The document provides oral hygiene instructions and information on periodontal disease signs and treatment in 3 paragraphs or less: 1) It outlines proper brushing and flossing techniques, including brushing at a 45 degree angle and using mouthwash for 30 seconds. 2) It describes signs of gingivitis and periodontal disease like bleeding gums and recession and ways to prevent diseases like reducing sugars. 3) It stresses brushing and flossing daily for 3-5 minutes, changing brushes every 3 months, and using mouthwash twice daily for oral hygiene.

1. ‫ |كلية الفارابي لطب األسنان والتمريض‬Alfarabi college |
The helper
in periodontics 2013
level 7 & 8
some basic info. Help you in the clinic
and the general knowledge in the
periodontology
✌My Friends ,
I made these papers to Facilitates you ,
To access the information quickly
And remember main info, in our course
I hope it benefit you
Osama almasry , level 8 28 / 2 / 2013
☂ Pepared by : Osama a. almasry
Course coordinator : Dr . khalid Azouni

2. Presenting the patient :
Mr| miss ( ) from Saudi arabia , and he ' she is 21 years old
He | she is a smoker , non smoker
The C.C " Chief complaint " is ….
His| her medical history :: Diabetes , hypertention , breathless , blood
disorder , medications , allergy , any abnormalities , etc ..
His | her Dental history :: last visit , oral hygiene , Bleeding , plaque , bad taste ,
Resto , ortho , scaling , etc
His | her habits are . . . .
The Diagnosis is :: Generalized marginal chronic gingivitis ,
Localized severe chronic periodontitis , etc ..
The G. prognosis is : Excellent , Fair , poor , Hopeless . etc ..
The treatment plan will be : non surgical treatment or sugrical
Supragingival scaling , or Subgingival scaling , root planning , etc
OHI : oral hygiene instructions
Follow up : After 4 - 6 weeks
re evaluation of the plaque , oral hygiene , codition of the gingiva , etc ..
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Denti | Signs
You have to tell your patient about these signs " it's Facilitates your treatment "

3. ❞The instruments ::
Scaling instruments :
☛Sickle scaler : to remove supragingival calculus
- two cutting edges " sharp pointed tip "
- straight shank to anterior and premolars teeth
- contra – angled shanks to posterior teeth
☛Curette : to remove subgingival calculus , root planning , removal of soft tissue
linning the pocket
- two cutting edge , not sharp pointed tip
- finer than scalers
Universal curette : Gracey " area specific " curette
- two cutting edge , one plane - one cutting edge , two plane
- blade not offset - blade offset
- 90 degree angle of blade - the terminal shank 70 degree
★ Method of application of Curette : Pull stroke ( UPWARD ) ★
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Gracey 1-2 , 3-4 | for anterior teeth
Gracey 5-6 | for anterior teeth and premolars
Gracey 7-8 , 9-10 | for posterior teeth ( Facial and lingual )
Gracey 11-12 | for posterior teeth ( mesial)
Gracey 13- 14 | for posterior teeth (distal )
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☛Chisel , Hoe , file scalers : to remove tenacious subgingival calculus and altered
cementum .
☛Ultrasonic : for scaling and cleansing tooth surface
and soft tissue wall of perio pocket
☛Cleaning and polishing instruments : rubber cup, brushes , dental tape
Air bowder abrasive system and prophy jet .
Rubber cup
Prophy jet
★ The most effective grasp for periodontal instruments :
Modified pen grasp

4. ❞The Gingiva
Normal ::
- pink - firm & resielient - knife edge – stippling - sulcus " 1-3 mm "
Gingivitis :: Periodontitis
- change In color to bluish red - Gingival inflammation
- edema - pocket - Furcation
- Round tip - bone loss " in X ray "
- loss of stippling - tooth mobility
- Bleeding on probe ! - tooth migration
★ Dental Plaque :
Is complex soft non calcified microbial deposit which accumulate on teeth , dentures ,
appliances
★ Materia alpa " same plaque but you can remove it by water " !
Lack the organized structure of plaque
★ Calculus :
Hard deposit form by mineralization of dental plaque and covered by un mineralized
plaque
Factors ☀ Local Factors of perio Diseases :::
" important in our sheets in hospital "
1 plaque and calculus
2 Iatrogenic factors " defects in Resto , improber denture , improber ortho "
3 Malocclusion 4 anatomical variation
5 Habits
" holding of nails , tooth pick biting , lip biting , thumb sucking , pipe smoke , Bruxism "
6 Food retention
7 mouth breathing " unknown cause but may due to dehydration "
8 Hypofuction teeth
Clenching thumb suck tooth pick malocclucion overhang hold nails
Tongue thrusing pipe smoking

5. ☀ Systemic factors of perio disease ::
1 Pregnancy 4 Abnormalities of endocrine system
2 Puberty 5 Weakened immune system
3 Diabetes 6 Smoking 7 Osteoporosis 8 Heart disease 9 Obesity
Medications can cause Gingival Disease ::
Anticonvulsant drug Hypertensive drug Immunosuppressive drug
phenytoin Nifidipine Cyclosporine
❞Pockets :
Pathologically deep gingival sulcus
Classifications :
A - Gingival pocket " psuedo pocket "
B - Periodontal pocket divided into ::
" suprabony pocket : bone loss horizontal
" intrabony pocket : bone loss vertical
Classification accord involved tooth surface :
* Simple pocket (A) * Compound Pocket (B)
* Complex Pocket ( C )
❞Gingival Recession :
Is exposure of root surface by apical shifting
Factors cause the Recession : age , inflammation , false brush , abnormal frenum , tooth malposition
❞Furcation involvement : BY Nabers probe
Is invasion of bifurcation and trifurcation of multi rooted teeth .
Grade 0 0 mm no furcation
^ Grade 1 1-3 mm
Grade 2 > 3 mm
surpassing half of buccolingual thic of tooth , not through and through
+ some interradicular bone attached
Grade 3 > 3 mm
Encompassing entire width of tooth , through and through + no bone attached
Grade 4 > 3 mm
Encompassing entire width of tooth , through and through + no bone attached
+ Gingival recession

6. ❞ Tooth mobility : Is loosening of tooth in socket
☀ Class 1
Slight mobility , up to 1 mm horizontal displacement " faciolingual direction "
☀ Class 2
Moderate mobility , greater than 1 mm horizontal displacement " faciolingual direction "
☀ Class 3
Severe mobility , greater than 1 mm horizontal displacement " faciolingual direction "
With vertical displacement
~ Horizontal mobility " Exam it by tow dental instruments on either side "
| Vertical mobility " Exam it by end of instrument handle "
Factors cause the mobility :
Loss of support , Trauma , inflammation , perio surgery , sometimes pregnancy , use of contraceptive ,
Associated with menstrual cycle
❞Gingival index :
0 normal
1 sign of inflamation ( mild ) without bleeding
2 sign of inflamation ( moderate ) with bleeding on probing
3 sign of inflamation ( severe ) with spontaneous bleeding
❞ Plaque index :
0 no plaque
1 film of plaque detectable on probe only
2 moderate plaque seen by eye and detectable by probe
3 abundance of plaque | more than 2/3 of the tooth covered by plaque
☉ Signs of inflammation :
Dolor (pain) Calor (heat Rubor (redness) Tumor (swelling)
Functio laesa (loss of function)
❞ Ramfjord Teeth
16 21 24
44 41 36
In the clininc we exam "Plaque or bleeding" on the ( Ramfjord teeth ) as indicator teeth
If on of them missing we exam the adjacent one ..

7. ❞Clinical attachment level (CAL)
Is the distance from CEJ to location of the inserted probe tip .
CAL = PD + GL pd = probing depth , GL = Gingival level
☉ The land mark to measure the CAL Is : CEJ cemento enamel junction
We measure the CAL by :
a) PD (the depth to probe pentrates )
b ) level of gingival margin ( distance from CEJ to gingival margin )
▪﹁ if there is Recession " Positive number of GL "
CAL = PD + GL
▪﹁ If the gingival margin cover the CEJ " negative number of GL "
CAL = PD + ( - GL )
CAL = PD - GL
▪﹁ If the gingival margin at CEJ , GL will be = 0 mm
CAL = PD + GL
❞The X ray :
The radiographic survey should consist of minimum of
14 intraoral periapical films and four posterior bite wings film
Or panoramic to detect pathologic lesion of teeth and jaw , fractures ,
severity of bone destruction ..

8. ❞The Diagnosis ::
2 Severity
Distribution
1 Location 3 the disease
Severity : slight ,
moderate , severe
Generalized or localized Chronic (periodontitis or gingivitis etc .. )
Distribution : Marginal ,
papillary , Diffuse
Diffuse
♦ Generalized : > 30 %of the teeth ♦ Localized <30% of the teeth
♦ Marginal : involve margin & papillae
♦ Papillary : papillae only
♦ Diffuse : involve margin & papillae & attached gingiva
♦ The severity :: the classification of severity is as follows:
 Mild: 1–2 mm
 Moderate: 3–4 mm
 Severe: ≥ 5 mm
‫ إلحدى الحاالت‬severity ‫لنحسب الـ‬ ‫مثال‬
168
= 27 × 6
] ‫نضرب عدد األسطح في عدد أسنان الحالة [ ال ننسى أن بعض الحاالت فقدت بعض األسنان‬
, ‫حيث 6 هو عدد األسطح لكل سن‬
] ‫72 هو عدد األسنان الموجودة [ يوجد خمس اسنان مفقودة لدى الحالة‬
‫ " لكل األسنان‬probind depth " PD ‫نحسب الـ‬
‫ 5 ومافوق‬mm ‫ 4-3 أو الـ‬mm ‫ 2-1 أو‬mm ‫ونحسب كم عدد األسنان التي حصلت على‬
‫ 2-1 هو 9 أسنان‬mm ‫لنفرض أن عدد األسنان التي حصلت على‬
‫ 4-3 هو 12 سن‬mm ‫وعدد األسنان التي حصلت على‬
‫ 5 ومافوق هو 6 أسنان‬mm ‫وعدد األسنان التي حصلت على‬
: ‫ للمرض نعمل اآلتي‬severity ‫لكي نحسب الـ‬
1-2 mm = ( 9 / 168 ) × 100 = 5 %
3-4 mm = (12 / 168 ) × 100 = 7 %
5 mm = ( 6 / 168 ) × 100 = 3%
7 % ‫اذا ٌ النسبة الكبرى هي‬
moderate = ‫ للمرض‬severity ‫اذاً الـ‬

9. ❞ The Prognosis
Excellent Good Fair
No bone loss -Adequate remaining - less than adequate
Excellent ginigiva bone support remaining bone support
Good cooperation - adequate control of - Some tooth mobility
No systemic factors etiological factors - Grade I furcation
- Adequate cooperation - Acceptable cooperation
- No systemic factors – limited systemic factors
Poor Questionable Hopeless
- Modrate , advanced - Advanced bone loss - Advanced bone loss
bone loss - Grade II or III furcation - non maintianable areas
- Tooth mobility - Tooth mobility - Extraction indication
- Grade I & II furcation - in access area - presence of
- doubtful cooperation - presence of systemic uncontrolled systemic
- presence of systemic factors factors
factors
Factors affect the prognosis : age , presence of plaque , calculus , local factors , severity , prosthetics
❞

10. ❞Oral Hygiene Instructions ( OHI )
A. Proper brushing Techniques and mouth rinse
1. Always use a soft bristled toothbrush
2. Use anti-cavity Fluoride toothpaste
3. Hold toothbrush at a 45-degree angle at the gum line, brushing in a
circular motion
4. Brush teeth for a minimum of three minutes at least twice a day.
5. Brush gums and tongue along with your teeth.
6. Don’t brush too hard because this can cause gingival (gum) recession.
7. Use mouthwash twice only 20 ml for thirty seconds then wash .
B. Proper flossing technique and the reason for flossing
1. Use an arms length (18 inches) of floss. Wrap around fingers mostly to one
side.
2. Floss each tooth forming a “C” shape with the floss each time.
3. A new area of floss should be introduced into each gingival pocket.
4. Don’t forget to floss behind your last molar.
5. Flossing removes plaque from behind your teeth that brushing misses.
6. Flossing helps prevent periodontal disease by removing plaque.
Types of oral disease and ways they can easily be prevented:
1. Dental Caries (cavities)
a) Brushing and flossing
b) Fluoride rinse from your dentist if he or she recommends it for you
c) Reduce your carbohydrate intake along with simple sugars
2. Periodontal Disease ‫مراجعة التعليمات التي يتم إخبارها‬
a) Gingivitis is the first stage of periodontal disease ‫للمريض بعد الزيارة [ حول العناية‬
1. Bleeding gingival tissue while brushing teeth ‫باألسنان ] بالعربي‬
2. Red puffy gingival tissue ‫- تنظيف األسنان يوميا مرتين على األقل لمدة‬
3. May be sensitive to touch ‫3 – 5 دقائق وعدم التفريش بطريقة خاطئة‬
‫وشديدة حتى ال يتم إيذاء اللثة‬
4. Bad breath (Halitosis) ‫- تبديل الفرشاة كل 3 شهور‬
b) Periodontal disease ‫- استعمال غسول الفم مرتين‬
‫وإزالة الرائحة الكريهة وإزالة الكميات الكبيرة‬
1. Recession of gingival tissue 12 [ .. ‫من البكتيريا والحماية من التسوس‬
2. May be sensitive to hot and cold liquids or foods ‫مل ] لمدة ثالثين ثانية ثم بصق الكمية‬
‫وغسل الفم بالماء وتجنب بلع أي كمية من‬
3. Root exposed due to gingival recession ‫الغسول‬
‫- استعمال خيط األسنان إلزالة البقايا بين‬
4. Slight bone loss ‫األسنان‬
5 Usually large amounts of plaque and calculus build up ‫- استعمال معجون مضاد للحساسية إذا كان‬
‫المريض يشكو من ذلك‬
6 Bone loss and periodontal ligament detachment ‫- توصيته بالمراجعة بعد شهر من الزيارة‬
7 Teeth could be loose
8 Puss maybe within gingival pocket
9. Major bone loss along with damaged periodontal ligaments.

11. ‫بإمكانك إطالع المريض على هذا الجزء :: وإخباره بأن الوقت المناسب لتنظيف األسنان هو 3 – 5 دقائق ثالث مرات باليوم‬
‫, وعليه أن يقوم بتغيير الفرشاة كل ثالث أو أربع شهور‬
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❞Treatments of Periodontal Disease
1. Root scaling to remove calculus and plaque below the gum line
2. Surgery to reattach gingival tissue to the surface of the tooth
3. Sometimes the gingival tissue may regenerate to fill the void
of the bone loss, but the bone itself will never regenerate.
☛Types of Periodontal Disease
Diagnosis Case Type Treatment by
Gingivitis Type I General Dentist
Mild Periodontitis Type II General Dentist
Moderate Periodontitis Type III General Dentist
Advanced Periodontitis Type IV Periodontist
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‫☈ كيفية الكتابة في الملف الخاص بالمريض‬
Procedure ‫في خانة‬
D.h ‫ و الـ‬m.h ‫ والـ‬C.c ‫نكتب اسم المريض , و الـ‬
.. ‫ للحالة‬Tx ‫ والـ‬Dx ‫والـ‬
Mr khalid , 21 years
c.c =pain in the lower gingival and bleeding
m.h = NAD ( nothing abnormalities detectable)
D.h = bad 0ral hygiene , bleeding on probing ,
Supragingival calculus
X ray ? :: ..
The Dx : generalized marginal chronic gingivitis
The Tx : Supragingival scaling , OHI
Follow up
✍ The Resources : Carranza ,clininc Manual of periodontics , Wikipedia , Google picture !