Periodontics

Periodontitis Periodontist Dentist specializes in treating tissues around the tooth. Peri = around Dont = tooth Periodontal tissues (Periodontium) Gingiva Sulcus Epithelial attachment Bone (alveolar) Lamina dura PDL Periodontal ligament Sharpey’s fibers Cementum Surrounds the root

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

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

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

Periodontal stages Stage III Moderate perio 4 – 6 mm pockets Recession Bone loss Mobility

Periodontal stages Stage IV Advanced perio 6+ mm pockets Mod – severe recession Severe bone loss Furcation involvement Mod- severe mobility

Refractory periodontitis ANUG Acute Necrotizing Ulcerative Gingivitis Aka Vincent’s Disease “trench mouth” Really bad perio… Additional signs/symptoms PAIN Dead tissue Sores Metallic taste ‘Death Breath’

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

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

Radiographs

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

Periodontal probing

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.

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

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.

Surgical Treatment Gingivectomy Surgical removal of the gums Gingivoplasty Reshaping / recontouring the gums Scallop

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

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

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.

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

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??????????