Periodontology

• Periodontitis

  Irreversible sequel to gingivitis. Caused by plaque bacteria.

  Inflammatory disease that involves:

  • Gingiva
  • Periodontal ligament
  • Cemetum
  • Alveolar bone.
• Periodontitis

  Damage pattern e.g.

  • Pocketing
  • Gingival recession.

  Damage exacerbates the problem.

  Extraction eventually required.

  Can not get periodontitis without gingivitis.

  May remain only as gingivitis. Multifactorial disease process. Can slow or arrest this disease by effective plaque removal.
• What are the systemic predisposing factors to periodontal disease

  Underlying disease

  Immune compromise

  Identification:

  • History
  • Examination
  • Blood biochemistry and haemotology
  • Urinalysis
  • Viral testing
• What are the local predisposing factors to periodontal disease

  Site specific disease

  Plaque trapping:

  • Calculus
  • Overcrowd
  • Gingival abnormalities
  • Foreign bodies
  • Trauma
• Complication of periodontal disease - local extension


  Adjacent teeth

  Abscess

  Osteitis

  Osteomyelitis

  Stomatitis

  Ulceration

  • E.g. contact/ ’kissing’ ulcers.

  Faucitis.
• Complication of periodontal disease - systemic extension

  Bacteraemia

  Dissemination to organs (kidneys, heart, liver).

  Pregnancy, performance etc.
• Periodontal therapy - prevention

  This is the best option.

  Oral hygiene and homecare
• Periodontal therapy - scaling


  Debulk calculus:

  • Hand scale
  • Calculus forceps.

  Scale:

  • Hand - difficult, technical, slow. Scaler is supragingival. Curette = supra and subgingival.
  • Rotary - destructive do not use.
  • Sonic - slow.
  • Ultrasonic - fast, efficient but heating.
• Periodontal therapy - polishing

  Plaque biofilm removal

  Smoothing

  • Low speed
  • Soft cup
  • Sub-gingival flare
  • Fine paste
• Periodontal therapy - flushing/ irrigation

  Flush

  • Paste (inhibits healing).
  • Calculus

  Chlorehexidine prep pre-op.
• Periodontal therapy - homecare

  Prevent/ treat = plaque removal.

  Homecare most important aspect.

  Brushing = gold standard

  • Soft-medium bristle brush.

  Daily
• Periodontal therapy - Other homecare aids

  Mouth wash - chlorhexidine 0.12%

  Chews

  • 5 minutes + - saliva, exercise
  • Avoid damage - bones, antlers.

  Dental diets:

  • Plaque removal
  • Fibrous and size

  Powders, gels, tablets - probably don’t work that well, not much evidence.