Periodontics & Restorative

• Tissues treated by periodontist

  • gingiva
  • cementum
  • periodontal ligaments
  • alveolar bone
• Symptoms a periodontist is interested in

  • bleeding gums
  • unpleasant breath which persists
  • loose soft gums (red instead of pale pink in color)
  • separation of teeth from gums/teeth changing positions (mobile, drifting, loose)
  • pus appears when gums are pressed
• Periodontal disease is the most common cause of tooth loss in adults
• Gingivitis


  1st stage of periodontal disease
• Symptoms of gingivitis


  • redness
  • tender
  • swollen gums
  • increased heat
  • disturbance of function
• Periodontitis


  2nd stage of periodontal disease (laymen's term pyorrhea - means flow of pus)
• Symptoms of periodontitis


  • Inflammation spreads around roots
  • gums become separated from teeth
  • pockets appear which collects food, calculus, bacteria and pus
• Causes of Periodontal Disease

  • Plaque
  • calculus
  • inadequate nutrition
  • malocclusion
  • missing teeth
  • bruxism
  • worn out restoration (crns, brgs, partial, old fillings)
• Periodontal abscess


  Usually found in a periodontal pocket
• Methods for treating periodontal problems

  • Root planing-removal of softened or rough cementum from surface of root
  • Gingival Curettage-scraping of soft tissue wall of gingival pocket, removing inflamed tissue
  • Gingivoplasty-surgical recontouring of gingiva that has lost its outer form
  • Gingivectomy-excision of soft tissue wall of gingival pocket
• Instructional/Educational Aids


  • Study models
  • films
  • slides
  • photographs
  • x-rays
  • pamphlets
  • posters
  • practice aids such as models or samples of teeth, cms, brgs, and dentures
  • Intra oral camera
• Good home care and regular recalls are required to prevent the re-occurrence of periodontal disease
• 6M R/C allows for early detection and easier, less costly treatment
• Generally recalls should be done every 6 months but it depends on the patients need
• Restorative dentistry


  Concerned with preventing, restoring, replacing defects in enamel and dentin of teeth
• Reasons restorations may be required

  • caries
  • trauma
  • impaired function
  • abrasion or erosion
• Areas most susceptible to caries

  • proximal surfaces
  • gingival areas
  • occlusal pit and fissures
  • all other areas covered by plaque
• Attrition


  Natural/gradual wearing away by abrasive forces. Eg. bruxism
• Abrasion


  Mechanical wearing away by friction by a foreign object. Eg. Opening bobby pins, hard tooth brush
• Erosion


  Chemical process that does not involve bacteria, affects gingival third of vestibular surfaces on maxillary incisors. (facial) Eg: coke, lemons, vomit
• The loss of one tooth often leads to the loss of other teeth, periodontal disease, impaired mastication and poor appearance
• Inlays


  Involve 1-3 surfaces, are often MI DI involved, made at lab, does not involve a cusp
• Onlays


  Involve replacement of one or more cusps must show MOD caries (posterior teeth)
• Reasons dental cements are used

  • Pulp capping
  • Temporary filling material
  • Medicated bases
  • Permanent cement
  • Root canal filler
  • Cavity liners
• Veneers


  Lab made shell like covering used on heavily stained teeth
• Composites


  Restorations made of resin that are bonded to teeth using ultra violet light to set resin
• Uses of composites


  • cover staining
  • repair chipped broken or eroded areas
  • recession on teeth
  • change the size or shape of teeth
  • close a diastema
  • replace posterior amgs
• After treatment is completed, the work performed needs to be entered on the patients chart
• TMJ Syndrome symptoms

  • headaches upon awakening
  • tenderness; pain in/around ear spreading to face
  • clicking popping grating sounds when opening/closing
  • pain or difficulty chewing yawning opening wide
  • jaws that get stuck or locks
  • earache or pain when no infection is present
  • dizziness
• Most common causes of TMJ syndrome

  • oral habits
  • malocclusion