diagnosis

Clinical periodontology

Clinical diagnosis
Roaa L. ahmed

History Examination of lymph nodes Oral examination Radiographical diagnosis

Clinical diagnosis

Oral examination

Mouth odors Oral hygiene. Wasting disease of the teeth Hypersensitivity Tooth mobility Trauma from occlusion Proximal contact relations Sensitivity to percussion Dentition with the jaws closed Periodontal assessment Palpation

Examination of the periodontium

Plaque and calculus Gingiva , gingival index and sulcus bleeding index.

Microbial analysis

Periodontal pocket


RadiographicalRadiographic changes

wedge shape radiolucent

reduced height

progressively reduced hight

PHASE I THERAPY
It is the first step in the procedure that constitute periodontal treatment.

It is achieved by:1. Complete removal of calculus2. Correction of defective restoration3. Treatment of carious lesions4. Institution of a comprehensive daily plaque control regimen

Phase I therapy has many specific goals:1. Evaluation patient.2. Plaque control.3. Removal of microbial plaque.4. use of antimicrobial agents

5. Control or eliminating of contributing local factors which including:a) restorationsb) prosthetic devicesc) carious lesiond) Odontoplastye) Tooth movementf) food impaction areasg) occlusal traumah) hopeless teeth

Refer to specialist:1. Extent of disease . 2. Root length 3. Hypermobility4. Difficulty of scaling and root planning5. Restorative work6. Age of the patient7. Resolution by shrinkage.


Plaque control
A) Self-performed plaque control 1. Tooth brushing 2. Interdental cleaning aids 3. Chemical plaque control

Tooth brushing methods

1. The roll method (modified stillman technique) 2. Vibrating method (bass,stillman,charter technique) 3. Circular method (the fones technique) 4. Vertical method (the leonard technique) 5. Horizontal method (the scrub technique)

Bass method

The modified stillman method:

Charter method

Powered toothbrushes 1. Children 2. mental disabilities 3. Hospitalized patients 4. fixed orthodontic appliances

2. Interdental cleaning aids

Chemical plaque control

Scaling and root planning 

Scaling: It is removal of plaque and calcified deposits from the crown of the tooth. Root planning: it is removal of plaque and calcified deposits from the root surface of the tooth, removal of altered cementum from subgingival root surface and debridement of the soft tissue lining the pocket.



Scaling and curettage instruments Sickle scaler used to remove supragingival calculus.

Currettes

Ulterasonic and sonic

Periodontal endoscope

Cleansing and polishing instruments

effective instrumentation is governed by:

1) Poroper position 2) optimal visibility 3) Sharp and clean instruments 4) Knowledge of instrument design 5) Proper grasp 6) Maintaining a clean field. 7) Instrument stabilization.

Supra and sub gingival irrigation

Chemotherapeutic agent
Chemotherapeutic agents: chemical substances that provides a clinical therapeutic benefit.

Guidelines for use antibiotics in periodontal therapy:

1. Clinical diagnosis 2. Continuing disease activity 3. microbiological sampling 4. periodontal surgery 5. patient's medical status. 6. not be used as a monotherapy.


Tetracycline 
reduce collagen and bone destruction as well as the antibiotic effect Tetracycline used as adjunctive in treatment of localized aggressive periodontitis ((doxycycline 100mg twice daily the first day then 100mg once daily for one week))

Metronidazole

Clinically used to treat gingivitis, acute necrotizing ulcerative gingivitis, chronic periodontitis and aggressive periodontitis.250mg twice daily for one week.