periodontal disease: diagnosis and treatment Dr.Zahra Sohrabi

Examination of Patients with Periodontal Diseases The history of the patient is a revealing document as a basis for comprehensive treatment planning and understanding of the patient's needs, social and economic situation.

The assessment of the patient's history requires an evaluation of the following six aspects: 1- chief complaint 2- social and family history 3- dental history 4- oral hygiene habits 5- smoking history 6- medical history and medications

Signs and symptoms of periodontal diseases Periodontal diseases are characterized by color and texture alterations of the gingiva, e.g. redness and swelling, as well as an increased tendency to bleeding .upon probing in the gingival sulcus/pocket area

Advanced stages of periodontitis may also be associated with increased tooth mobility as well as .drifting or flaring of teeth

In radiographs, periodontitis may be recognized by moderate to advanced loss of alveolar bone. Bone loss is defined either as "horizontal" or "angular".

In order to evaluate the amount of tissue lost in periodontitis the following parameters should be recorded: 1. Probing pocket depth ( PPD) 2. Clinical attachment loss (CAL) 3. Furcation involvement (PI) 4. Tooth mobility (TM).

Diagnosis of periodontal lesions • Gingivitis: This diagnosis is applied to teeth displaying bleeding on probing. The sulcus depth usually remains at levels of 1-3 mm irrespective of the level of clinical attachment. "Pseudopockets" may be present in cases of slightly increased probing depth without concomitant attachment and alveolar bone loss and presence/absence of bleeding on probing. The diagnosis of gingivitis usually characterizes lesions confined to the gingival margin.

Diagnosis of periodontal lesions • mild-moderate periodontitis: Gingivitis in combination with attachment loss is termed "periodontitis". If the PPD does not exceed 6 mm, a diagnosis of mild-moderate periodontitis . This diagnosis may, therefore, be applied to teeth with "horizontal“ loss of supporting tissues, representing supra bony lesions, and/or to teeth with "angular" or "vertical“ loss of supporting tissues, representing Infra bony lesions. "Infra bony" lesions include "intra bony one-, two- and three-wall defects" as well as "craters" between two adjacent teeth.

Diagnosis of periodontal lesions •advanced periodontitis: If the PPD does exceeds 6 mm, a diagnosis of advanced periodontitis. As for mild moderate periodontitis, angular as well as horizontal alveolar bone loss are included in this diagnosis. The distinction between mild-moderate and advanced periodontitis is only based on increased PPD.

Diagnosis of periodontal lesions periodontitis in the furcation area

Treatment Planning of Patients with Periodontal Diseases Dr. Zahra Sohrabi

TREATMENT PLAN 1. Systemic phase of therapy 2. Initial phase of periodontal therapy, cause-related therapy 3. Corrective phase of therapy 4. Maintenance phase ,supportive periodontal therapy (SPT)

Systemic phase The goal of this phase is to eliminate or decrease the influence of systemic conditions on the outcomes of Patients with systemic diseases such as diabetes mellitus or cardiovascular diseases usually are treated with a number of medications that may interact with drugs prescribed during periodontal therapy. It has to be realized that periodontal treatment may have a beneficial effect on the systemic health of the patient as well. Glycemic control may be facilitated in diabetics if proper periodontal therapy is rendered. .

smoking counseling is part of modern periodontal treatment owing to the fact that, after inadequate oral hygiene standards, cigarette smoking constitutes the second most important risk factor for .periodontitis

Initial phase This phase represents the cause-related therapy. The objective of this phase is the achievement of clean and infection-free conditions in the oral cavity through complete removal of all soft and hard deposits and their retentive factors. this phase should aim at motivating the patient to perform optimal plaque control. The initial phase of periodontal therapy is concluded by re-evaluation and planning of both additional and supportive therapies.

Corrective phase of therapy The amount of corrective therapy required and the selection of the type of restorative and prosthetic therapy can be determined only when the degree of success of the cause-related therapy can be properly evaluated. The patient's willingness and ability to cooperate in the overall therapy must determine the type of corrective treatment.

This phase includes : •periodontal and implant surgery •endodontic therapy •restorative and/ or prosthetic treatment.

Maintenance phase 1- assessment of deepened sites with bleeding on The aim of this treatment is the prevention of reinfection and disease recurrence. For each individual patient a recall system must be :designed that includes 1- assessment of deepened sites with bleeding on Probing 2- instrumentation of such sites 3-fluoride application for the prevention of dental caries.

this treatment involves the regular control of prosthetic restorations incorporated during the corrective phase of therapy. Tooth sensitivity testing should be applied to abutment teeth as loss of vitality is a frequently encountered *.complication *Bergenholtz & Nyman 1984; Lang et al. 2004; Lulieet aL. 2007.

Based upon the individual caries activity, bitewing radiographs should be incorporated into SPT at regular intervals.

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