop participants were from Europe and Asia as well as North America, it is anticipated that the proposed classification will be adopted in most parts of the world.
All of my Lectures are based on information purposes.
It is based on the viva explanation and understanding basis.
Basically for 4th BDS Professional Year.
All of my Lectures are based on information purposes.
It is based on the viva explanation and understanding basis.
Basically for 4th BDS Professional Year.
A MAGNIFICENT ORTHODONTIC TREATMENT CAN BE DESTROYED BY POOR PERIODONTAL SUPPORT. EVALUATION AND MAINTENANCE OF PERIODONTAL HEALTH BEFORE, DURING AND AFTER TREATMENT IS VERY IMPORTANT.
Dr. Abhishek Gaur
BDS, MDS
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Dental Calculus: Short Presentation
Dr. Abhishek Gaur
BDS, MDS
Some of the slides may appear Blank/White/Black, those are the Videos that I added in the presentation.
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Dr. Abhishek Gaur
BDS, MDS
Some of the slides may appear Blank/White/Black, those are the Videos that I added in the presentation.
Kindly Ignore those slides.
Reconstructive periodontal therapy
Some of the slides may appear Blank/White/Black, those are the Videos that I added in the presentation.
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Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
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The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
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2. Oral Malodour
Dr. Abhishek Gaur
BDS, MDS, (Ph. D.)
Periodontist & Implantologist
R. R. Dental College & Hospital
Umarda, Udaipur (RAJ.)2
Oral Malodour
3. Breath odor can be defined as the subjective perception
after smelling someone’s breath.
• It can be pleasant, unpleasant or even disturbing.
Synonyms:
• Breath malodor
• Halitosis
• Bad breath,
• Fetor ex ore
Carranza (11th edition)
Breath malodor means an unpleasant odor of the expired
air, whatever the origin may be.
Jan Lindhe (4TH edition)3
4. Halitosis is derived from:
• The Latin word “Halitasia” --bad breath
• The Greek word “Osis” -- disease or condition
• Halitosis, also termed fetor ex ore, fetor oris, and
oral malodor, is foul or offensive odor emanating
from the oral cavity.
Carranza (9th edition)
3rd most frequent reason for seeking dental aid,
following tooth decay and periodontal disease.
(Loesche W J et al 2002)
4
5. Classification
ADA classification based on the etiological
pathways involved :
Extrinsic pathways - Tobacco, alcohol and foods
like onions, garlic and certain spices.
Intrinsic pathways – Oral origin (90 %)
– Systemic origin (10 %)
5
6. Classification based on the origin of halitosis:
1. Due to local factors of Pathological origin.
2. Due to local factors of Non-pathological origin
3. Due to systemic factors of Pathological origin
4. Due to systemic factors of Non-pathological
origin
5. Due to systemic administration of Drugs
6. Due to xerostomia.
(Dominic 1982)
6
7. Etiology
90% of breath malodor originates from the oral cavity. Gingivitis ,
periodontitis and special tongue coating are the predominant causative
factors. The remaining 10% has systemic or local causes.
In general, one can identify two pathways for bad breath, the first one
involves an increase of certain metabolites in the blood circulation (due
to the systemic disease), which will escape via the alveoli of the lungs
during breathing.
And, the second pathways involves an increase of either the bacterial
load of the amount of substrates for these bacteria at one of the lining
surfaces of the oropharyngeal cavity, the respiratory tract, or the
oesophagus.
7
8. For oral malodor, the unpleasant smell of the breath mainly
originates from VSCs (volatile sulphur compounds)
especially hydrogen sulphide, methyl mercaptan and less
important dimethyl-sulphide.
-however in certain condition, indole, skatole and volatile
organic acids like butyric or propionic acid.
Most of these compounds results from the proteolytic
degradation by oral micro-organisms of peptides present in
saliva, interdental plaque, postnatal drip, and blood.
For the extra oral cases other than VSCS may be involved,
which has not been identified yet.
8
12. Fundamentals/
Physiology of malodor
detection
Breath of a person contains up to 150 different molecules.
Perception of the molecules depends on the following factors:
1. Olfactory response (odor of molecule)
2. Threshold concentration (conc. at which it can be detected)
3. Odor power (conc. to increase it score by one limit)
4. Volatility (express when they become volatile)
5. Substantivity (capacity to stay present)
12
Fundamentals/
Physiology of malodor
detection
13. Diagnosis of Malodor
1. History taking and medical questionnaire
2. Clinical and Laboratory Examination
3. Self-Examination
4. Oropharyngeal Examination
5. Organoleptic Rating
6. Portable Volatile Sulfur Monitor
7. Gas Chromatography
8. Dark-Field or Phase-Contrast Microscopy
9. Saliva Incubation Test
10.Electronic Nose
11.Chair-Side Test 13
Diagnosis of Malodor
14. MEDICAL HISTORY
•Proper diagnostic approach should starts with
a thorough questioning about the medical
history and about all the relevant pathologies
for breath malodor.
•Patient history should be discretely and
intermittently noted.
14
15. Clinician should ask about the:
1.Frequency (eg.every month).
2.Time of appearance during the day(eg.after meal
indicate the stomach hernia)
3.Time when the problem first appeared.
4.Whether others (non-confidants) have identified the
problems(to exclude imaginary breath odor).
5.Which medications are taken and whether there are
possible contributing factors such as mouth breathing,
dry mouth ,allergies and nasal problems.
15
17. SELF EXAMINATION
It is done when intra-oral cause has been determined.This can
motivate the patient to continue the oral hygiene instructions.
Following self testing can be used:
•Smelling a metallic or non odorous plastic spoon after
scraping the back of the tongue.
•Smelling a toothpick after introducing it in an interdental
area.
•Smelling saliva spit in a small cup or spoon.
•Licking the wrist and allowing it to dry.
17
18. OROPHARNGEAL EXAMINATION
1.Inspection of deep carious lesion.
2.Interdental food impaction.
3.Wounds.
4.Bleeding of gums.
5.Periodontal pockets.
6.Tongue coating.
7.Dry mouth.
8.Tonsils and pharynx for tonsillitis and pharyngitis.
18
19. ORGANOLEPTIC
RATING
“Gold standard” in the examination of breath odor. Easiest
and most often used method assets by judge. In an
organoleptic evaluation ,a trained and preferably calibrated
judge sniffs the expired air and assesses whether it is
unpleasant by using an intensity rating, normally from 0 to 5,
as proposed by Rosenberg and McCulloch.It is thus solely
based on the olfactory organs of the clinician.
19
21. The judge smells a series of different air samples as follows:
1) Oral cavity odor
2) Breath odor
3) Saliva
4) Tongue coating
5) Nasal breath odor 21
22. The specific character of odor can provide additional information
such as:
The smell of sulphur can be indicated for an intra-oral origin of
halitosis.
The smell of sulphur can however also point out to liver disease
(accumulation of ketones).
The smell of rotten apples has been associated with unbalance
insulin-dependent diabetes, which leads to the accumulation of
ketones.
A “fish odor” can suggest kidney insufficiency characterised by
uraemia and accumulation of di-methylamine and tri-
methylamine.
22
23. Portable Volatile Sulfur Monitor
The portable volatile sulphur monitor (Halimeter) is an electronic device that
analyses the concentration of hydrogen sulphide and methyl mercaptan but
without discriminating them.
• The mouth air is aspirated by inserting a drinking straw fixed on the flexible
tube of the instrument.
• The straw is kept about 2cm behind the lips, without touching any surfaces,
while the subject keeps the mouth slightly open and breathes through the
nose.
• The sulphur meter uses a volta-metric sensor that generates a signal when
exposed to sulphur-containing gases.
• Readings-
• Absence of breath malodor: 150 ppb or less.
• Elevated concentrations of VSCs: 300-400 ppb.
• Using a recorder or specific software, a graphic presentation can be obtained,
called a haligram. 23
25. Advantages-
• Easy to use as a chair side test.
• Relatively inexpensive.
• Patients are usually less embarrassed.
• Absence of odor in case of halitophobia can be more convincingly
proven.
Drawbacks-
• It detects only sulphur compounds and thus is used only for intra-oral
causes of halitosis.
• It has no specificity and thus cannot discriminate among the different
sulphur compounds.
• The sensitivity for methyl-mercapton is very low (5 times lower than
for hydrogen sulphide) and is almost insensitive to dimethyl sulphide.
• Ethanol and other compounds can disturb the measurement.
25
26. Gas Chromatography
It can analyse air, saliva, or crevicular fluid for different chemical
compounds present in
them.
Advantage-
• It can detect virtually any compound when using adequate materials and
conditions.
• It has a very high sensitivity and specificity.
• Useful for identifying non-oral causes of breath malodor.
Drawbacks-
• Only available in specialised centres.
• Expensive.
• Needs trained personnel. 26
28. Oral Chroma (Portable “Gas
Chromatograph”)
It is a recently introduced device for periodontal clinics.
It has a capacity to measure the concentration of 3 key sulphur compounds:-
• Hydrogen sulfide.
• Methyl-mercaptan.
• Dimethyl sulphide.
This can be helpful in differential diagnosis:
• High concentration of methyl-mercaptan compared to hydrogen sulphide-
periodontitis.
• Only hydrogen sulphide is increased- oral hygiene problem.
• Dimethyl sulphide- extra-oral causes.
Drawback- Cannot detect other than sulphur compounds and some intra-oral and
extra-oral causes can thus be overlooked. 28
31. General treatment strategies
1.Masking malodor.
2.Mechanical reduction of intra-oral nutrients (substrates) and
microorganisms.
3.Chemical reduction of oral microbial load.
4.Rendering malodorous gases non volatile.
Masking malodor
Treatment with rinses, mouth sprays and lozenges containing volatile with a
pleasant odor have only a short term effect.
Examples are:
• Mint containing lozenges.
• Aroma present in rinses. 31
32. Another pathway is to increase
the solubility of malodorous
compounds in saliva by
increasing secretion of saliva
which can be achieved by
chewing gum.
32
33. Mechanical reduction of intra-oral
nutrients and microorganism
• Because of extensive accumulation of bacteria on the dorsum of tongue,
cleaning of tongue should be emphasised.
• Previous investigation demonstrated that tongue cleaning reduces both
amount of coating s well as number of bacteria and thereby improves
oral malodor effectively.
• Cleaning of tongue can be carried out with normal toothbrush but
preferably with a tongue scraper if coating is established.
• Tongue cleaning using tongue scraper reduces halitosis level 75% after1
week.
• It is best to clean as backward as possible as posterior portion has most
coating. 33
34. Chemical reduction of oral
Microbial load
Chlorhexidine
Most effective anti-plaque and anti-gingivitis agents.
Mode Of Action :
•Disruption of bacterial cell membrane
•Increase in permeability
•Cell lysis and then death
Because of its strong antibacterial effect and superior substantivity in oral
cavity, it provides significant reduction VSCs level and organoleptic rating.
But unfortunately, it at concentration greater than 0.2% causes increased tooth
and tongue staining, bad taste and temporary reduction on taste sensation.34
35. Other chemical Methods
are :
•Essential oils
•Chlorine dioxide : Is powerful oxidising agent
•Aminefluoride/stannous fluoride
•Hydrogen peroxide
•Oxidising lozenges
•Baking soda 35