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Periodontitis 2nd stage of perio disease-EFFECTS GINGIVA, PERIODONTAL LIGAMENTS, CEMENTUM AND ALVEOLAR BONE Distribution 1)increases with age 2)more prevalent in men than women 3)directly related to increased education and social economic status Clinical Signs of Periodontitis a)same signs as gingivitis including: 1)gingival recession 2)tooth mobility 3)bone loss a)can only be seen on a radiograph Perio Pocket a)epithelial attachment migrates apically b)greater than 3mm c)can be measured with a perio probe d)tooth surface rough with calculus Gingival Recession progressive exposure of the tooth's root surface due to apical migration of gingiva Stillman's Cleft recession characterized by narrow slits that run in an apical direction from the marginal gingiva Dehiscence exposure of root extending the full length of the root Fenestration isolated areas of the root and marginal bone intact Acute Periodontal Diseases a)Acute Necrotizing Ulcerated Gingivitis-(ANUG) 1)trench mouth 2)vincent's Disease b)periodontal abscess Desquamative Gingivitis shedding of tissue d)pericoronitis e)furcation involvement f)leukoplakia Moniliasis caused by fungus-candida albicans 1)thrush in babies Role of Dental assistant in Perio Treatment a)assist in documentation b)instruct patient in plaque control and oral hygiene instructions (OHI) c)remove sutures d)assist dentist and hygienist e)post operative instructions f)insure recall RDA Duties 1)perio pak 2)coronal polishing Pain 1)Analgesics-Tylenol, Codeine, Percodan Apprehension 1)tranquilizers 2)barbiturates Hemorrhage 1)surgical dressings 2)wet tea bags 3)pressure packs Swelling 1)Preventive-Ice Packs 2)Alleviation-Hot Packs Infection 1)antibiotics Exam of Oral Cavity in Perio a)radiographs b)pocket depths in mm c)mobility of teeth d)missing teeth e)extractions needed f)gingival contour g)furcation involvement h)open contacts i)malposed teeth j)Etiologic factors k)diagnosis l)prognosis m)treatment plan Treatment Of Gingivitis a)patient education 1)explain the diagnosis b)OHI c)Re-evaluation d)recall (3-6 months) Remove all Plaque and Calculus 1)scaling 2)curettage 3)root planing 4)prophy Treatment of Etiological Factors 1)remove overhangs 2)replace poor restorations 3)restore carious areas Phase 1 1)patient education 2)OHI 3)scaling and root planing 4)treatment of carious or endo lesions 5)Occlusal adjustments 6)temporary splinting of teeth 7)ortho 8)re-evaluation Phase 2 1)corrections of anatomical deformities-surgical elimination of pockets a)gingivectomy b)tissue grafting c)bone grafting d)bone contouring Phase 3 1)maintenance of Perio treatment a)re-evaluation every 4-6 months b)radiographs (bitewings) annually c)OHI-Oral Hygiene Instructions d)scaling and polishing every 4-6 months Treatment Of Gingival Recession a)immaculate plaque control b)scaling and root planing c)frenectomy d)grafting e)replacement of over contoured restorations f)correction of habits causing injury (EX:chewing tobacco) g)occlusal adjustment h)ortho Periodontal flap 1)periodontal flap is a section of gingiva surgically separated from underlying tissue a)part of the tissue remains in the original site Periodontal Graft involves total removal of a section of gingiva from donor site Periodontal Planing 1)removers voids of cementum 2)helps prevent rapid accumulation of plaque 3)helps prevent gingival irritation Curettage cleansing of a pocket by removing necrotic tissue Scaling removing of materials that adhere to the tooth Osteoplasty sugical reshaping of bone Gingivoplasty reshaping of gingiva Periodontal Dressings a)uses 1)aids in healing gingival tissue 2)maintains gingival tissue incorrect position 3)minimizes post-op discomfort 4)minimizes post-op hemorrhage 5)prevents accumulation of foof debris 6)provides support for mobile teeth 7)helps shape new forming tissue Post Surgical Instructions a)what medications to take and how often b)ice packs (prevention) 1 on and 10 off c)perio pak comes off-call office d)chew on opposite side of surgery e)do not eat hot spicy foods f)oozing of blood is normal g)continue to clean other areas of mouth h)use wet gauze if bleeding is more than normal