B Wbd
Fig. 16-2 Human biopsy, experimental gingivitis. A, Control biopsy specimen from a patient with good oral hygiene and no detectable plaque accumulation, the junctional epithelium is at the left. The connective tissue CT shows few cells other than fibroblasts, blood vessels, and a dense background of collagen fillers Magnification 500. B, Biopsy specimen taken after 8 days of plaque accumulation. The connective tissue is infiltrated with inflammatory cells, which displace the collagen fibers. A...
C H A P T E R Tsw
WHAT DOES PERIODONTAL THERAPY ACCOMPLISH Local Therapy Systemic Therapy FACTORS THAT AFFECT HEALING Local Factors Systemic Factors HEALING AFTER PERIODONTAL THERAPY Regeneration Repair WHAT DOES PERIODONTAL THERAPY ACCOMPLISH T he effectiveness of periodontal therapy is made I possible by the remarkable healing capacity of the J_ periodontal tissues d ig. 36-1 . Periodontal therapy can restore chronically inflamed gingiva so that from a clinical and structural point of view it is almost...
Table 53
Criteria for the Modified Gingival Index 1 Mild inflammation slight change in color and slight edema. No bleeding on probing. 2 Moderate inflammation redness, edema, and 3 Severe inllammation marked redness and edema. Ulceration. Tendency toward spontaneous bleeding. From Loe H Ihe gingival index, the plcique index, and the retention index systems J Periodontol 196 38 610 suppl . Gingival Index. Ihe gingival index I was proposed in 1963 as a method for assessing the severity and quantity of...
Occlusal Therapy
The purpose of occlusal therapy is to establish stable functional relationships favorable to the oral health of the patient, including the periodontium. A variety of procedures could contribute to this objective interoc-dusal appliance therapy, occlusal adjustment, restorative procedures, orthodontic tooth movement, and orthognathic surgery. Some overall guidelines apply to occlusal therapy in general. First, there should be a sound biologic rationale for the intervention. Second, occlusal...
Osseous Craters
An osseous crater is an interproximal, two-wall deled that does not improve with orthodontic treatment. Some shallow craters i.e., 4- to 5-mm pocket may be maintainable nonsurgically during orthodontic treatment. However, il surgical correction is necessary, this type ot osseous lesion can easily be eliminated In reshaping the defect12,1 and reducing the pocket depth lFig. 53-1 see Chapter 62 . Ibis in turn enhances the ability to maintain these interproximal areas during orthodontic treatment....
Info Knb
DRB1 x 0401, x0404. gt 0405, or gt 0408 Trend for J A2 in P. No 42, 91 Subjects had no evidence of past 45 P. No significant f in B15 or DR antigens although trerd for DR5. difference in A9, A28, Bwl5. Also tested ABO blood groups. No significant associations with 76 Trend for B12 in whites. Small 20 samples. No evidence of linkage to HLA region in collection of 8 families. Trend for DRB1 x 1401, x 1501, 67 St DQB1 x0503, x0602. DR association thought to be due to linkage disequilibrium with DQ...
Frequency Of Plaque Removal
In the controlled and supervised environment of clinical research, where well-trained individuals remove all visible plaque, gingival health can be maintained by one thorough cleaning exercise with brush, floss, and toothpicks every 24 to 48 hours sl Most patients, however, tall tar short of this goal. I he average cleaning lasts less than 2 minutes every day and removes only 40 of plaque.is Several studies report improved plaque removal and therefore improved periodontal health associated with...
Plaque Control Record the OLcary Index17
Disclosing solution is applied to all supragingival tooth surfaces. After the patient has rinsed to remove excess dye, each tooth surface except occlusal surfaces is examined for the presence or absence of stained deposits at the dentogingival junc tion, four surfaces lor each tooth. Plaque, it present, is indicated on the appropriate box in a diagram. After all teeth have been scored, the index is calculated by dividing the number ol surfaces with plaque by the total number lt gt t surfaces...
References Qzq
1. Adriaeits I', Edwards i . DeBoever J, et al I Mtrastructural observations on bacterial invasion in ccmcntum and radicular dentin ol periodontal diseased human teeth. I Peri-odpntol 1988 59 403 2. Aleo J, DeRenzis I. l-arber I' In vitro attachment lt 1 human gingival fibroblasts to root surfaces. I Periodontol 1975 46 639. V Aleo I, DeRen is I. larber P. el al I lie presence and biological activity ol ccmenlum-hound endotoxin I Periodontal 1974 45 072. 4. Allen I I. Khoads KM I Meets of...
B Ago
Fig. 11-7 Calculus A, Calculus attached to pellicle on enamel surface e . rhe enartiel was removed in the preparation ol the specimen. Also note calculus attached to dentin and associated penetration of dental tubules arrows . B, Interproximal area with early and advanced root caries of adjacent teeth and with calculus attached to carious surfaces atrows . does not develop into calculus reaches a plateau ot maximal mineral content within 2 days.1 1 Microorganisms are not always essential in...
Orofacial Pain
Discomfort associated with masticatory system disorders falls under the larger umbrella of orofacial pain. Pain associated with TMJ dysfunction is most frequently muscular in origin.w Working knowledge of even the uncommon sources of pain perceived in the region of the masticatory system is essential to providing comprehensive diagnosis and treatment. Sources of dental or periodontal pain should be identified by clinical, radiographic, and or historical information. Nondental sources of pain...
Distribution
Locali ed gingivitis is confined to the gingiva of a single tooth or group of teeth while generalized gingivitis involves the entire mouth. Marginal gingivitis involves the gingival margin and may include a portion of the contiguous attached gingiva. Papillary gingivitis involves the interdental papillae and often extends into the adjacent portion of the gingival margin. Papillae are involved more frequently than the gingival margin, and the earliest signs of gingivitis often occur in the...
Table 161
2-4 Vascular dilation Vasculitis 4-7 Vascular proliferation 14-21 Same as Stage II, plus blood stasis Same as Stage I Rete peg formation Atrophic areas Same as Stage II but more advanced probing Changes in color, size, texture, etc. PMNs, Polymorphonuclear neutrophils. Fig. 16 1 Human biopsy sample, experimental gingivitis. After 4 days of plaque accumulation, the blood vessels irrmediately adjacent to the junctional epithelium are distended and contain polymorphonuclear neutrophils PMNs ....
Table 81
Selected Bacterial Adhesins and larget Substrates 5. sanguis A. naeslundii A. israelii S. sanguis A. israelii P. gingivalis T. denticola P. micros P. gingivalis A. viscosus A. naeslundii T. denticola A. viscosus A. naeslundii P. nucleatum P. gingivalis 00- to 330-kd outer membrane protein Membrane protein Membrane protein Fimbriae fimbrial proteins Heat and protease sensitive protein Proline-rich proteins Sialic acid residues Galactosyl residues Galactosyl residues Galactosyl residues...
Therapeutic Procedures
Periodontal therapy is an inseparable part of dental therapy. The list of procedures presented here includes periodontal procedures tin italics and other procedures not considered to be within the province of the periodontist. They are listed together to emphasize the close relationship of periodontal therapy with other phases of therapy performed by general dentists or other specialists Box 35-1 . The sequence in which the above phases of therapy are performed may vary to some extent in...
The Subgingival Environment As A Reservoir Of Bacteria
The subgingival microbiota in patients with periodontitis provides a significant and persistent gram-negative bacterial challenge to the host see Chapters 6 and 8 . These organisms and their products, such as lipopolysac-charide LPS , have ready access to the periodontal tissues and to the circulation via the sulcular epithelium, which is frequently ulcerated and discontinuous. Kvcn with treatment, complete eradication of these organisms is difficult, and their recmergence is often rapid. The...
Microbiology And Immunology In Periodontal Diseases
Ihe most common form ol gingivitis is plaque-iiuluccd gingivitis.1 Common clinical findings in gingivitis include erythema, edema, tissue enlargement, and bleeding. I wo forms of plaque-induced gingivitis have been investigated a naturally occurring gingivitis and experimental gingivitis. I'.xpcri mental gingivitis is a longitudinal clinical model that has been widely used in human and animal studies.1' In humans, experimental gingivitis is induced through abstinence from oral hygiene measures...
J
Fig. 1 Illustration of Abu'l-Qasim's periodontal instruments, showing scalers se , I les I , and the wiring ot loose teeth w . that is required for them. I he scalers that one uses lot-scaling the inner surfaces ol the teeth are different than those employed lor the scaling of the exterior surfaces, and those that are used to scale the interdental surfaces. Here is an assortment of scalers all of which you have it your disposition 11 ig. I . In lapan in 984, a book by Yasuyori fanba, entitled...
Subgingival Irrigation
Subgingival Irrigation as a Monotherapy for Periodontitis Antimicrobial Agents and Scaling and Root Planing SAFETY OF IRRIGATION n the treatment of periodontal diseases, irrigation is used as a lavage to flush away the bacteria that ire in contact with the periodontal tissues. Irrigation is a nonspecific reduction of plaque bacteria. The two types of irrigation are supriigingiv.il and subgingival irrigation. They vary by the depth to which the irrigant is projected into the gingival or...
Determination Of A Prognosis
I he factors often considered when determining the prognosis are listed in lable iM. Although some of these factors may be more important than others when assigning a prognosis consideration of each may be beneficial to the clinician. In most cases, careful analysis of these factors allows the clinician to establish one ol the following prognoses lixcellent prognosis No bone loss, excellent gingival condition, good patient cooperation, no systemic environmental factors. iooiI prognosis One or...
References 1
1 mamo Influence lt 1 age on the location of the maxillary mucogingival junction. I IVriodont Res 1978 I 1 189. 2 Ainamo V inamo I I he width ol attached gingiva on supraerupted teeth I IVriodont Res P gt 7ft I VI94. I. Ainamo I. I.oe II natomkal characteristics of gingiva. A clinical and microscopic study ot the tree and attached gingiva. I IVriodontol ll gt l'n. W-.S 4 inamo , Talari A I he increase with age ol the width of attached gingiva. IVriodont Res 1976 1 I 182 5. mstad- ossi M, Si...
Table 321
Risk Moments lor Periodontal Disease Pathogenic bacteria Microbial tooth deposits Risk Determinants Background Characteristics HIV AIDS Osteoporosis Infrequent dental visits periodontal disease Bleeding on probing HIV, human immunodeliciency virus AIDS, acquired immunodeficiency syndrome. smokers and nonsmokers have shown that smoking has a negative impact on the response to therapy. However, former smokers respond similarly to nonsmokers. ' These studies demonstrate the impact intervention...
Results
Phase I therapy is a complex and individualized treatment. It requires detailed analysis of each patient's disease and contributing factors and customized therapy. I he treatments common to ill Phase I therapy are patient plaque control, caries control, and scaling and root planing to remove supragingival calculus, subgingival calculus, and plaque deposits. Plaque control performed by the patient at home is complex and requires c hanging lifelong habits. It is difficult to achieve and varies...
Reevaluation
Kcevaluation of the periodontal case should occur about 4 weeks afiet the completion of the scaling and root planing procedures. This permits time for both epithelial and connective tissue healing, correction of conditions such as overhanging margins, and .sufficient practice with oral hygiene skills so that the dentist can accurately assess the periodontal condition at the end of Phase I therapy. Gingival inflammation is usually substantially reduced or eliminated within to 4 weeks after...
References Lsc
1. Abrasivits of current dentifrices Report of the Council ol Dental therapeutics. I Am Dent Assoc ll gt 70 8hi 177. 2. Accepted Dental Therapeutics. ed liicago, American Dental Association, 1969- 1970. ADA l ouncil on Ncientilu Affairs 2001 www.ada.org I. Addy M. Aclriaens P lt onsensus report ol group A epidemiology and etiology of periodontal diseases and the role ol plaque control in dental caries. In Tang NP, Mtstrom R, I .be II eds Proceedings ol the l uropean Workshop on Mechanical...
DENTAL AND MEDICAL ASSESSMENTS Review of Dental History
At the vers least, the review should include past restorative, periodontal, and other dental treatment head and neck cancer and its treatment allergies, oral hygiene care techniques tobacco and alcohol use and any difficulties or problems associated with dental treatment. In addition, the dental history should review past injuries, the individual's perception ol past and future dental treatment outcomes, the fluoride status ol the drinking water bottled, well, community , and the type of...
Oral Hairy Leukoplakia
At present, there appears to be little advantage in treating oral hairv leukoplakia Olll. in most patients. Lesions can be successfully removed, however, with laser or conventional surgery. Resolution has been reported after therapy with zidovudine Pig. SI-3 or topical retinoids, but systemii antiviral agents such is acyclovir may elicit remission more predictably dig. 51-4 , although lesions reappear when antiviral therapy is discontinued. ' S 4 c linical impressions suggest that the incidence...
References Kny
1, Armitage c lt Development ol a classification svstem lor periodontal diseases and conditions Annals IVriodoniol 1999 4 1. 2. Bjorn A-L, Bjorn II. Crkovk B Marginal til ol restorations and its relation to periodontal bone levels. I Metal fillings. Odontol Rev 1969 20 311. Bolin A, rklund G, Frithiol I , ct al Ihe effect of changed smoking habits on marginal alveolar bone loss. longitudinal study. Svved Dent I 1993 17 21 I 4. Bower R furcation morphology relative to periodontal treatment...
Periodontal Disease And Pregnancy Outcome
Low-birth-weight LBW infants those weighing less than 2500 g at birth are 40 times more likely to die in the neonatal period than normal-birth-weight NKW infants.Although about 7 of all infants weigh less than 2500 g at birth, they account lor two thirds of neonatal deaths. LBW infants who survive the neonatal period are at increased risk for congenital anomalies, respiratory disorders and neurodevelopmental disabilities. The social and financial costs of LBW infants are enormous, and an...
Info Idb
Fig. 29-3 Depapillation of the tongue. A smear obtained from the tongue was positive tor Candida sp. Fig. 29-3 Depapillation of the tongue. A smear obtained from the tongue was positive tor Candida sp. Fig. 29-4 Large area of mucosal necrosis extending from the lingual gingival tissue onto the floor of the mouth in a 28-year-old patient with AIDS. Fig. 29-4 Large area of mucosal necrosis extending from the lingual gingival tissue onto the floor of the mouth in a 28-year-old patient with AIDS....
Periodontal Treatment Protocol
lb safelv and effectively provide periodontal therapy to HIV-infected individuals, several treatment considerations are important. Ihe patient's health status should be determined from the health history, physical evaluation, and consultation with his or her physician, treatment decisions will vary depending oil the patient's stale of health. For example, delayed wound healing and increased risk of postoperative infection are possible complicating factors in AIDS patients, hut neither concern...
Calculus 1
'tihulus consists of mineralized bacterial plaque that forms on the surfaces of natural teeth and dental prostheses. Calculus is c lassified as supragingival or subgingival, according to its relation to the gingival margin. Supragingival and Subgingival Calculus Supragingiiiil al enlas is located coronal to the gingival margin and therefore is visible in the oral cavity. It is usually white or whitish yellow in color, hard with clay-like consistency, and easily detached from the tooth surface....
Chemical Plaque Control
Mechanical plaque removal remains the primary method used to prevent dental diseases and maintain oral health. However, an improved understanding of the infectious nature of dental diseases has dramatically revitalized interest in chemical methods of plaque control. The ADA Council on Scientific Affairs has adopted a program for acceptance of plaque control agents. The agents must be evaluated in placelxxontrolled clinical trials of 6 months or longer that demonstrate significantly improved...
Table 191
Differentiation between Necrotizing Ulcerative Gingivitis and Primary Herpetic Gingivostomatitis Etiology Interaction between host and bacteria, most probably fusospirochetes Necrotizing condition Punched out gingival margin pseudomembrane that peels off, leaving raw areas. Marginal gingiva affected other oral tissues rarely affected Uncommon in children No definite duration No demonstrated immunity Contagion not demonstrated Diffuse erythema and vesicular eruption Vesicles rupture and leave...
Advances In Microbiologic Analysis
Since subgingival oral bacteria are the main initiating agents in the development ot periodontal disease, it makes sense to look for specific bacteria in the subgingival microflora of patients with disease. 4,81 These microbiologic tests have the potential to support the diagnosis of the various forms ot periodontal disease, to serve as indicators of disease initiation and progression i.e., disease activity , and to determine which periodontal sites are at higher risk for active destruction....
Info Slu
I'A.RI 5 licutnient of l'eriotlonhil Dis use Ultrusonit iiiul soh'h instruments arc used lor scaling and cleansing tooth surfaces and curetting the soft tissue wall of the periodontal pot ket. s ,s 4. I he periodotital endoscope is used to visualize deep sub-gingivally in pockets and furcations enabling the de-tec lion of deposits. 5. leu using und polishing instruments such as rubber cups, brushes, and dental tape are used to clean and polish tooth surfaces. Also available are air-powder...
Bop
Loe H Periodontal disease The sixth complication of diabetes mellitus. Diabetes Care 1993 16 suppt 1 329. Fig. 13-7 Periodontal treatment effects on glycemic control. In five patients, reductions in periodontal inflammation after mechani cal therapy combined with systemic doxycycline antibiotic were accompanied by improved glycemic control decreased glycated hemoglobin values HbAlc . In four patients with no improvement in periodontal health, no improvement in glycemic control occurred. From...
General Principles Of Instrumentation
Fffective instrumentation is governed by a number of general principles that are common to all periodontal instruments. Proper position of the patient and the operator. illumination and retraction for optimal visibility, and sharp instruments are fundamental prerequisites. A constant awareness of tooth and root morphologic features and of the condition of the periodontal tissues is also essential. Knowledge of instrument design enables the clinician to efficiently select the proper instrument...
Table 171
linical and Histopathologic hanges in iingival Consistency PMIV. Polymorphonuclear neutrophils. liniall Features of iigivitis IIAIM IK 17 275 Fig. 17-14 Cementicles in the gingiva. Fig. 17-15 Diagram illustrating the apparent and actual positions of the gingiva and visible and hidden recession. Fig. 17-13 Chronic gingivitis, showing a firm gingiva with a minutely nodular surface produced when fibrosis predominates in the inflammatory process Changes in the Position of the Gingiva Actual and...
Info Tqa
Noti This table is meant merely as a guide to choosing power-operated instruments. The clinician is advised to investigate the various types and models ol sonic and ultrasonic scaling devices, because technical improvements and changes have affected and will continue to affect the way powered instruments are used in dentistry From Perry DA, Beemsterboer P, Carran a FA Techniques and Theory ol Periodontal Instrumentation. Philadelphia, WB Saunders, 1990 Fig. 41-40. Ultrasonic and sonic tips. A,...
D 1
Fig. 42-21 Blade angulation. A, 0 degrees correct angulation for blade insertion. B, to 90 degrees correct angulation for scaling and root planing. C, I ess than 4S degrees incorrect angulation for scaling and root planing D, More than 90 degrees incorrect angulation for scalincj and root planing, correct angulation for gingival curettage. Fig. 42-22 Three basic stroke directions A, Vertical B, oblique C, horizontal. Fig. 42-22 Three basic stroke directions A, Vertical B, oblique C, horizontal....
Periosteal Elevators
These instruments .ire necessary to relied and move the flap after the incision has been made for tlap surgery. The 24 j Tig. 41-5. and the Goldman-Pox 14 are well-designed periosteal elevators. Chisels and hoes are used during periodontal surgery for removing and reshaping bone. The hoe shown in Fig. 41-54 has a curved shank and blade, whereas the IViedelstadt and Fodd-Ciiltnorc chisels are straight shanked. I he surgical hoe has a flattened, fishtail-shaped blade with a pronounced conve. it...
Other Systemic Conditions
The ingestion ot metals such as mercury, lead, and bismuth in medicinal compounds and through industrial contact may result in oral manifestations owing to either intoxication or absorption without evidence of toxicity. Bismuth Intoxication. Chronic bismuth intoxication is characterized by gastrointestinal disturbances, nausea, vomiting, and jaundice, as well as by an ulcerative gingivostomatitis, generally with pigmentation and accompanied by a metallic taste and burning sensation of the oral...
Info Acp
depth, bleeding on probing, and periodontal pathogens and provide gains in clinical attachment level. Such effects are significantly heller than those attained with scaling and root planing alone or with placebo fibers. In a 2-month study, compared with scaling and root planing, the libers used alone have provided more than a 60 greater improvement in probing depth and clinical attachment level than scaling alone.' No change in antibiotic resistance to tetracycline has been found following...
Factors That Affect Healing
In the periodontium, .is elsewhere in the body, healing is affected by local and systemic factors. Systemic conditions that impair healing may reduce the effectiveness of local periodontal treatment and should be corrected before, or along with, local procedures. However, local factors, particularly plaque microorganisms are the most common deterrents to healing follow-ing periodontal treatment. Healing is also delayed by excessive tissue manipulation during treatment, trauma to the tissues,...
F G
Fig. 49-20 A large variety ol interproximal cleaning devices are available wooden tips A and B , interproximal brushes C-F , and rubber tip stimulators G . Fig. 49-20 A large variety ol interproximal cleaning devices are available wooden tips A and B , interproximal brushes C-F , and rubber tip stimulators G . Fig. 49-19 Cleaning ol concave or irregular proximal tooth surfaces Dental lloss A may be less effective than an interdental brush B ou long rool surlaces with concavities Fig. 49-21...
Safety Of Irrigation
Supragingival irrigation appears to be i safe method of treatment. Daily supragingival irrigation with water has shown no clinicallv significant adverse effects over longer observation periods In addition, no micro- morphologic changes of periodontal tissues after supragingival irrigation have been found. I here has only been one recent report on extensive tissue necrosis and permanent loss ol alveolar bone after subgingival irrigation with 2 stannous fluoride.-' It is important to know tli.it...
Gingival Massage
Massaging the gingiva with a toothbrush or an interdental cleaning devices produces epithelial thickening, increased keratini ation, and increased mitotic activity in the epithelium and connective tissue.--- 1 H lt 1 The increased keratini ation occurs on the oral gingiva and not on the areas more vulnerable to microbial attack, the sul-cular epithelium and the interdental areas where the gingival col is present. It has never been demonstrated that epithelial thickening, increased keratini...
Supragingival Irrigation 1
Oral irrigators lor daily home use by patients work by directing a high-pressure, steady or pulsating stream of water through .i nozzle to the tooth surfaces see also Chapter 44 . Most commonly, a device with a built-in pump generates the pressure ilig. 40-24, A , but other devices attach to the water faucet. Oral irrigators clean nonadherent bacteria and debris from the oral cavity more effectively than toothbrushes and mouthrinses. I hey are particularly helpful for removing debris from...
Box 352
Preferred Sequence of Periodontal Therapy Preliminary Phase Treatment of emergencies Extraction of hopeless teeth and provisional replacement if needed may be postponed to a more convenient time Etiotropic Phase Phase I literal Plaque control and patient education Diet control in patients with rampant caries Removal of calculus and root planing Correction of restorative and prosthetic irritational factors Excavation of caries and restoration temporary or final, depending on whether a definitive...