Periodontics

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Periodontics
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Periodontitis

• Periodontal tissues (Periodontium)
• Gingiva
• Sulcus
• Epithelial attachment
• Bone (alveolar)
• Lamina dura
• PDL
• Periodontal ligament
• Sharpeys fibers
• Cementum
• Surrounds the root

• Periodontist
• Dentist specializes in treating tissues around
  the tooth.
• Peri around
• Dont tooth

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Periodontitis

• Signs / symptoms
• Swollen gums
• Shiny gums
• Red gums
• Bleeding
• Plaque
• Calculus
• Recession
• Maloclussion

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Periodontitis

• Causes
• Poor oral hygiene
• Plaque
• Calculus
• Poor diet
• Lack of sleep
• Genetics
• Medications / drugs
• Stress
• Bruxism

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Periodontal stages

• Stage I
• Gingivitis
• Inflammation of the gingiva.
• Not true perio
• Must have pockets!
• Stage II
• Early perio
• Pocket formation
• 4 -5 mm
• No mobility

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Periodontal stages

• Stage III
• Moderate perio
• 4 6 mm pockets
• Recession
• Bone loss
• Mobility

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Periodontal stages

• Stage IV
• Advanced perio
• 6 mm pockets
• Mod severe recession
• Severe bone loss
• Furcation involvement
• Mod- severe mobility

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Refractory periodontitis

• ANUG
• Acute
• Necrotizing
• Ulcerative
• Gingivitis
• Aka
• Vincents Disease
• trench mouth

• Really bad perio
• Additional signs/symptoms
• PAIN
• Dead tissue
• Sores
• Metallic taste
• Death Breath

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Mobility

• Movement of the tooth within the socket.
• Scale of 0 4
• 0 normal
• 1 slight
• 2 moderate
• 3 severe

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Diagnosis

• Extraoral exam
• Skin, lips, TMJ
• Intraoral exam
• Color
• Size
• Texture
• Consistency
• Of all tissues

• Radiographs
• X-rays
• Vertical BWX
• Pano
• Indicate
• Bone loss
• Vertical
• Horizontal
• Diseased tissue
• abscesses

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Radiographs
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Periodontal probing

• Measures the sulcus / pocket depth.
• Instrument?
• Periodontal probe
• 0 3 mm healthy
• 6 readings / measurements around the tooth.

• Anterior teeth
• F, MF, DF
• L, ML, DL
• Posterior teeth
• B, MB, DB
• L, ML, DL

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Periodontal probing
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Treatment

• Full Mouth Debridement
• Too much calculus to probe.
• Root Planing
• Smoothing root surface
• Calculus
• Dead cementum

• Gingival curettage
• Scraping the gums
• Remove dead / diseased gingival tissue.

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Treatment

• Prophylaxis
• Fine scale and polishing.
• Remove
• Calculus
• Sub-gingival
• Supra-gingival
• Stain
• Extrinsic
• Soft depostis
• Plaque
• stain

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Surgical Treatment

• Flap surgery
• Used to gain access to the bone.
• Allows other procedures to be completed.

• Alveoplasty
• Reshaping the alveolar bone
• Ostectomy
• Bone removal
• Additive osseous surgery.
• Bone graft.

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Surgical Treatment

• Gingivectomy
• Surgical removal of the gums

• Gingivoplasty
• Reshaping / recontouring the gums
• Scallop

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Mucogingival Surgery

• Frenectomy
• Removal of the frenum and attachment to bone.
• Tongue tied
• Anklyoglossia

• Gingival grafting
• Tissue is taken from one site and place on
  another.
• Palate

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Periodontal instruments

• Periodontal probe
• Measures the sulcus
• Ultrasonic scaler
• Used with hand scaling to remove gross calculus
• Scaler
• Removes gross calculus
• supragingival

• Curette
• Root planing
• Curettage
• Sub-gingival calculus
• Pocket marker
• Marks tissue for incision
• Periosteal elevator
• Separates tissue from bone

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Periodontal instruments

• Rongeurs
• Cut / trim bone
• Periodontal knives
• Cut / incise tissue
• Orban
• Kirkland
• Bard parker and 15 blade.

• Electrosurgery machines.
• Uses electric current to incise tissue.
• Lasers
• Many different uses in periodontics.

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Periodontal dressing

• Band-aid for the gums after perio treatment
• Protects tissue w/ chewing
• Support for mobile teeth
• Holds flaps in place
• Stay on about 1 week

• Please reference pics in your textbook on pgs.
  525, 526, 527

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Conclusion

• Understanding signs and symptoms of perio is a
  very important part of your job.
• Being able to explain different treatments and
  procedures to your patients increases your value
  to your dentist.
• Any questions??????????