This document discusses periodontal health, gingivitis, and periodontitis. It defines a periodontally healthy patient as having no bleeding, erythema, edema, clinical attachment loss, or bone loss. Gingivitis is diagnosed when 10% or more sites have bleeding upon probing with pocket depths less than 3.5mm. Periodontitis involves loss of alveolar bone. Treatment planning involves controlling calculus and biofilm, eliminating retentive factors, and subgingival instrumentation to reduce inflammation. For residual pockets between 3.5-5.5mm, repeated instrumentation with antiseptics like chlorhexidine is recommended, while pockets over 5.5mm may require surgery.
Treatment of Gingival Enlargement (2).pptpayampayamy1
Treatment of Gingival Enlargement
Chronic Inflammatory Enlargement
Characterized by: soft gingival tissues, altered gingival color, usually caused by edema and cellular infiltration.
Therapy: SRP to remove deposits
when there is a significant fibrotic component that does not undergo shrinkage after SRP, or if the extent of GO is so severe that access to the deposits on the tooth surface is impossible, surgical removal is the treatment of choice.
The long-term preservation of the dentition is closely associated with the frequency and quality of recall maintenance. The therapist should use risk assessment and educate the patient on the need for periodontal maintenance. Supportive periodontal therapy is a lifetime effort to prevent the disease from recurring. Patients who do not return for supportive periodontal therapy lose more teeth than compliant patients.
Periodontitis is a chronic, slowly progressing disease which mainly results in the destruction of tooth supporting apparatus. Earlier it was classified as Chronic and Aggressive periodontitis with different clinical features and etiology. Current classification ( 2017) of periodontal disease involves periodontitis with is further divided into 4 stages and 3 grades depending on severity and rate of disease progression respectively. Diabetes meelitus and smoking are the validated risk factors for the progression of periodontitis.
Treatment of Gingival Enlargement (2).pptpayampayamy1
Treatment of Gingival Enlargement
Chronic Inflammatory Enlargement
Characterized by: soft gingival tissues, altered gingival color, usually caused by edema and cellular infiltration.
Therapy: SRP to remove deposits
when there is a significant fibrotic component that does not undergo shrinkage after SRP, or if the extent of GO is so severe that access to the deposits on the tooth surface is impossible, surgical removal is the treatment of choice.
The long-term preservation of the dentition is closely associated with the frequency and quality of recall maintenance. The therapist should use risk assessment and educate the patient on the need for periodontal maintenance. Supportive periodontal therapy is a lifetime effort to prevent the disease from recurring. Patients who do not return for supportive periodontal therapy lose more teeth than compliant patients.
Periodontitis is a chronic, slowly progressing disease which mainly results in the destruction of tooth supporting apparatus. Earlier it was classified as Chronic and Aggressive periodontitis with different clinical features and etiology. Current classification ( 2017) of periodontal disease involves periodontitis with is further divided into 4 stages and 3 grades depending on severity and rate of disease progression respectively. Diabetes meelitus and smoking are the validated risk factors for the progression of periodontitis.
Mandibular Third Molar Surgery in Patients with Oral Submucous Fibrosis: Mana...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This presentation focusses on definition, history, goals and objectives of SPT, patient compliance, ways to improve patient's compliance, parts of SPT, SPT in daily practice, classification of post treatment patients, AAP Guidelines for periodontist and dentist and studies related to SPT.
Abstract
Focused Clinical Question: Debates and questions related to the newly developed two-vector system
for classification of periodontal diseases have emerged as to how to accurately assign stage and grade
to the periodontitis cases. The aim of the present manuscript is to demonstrate the essential thought
processes that are needed in utilizing the new periodontitis classification system to diagnose two gray
zone cases.
Summary: Clinical case 1 includes an 83-year old patient diagnosed with periodontitis and classified as
Generalized Stage III Grade B periodontitis, while clinical case 2 , a 73-year old male was classified as
presenting Generalized Stage IV Grade B periodontitis. Although clinical and radiographic evaluations
revealed similarities between the cases, the thought process that includes clinical judgement is
described to guide a more accurate diagnosis following the guidelines of the new classification
system.
Conclusion: The two cases demonstrated here offer an opportunity for clinicians to recognize the
essential role of sound clinical judgment in certain cases when applying the new periodontal disease
classification system and also to clarify questions emerging from implementing this classification
system.
Key words: Staging and grading of periodontal diagnosis, Periodontal Diseases, Periodontal Diagnosis,
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2. WHAT ARE WE GOING TO UNDERSTAND ?????
2
WHO IS A PERIODONTALLY
HEALTHY PATIENT?
WHAT IS GINGIVITIS,
PERIODONTITIS
TREATMENT PLANNING OF
PATIENT
3. CLINICAL GINGIVAL HEALTH
The lack of bleeding upon probing, erythema,
edema, clinical attachment,
and bone loss define clinical gingival health.
3
4. GINGIVITIS
• presence of ≥10% bleeding sites with PDs ≤3.5 mm in the oral
cavity has been adopted as an objective criteria
• primarily a clinical diagnosis, radiographs have no role in
diagnosing a case of gingivitis, as there is no involvement of
alveolar bone
9. Guidelines for treatment
Controlling calculus, subgingival biofilm- goal of the treatment.
Retentive factors- by the tooth’s architecture or, more frequently,
by insufficient restorative margins, should be eradicated to reduce
their detrimental effects on periodontal health.
They frequently induce gingival inflammation and/or the loss of
periodontal attachments.
Subgingival instrumentation removes hard and soft deposits from
the tooth surface in an effort to reduce soft-tissue inflammation.
10. It is therefore recommended using either manual or powered
(sonic/ultrasonic) tools, either separately or in combination, for
subgingival periodontal instrumentation
A traditional quadrant-wise or complete mouth delivery of
subgingival periodontal instrumentation can be accomplished
within 24 hrs
No evidence related to need for an adjunct drug for gingivitis
unless medically compromised.
11. The residual pocket depth after Step 1 of Phase I therapy determines further
line of treatment and shifting the step 2 of phase I therapy.
If end-point of treatment is achieved, the patient is shifted to SPT (Phase III)
If the PD is more than 3.5 mm with BOP, Step 2 of Phase I should be initiated
On re-evaluation, after Step 1 of Phase I therapy, the treatment options can be
divided on the basis of residual pocket depth
Residual pocket is 3.5-5.5 mm
Residual pocket is more than 5.5 mm.
12. Treatment options in case with residual pocket depth is in
between 3.5-5.5 mm.
Repetitive subgingival instrumentation in adjunct with short-
term use of chemotherapeutics (antiseptics)
chlorhexidine mouthwashes is indicated
Specific systemic antibiotics as an adjunctive may be considered
for specific patient category for example generalized
periodontitis in young adult patients
13. The treatment options in case with residual pocket depth is
more than 5.5 mm
These categories of patients are treated under surgical phase.
In order to reduce the inflammation, patients with pocket depth of more than
5.5mm may be subjected to Step 2 of Phase I therapy, as subgingival
instrumentation may be used as presurgical procedure to reduce
inflammation.
14. Surgical treatment, although indicated, may not be feasible due
to uncontrolled diabetes or patients with CVS disorders, age
factors, patient’s apprehensions, economic factors and post
treatment recurrence.
In such cases, shifting the patient to Phase II may not be possible
Such patients where surgery is indicated but cannot be
undertaken, are maintained by implementing Step 2 of Phase I
therapy by repeated use of subgingival instrumentation in
adjunct with short-term use of chemotherapeutics (antiseptics),
notably chlorhexidine mouthwashes