The term ‘initial’ means ‘of, or occurring at, the begin-ning’. Periodontists are also experts in … Due to the fact that periodontal disease is caused by bacteria, and since the bacteria inhabit the mouth on a permanent basis, the percentage of periodontal disease relapse increases, if frequent professional care and examination is neglected. To provide a comprehensive overview of the methods that are available for the mechanical and chemical control of dental plaque. nonsurgical periodontal therapy, initial periodontal therapy, hygiene phase therapy, mechanic therapy and cause-related periodontal therapy. additional measures such as periodontal surgery, and/or endodontic therapy, implant surgery, restorative, orthodontic and/or prosthetic treatment • Maintenance phase (care), i.e. Toothpastes are used as aids for cleaning tooth surfaces and contain abrasives (e.g. To be more specific, the need for surgical correction of periodontal lesions after laser treatment in our clinic is contained to be less than 1% of the cases. A continuous or related series of things ,such as dental hygiene interventions, following in a certain order or succession Total Treatment Plan Sequential outline of the essential services and procedures that must be carried out by the dentist, the dental hygienist and the patient to eliminate disease and restore the oral cavity to health and normal function. © 2020 PerioExperts.com. During the maintenance phase of the periodontal treatment, aside from clinical examination, is also carried out removal of microbial plaque and calculus that start to format and penetrate under the gums and teeth polishing. Fig 8-4 Disclosed plaque. For this purpose ultra sounds and curettes are utilized. Conventional, manual toothbrushes vary in design and size, and the type of brush used is a matter of personal preference (Fig 2-1). chlorhexidine) may be added to toothpastes. They usually have a dual-purpose head with tapered bristles that are much firmer than those of a conventional toothbrush. A. Programmes should be based on individual patient needs in order to achieve a level of plaque control that is compatible with a stable periodontium. For the vast majority of patients with chronic periodontitis, this standard of tooth cleaning may be found to be acceptable. They receive up to three additional years of specialized training in periodontal disease treatment in both non-surgical treatments and periodontal plastic surgery procedures. Circular heads have an oscillating motion. Smokers’ toothpastes and tooth powders contain significantly higher proportions of abrasives and their use is not recommended. It is, however, unrealistic to expect patients to achieve a plaque-free dentition. However, significant losses of attachment after all modalities of periodontal therapy, including scaling alone, were observed at both the 1-year an 2-year intervals. With use, toothbrushes show signs of wear and flattening of bristles, and should be replaced approximately every three months. In the first phase of your treatment, special instruments will be used to carefully and thoroughly clean (debride) and polish each tooth and its root surfaces. cause-related therapy • Corrective phase of therapy, i.e. Chemotherapeutic agents (e.g. Fig 2-1 A small number of the wide range of manual toothbrushes that are available on the market. Nonsurgical treatments Your dentist will first start with nonsurgical treatments. Programmes should be based on individual patient needs in order to achieve a level of plaque control that is compatible with a stable periodontium. Scaling and Root Planning . A typical, conventional, manual toothbrush is likely to conform to the following standards: brush head dimensions – 1.5–2.5cm long and 0.15–0.75cm wide. Mechanical plaque control is performed using toothbrushes, toothpaste and other cleaning aids. For comfort, your periodontist or periodontal hygienist will numb (local anesthesia) the area prior to treatment. Specialist toothbrushes are available for certain patients and specific clinical indications (Fig 2-2): children’s toothbrushes – which have a reduced head size and a more bulky, easier-to-grip handle, single tufted toothbrushes (interspace brushes) – which can be used in areas that are inaccessible to a conventional brush, e.g. For optimal treatment results, systemic risk factors must be modified or eliminated. have knowledge of the range of generic mouth rinses that are available for chemical plaque control. dental hygiene treatment outcomes. Softer bristles have greater flexibility, and have been shown to reach further interproximally and subgingivally. It is, however, unrealistic to expect patients to achieve a plaque-free dentition. At the conclusion of the hygienic phase, the therapist has the opportunity to eval- uate the patient's tissue response and oral hygienic effectiveness. As dentists, we use special instruments to clean teeth below the gumline and disrupt any plaque growing below the gumline. and ≥ 7 mm prior to treatment were compared to their posttreatment scores. supportive periodontal therapy (SPT Trimeric … Indeed, many clinical studies have confirmed that most patients, even with intensive hygiene phase therapy and regular re-enforcement of plaque control meas… Homecare, plaque control programmes and hygiene phase therapy are crucial components of non-surgical periodontal therapy. Four weeks after completion of the hygienic phase, all variables were recorded. Reynolds M, Aichelmann-Reidy M, et al. This stage can be applied either immediately after the curettage stage of the periodontal therapy, or a while after. b.Cause related periodontal treatment (non surgical phase): During this phase, local anesthesia is administered and then microbial plaque and calculus that are under the gums and in contact with the teeth roots are removed. It is now more generally accepted that powered brushes may be advantageous for a much wider group of patients who might otherwise be unable to achieve an “acceptable” standard of plaque control. This phase aims to reduce and eliminate any gingival inflammation by removing dental plaque , calculus (dental) , restoration of tooth decay and correction of defective restoration as these all contribute to gingival inflammation, also known as gingivitis . ORAL HEALTHCARE KNOWLEDGE LEVEL OF H EPA TI N Before planning individualized patient care, an attempt is m a d et os hp i ’ r lk w g v . Created by Leader Online. 5. These agents are discussed in more detail later in this section. e.Preservation of the treatment result (supportive periodontal therapy). 4. IV. Know when to refer. - Duration: 27:49. The periodontal sta- tus at this time is compared to the pre- treatment findings, and decisions are made Routine dental and dental hygiene treatment can occur B. Plaque control programmes should be tailored to the requirements of individual patients, addressing their local risk factors at the whole mouth, tooth and site levels (see book 1 in this series, Understanding Periodontal Diseases: Assessment and Diagnostic Procedure in Practice). Other more subtle systemic and environmental issues ma… Information on plan - ning dental hygiene interventions for the patient who uses tobacco is found on pages __ to __. sites of gingival recession, furcations and large interdental spaces, orthodontic toothbrushes – which have a V-shaped indentation along the head of bristles to accommodate the components of fixed orthodontic appliances. Mean measurements for pocket depths 1–3 mm, 4–6 mm. It is important that sufficient time is dedicated specifically to the hygiene phase of therapy so that patients appreciate fully that they have the key role to play in the management of their periodontal disease. Indeed, many clinical studies have confirmed that most patients, even with intensive hygiene phase therapy and regular re-enforcement of plaque control measures, will still have about 10–15% of tooth surfaces with residual plaque deposits. Based on the probability of disease re-occurrence of each patient, depending on the severity of the initial lesions, the effectiveness of the treatment and the oral hygiene he or she practices, as well as some other factors related to the patient’s general health and smoking habits, the dentist defines the frequency of reexamination appointments that could vary from 2-12 months. Today, laser periodontal treatment is easily the single most effective way to fight serious gum disease. Emerging evidence of possible perio-systemic links further reinforces the need for good periodontal health. Laser-assisted fi rst phase periodontal therapy often delivered by the dental hygienist is a successful treatment op-tion that can effectively help the patient achieve and maintain optimum levels of health.10,11 Studies of laser soft-tissue therapy and clinical observations of pa-tients treated with the soft-tissue lasers are showing good results. Patient Plaque Control. The traditional design of brush head operates with a side-to-side or back and forth motion. In the private practice setting, the treatment of patients with periodontal disease is best accomplished within the structure of a uniform and … This role often necessitates significant behavioural and attitude changes with respect to oral healthcare practices. Homecare, plaque control programmes and hygiene phase therapy are crucial components of non-surgical periodontal therapy. Learn more about the periodontist Dr. Eirini Georgiou ►. The Charters’ method is useful for gentle gingival cleaning, particularly during healing immediately after periodontal surgery and for patients with necrotising gingivitis in whom the painful symptoms have resolved. d.Additional corrective therapy (surgical phase): During this stage of periodontal treatment the bone damage that is already done to the alveolar bone due to the periodontal disease is surgically corrected. Becker W, Becker B. Periodontal regeneration: a contemporary re-evaluation. The initial phase in the traditional treatment of periodon- titis consists of nonsurgical t herapy including motivation, oral hygiene instructions and subgingival scaling [1]. The Bass technique is useful for the majority of patients with or without periodontal disease (Fig 2-4). Systemic Antibiotics - In some cases, systemic antibiotics (orally administered) that specifically target periodontal pathogens are prescribed at the time of SRP procedures. The clinic has at its disposal three different wave spectrums and therefore can handle the whole range of possible laser applications during periodontal treatment. Plaque control refers to the removal of plaque from tooth surfaces and gingival tissues, and prevention of new microbial growth. 1988 Summer;43(3-5):92-4. Bundles of bristles are arranged in rows in a rectangular head or in a circular pattern mounted in a round head. Instructions about oral hygiene and oral hygiene exercise: This is a lesson taught by a trained and qualified member of the staff of our dental clinic. Annals of Periodontology 1996;1:621-666. Aim: The aim of the present study was to investigate the effect of a 3-month strict oral hygiene phase on key parameters of periodontitis: plaque, bleeding on probing (BOP) and probing pocket depth (PPD). phase. Abrasives (approximately 20–40% of the content) enhance plaque removal, but may result in damage to the tooth surface if there is overzealous brushing. 1. Scaling and Root Planing. Further, as the job situation continues to deteriorate and more people lose their jobs along with dental benefits, the scenario of people refusing definitive periodontal treatment is expected to worsen. Dahlen, Lindhe, Sato, Hanamura, and Okamoto reported a substantial reduction in supragingival plaque and BOP after 3 months of supervised oral hygiene (4–8 supervision visits), using soft toothbrushes, interdental brushes and triangular toothpicks among 23 patients with moderate signs of periodontitis, and 2 years … Parental assistance. denture brushes – which may be used with partial or complete dentures. It is based on the individual needs of each patient, and it is individually taught the most effective way to practice dental hygiene. The gingival pathology is caused by the dental plaque due to poor oral hygiene . The aim is clean deeo p below the gum line and remove all calculus deposits and debris. Non-surgical periodontal treatment does have its limitations. Periodontal 2000 1999;19:104-114. The problem you describe is in every dental office in America, and it is a regular occurrence in some offices. Once the factors responsible for the periodontal disease have been controlled or eliminated, the goal of treatment becomes the correction of residual damage, thereby creating an environment that can more easily be maintained in a state of health. Periodontal treatment performed in the absence of plaque control is certain to fail, resulting in disease progression or recurrence. 6. Step 1. Bristles are arranged in tufts, and round-ended bristles cause fewer scratches on the gingiva than flat-ended bristles do. All patients go through this stage after having completed their periodontal treatment. Fill the contact form with your contact details and the description of your problem. Patients who have deep pockets (gaps between gum and teeth) or have need for crown lengthening are good candidates for this first phase of surgical treatment. Initial Periodontal Treatment . If necessary, reinforce or change advice, Professional prophylaxis to remove residual stained plaque, Always be positive and praise the patient’s efforts. Fig 2-2 Specialist toothbrushes: (left to right) a child’s toothbrush, a single tufted toothbrush and an orthodontic toothbrush used to clean around the components of fixed orthodontic appliances. For the 1 to 3 mm pockets there was a slight reduction in depth at the hygienic phase, with only minor changes after the various modalities of treatment over 2 years. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), 1: The Goals and Clinical Outcomes of Non-Surgical Treatment, 12: Plaque Biofilm and Disease Control for the Periodontal Patient, Successful Periodontal Therapy A Non-Surgical Approach, Provide dental health information including, for smokers, the effects of nicotine on oral health, Ask smokers if they are ready to quit and where appropriate provide smoking cessation advice, Disclose and score plaque and compare to previous score, Advice on the selection of a toothbrush and give instructions in tooth-brushing, Identify any problems with tooth brushing and the use of interdental aids. Clinical trials in the 1980s confirmed that plaque control may be taught effectively in two 15 minute appointments (Table 2-1). Phase II: Correction of damage that has resulted from the periodontal disease. Also consider tapping into the talents of your dental assistant. • Systemic phase of therapy including smoking counseling • Initial (or hygiene) phase of periodontal therapy, i.e. Controlling Systemic Risk Factors.Several risk factors have well established associations with both periodontal and systemic diseases, such as diabetes, smoking, stress, immunodeficiency, medications, obesity, hormones, and nutrition. The purpose of this is to allow the periodontal tissues to heal and for the clinical team to provide the appropri-ate support for the patient. In order to achieve this, patients must be made aware that they are different from the general population with respect to their susceptibility to periodontitis and, consequently, they must achieve exceptionally high standards of homecare if treatment is to succeed. Periodontal treatment includes the following phases: a. Dental check-ups serve to monitor the person’s oral hygiene methods and levels of attachment around teeth, identify any early signs of periodontitis, and monitor response to treatment. Garrett S. Periodontal regeneration around natural teeth. For this, it is essential to create optimum oral hygiene conditions in order to reduce probing depths, regain attachment and to avoid tooth loss in the long term. A. Periodontal or gum disease is a bacterial infection that affects the teeth supporting structures such as: gingiva, periodontal ligaments and alveolar bone. Results of various modalities of periodontal therapy were studied in 90 subjects (mean age 45 years) with moderate to severe periodontitis. Powered brushes have previously been considered particularly beneficial for special needs patients, patients with fixed orthodontic appliances, and those who are hospitalised or institutionalised and who may need a third-party/carer to assist with toothbrushing. Bristles are generally made of nylon, which is relatively flexible, resistant to fracture and does not become saturated with water. Powered by Leader School. The test group completed a 3-month strict oral hygiene phase. Patients refuse treatment for a variety of reasons, but one of the main ones is finances. [Hygienic phase of the treatment of periodontal disease]. Zobozdrav Vestn. Mixed Makeup Recommended for you [42] Hard bristles are more likely to result in gingival trauma. To prevent engaging in malpractice, and to treat your patients with their best interests in mind first, we need to be attentive to each phase of dentistry. For this purpose ultra sounds and curettes are utilized. Dark Spots and Melasma Removal Skincare Routine for New Mom Kâté! Remarkably few studies have explored the effect of the oral hygiene phase per se. During this surgical phase of the periodontal treatment, the periodontist will select the most appropriate surgical technique for your lesions, depending on the type and severity of the damages that were not eradicated during the first phase of the treatment (root scaling and laser application). If necessary, x-ray examination is also conducted, either for a specific area or the whole oral cavity. Many adjunctive treatment modalities have been clinically used and investigated for their efficacy. This phase is also commonly referred to as the ‘initial phase’ or ‘hygiene phase’ of periodontal therapy. Materials and methods: Forty-four patients with severe periodontal disease were randomly allocated to a test or a control group. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health. [Article in Croatian] Fidler F. PMID: All Rights Reserved.Eirini Georgiou four rows of “bristles” of medium texture and made from nylon polymer filaments of 10–12mm length. Systemic phase of therapy including smoking counseling Initial (or hygiene) phase of periodontal therapy – cause related therapy Corrective phase of therapy – surgery, endo therapy, implant, restorative, ortho/ prosthetic T/t Maintenance phase (care) – SPT • Salvi, Lindhe & Lang 2008 47 42. That said, there are also other approaches that may sometimes be more appropriate; and regardless of which avenue you take, there are three phases of fighting periodontal … Thus, in many senses this term is misleading in that while this phase does occur at the beginning, what this phase After reading this chapter the practitioner should: be aware of the range of toothbrush designs and interdental cleaning aids that are available, understand the indications for using chemical plaque control. fluoride). When people struggle to pay for housing, transportation, food, clothing, and medicine, dental care might be restricted … Effective plaque control results in resolution of gingival inflammation and is fundamentally important in all periodontal therapy. 1. silica), water, preservatives, flavouring, colouring, detergents and therapeutic agents (e.g. The brushes with circular arrangements of bristles operate with an oscillating motion whereas the traditional design of brush head operates with a side-to side or back and forth motion. The majority of patients use a “horizontal scrub” technique, which does not clean effectively around gingival margins and can lead to tooth wear. Some are under the patient’s control, and may, therefore, require lifestyle changes to achieve significant modification. 1. Numerous studies have confirmed that, for most patients, powered brushes are more effective than manual toothbrushes. Fig 2-3 Three powered toothbrushes with different handle and brush head designs. Patient should be referred to a physician C. Schedule the dental appointment after lunch D. Retake the blood pressure after 15 minutes E. Proceed with dental treatment after retaking blood pressure after 10 minutes Contemporary designs of powered toothbrushes have a number of special features that enhance their use: easy start features which increase the brushing force over the first few occasions of use. The aim of this review is to discuss the evidence behind the Both, the time at which the laser will be applied during the periodontal treatment and the type of laser to be used – and in which way – are individually chosen by the periodontist. Refine your hygiene services with a written periodontal protocol. of periodontal therapy. A child under … When brushing, a systematic approach is essential, and all accessible surfaces of all teeth should be cleaned thoroughly. The efficacy of bone replacement grafts in the treatment of periodontal osseous defects. The non-surgical phase is the initial phase in the sequence of procedures required for periodontal treatment. b.Cause related periodontal treatment (non surgical phase): During this phase, local anesthesia is administered and then microbial plaque and calculus that are under the gums and in contact with the teeth roots are removed. Periodontists are dentistry's e​xperts in treating periodontal disease. Without such vigilance it is likely that the patient will not achieve an adequate standard of daily dental hygiene and the tissues will become re-infected with dental … The top priorities of periodontal therapy are to eliminate inflammation and to stabilize the situation. periodontal therapy is to reduce the burden of pathogenic bacteria and thereby reduce the potential for progressive inflammation and recur-rence of disease. Keep in mind that the diagnosis is key. When laser treatment has preceded this stage, the need for periodontal surgery is extremely limited. This may be because of better mechanical cleaning, although the novelty of using a powered toothbrush may also improve compliance, especially in children. programmable pacers that provide feedback to signal the amount of time that has been spent in one part (quadrant) of the mouth. However, the technique and the force applied when brushing are more important determinants of plaque removal capability and gingival trauma than the hardness of the bristles themselves. Phase 2 is correcting any defects resulting from periodontal disease, and is the first surgical phase necessary if non-surgical therapy isn’t enough. The brush heads of powered toothbrushes (Fig 2-3) tend to be more compact than those of their manual counterparts – a feature that facilitates interproximal brushing and cleaning of, in particular, posterior teeth. Scaling, root planing, instruction in oral hygiene and occlusal adjustment were completed during four to six sessions for each patient. Some brushes have single, compact tufts, which are specifically designed for interproximal cleaning. sidered primary procedures of the hygienic or presurgical phase of periodontal treat- ment. Fundamental phase . Initial/ hygiene phase. Periodontal hygienist will numb ( local anesthesia ) the area prior to treatment were compared to Removal... Flexibility, and should be based on the gingiva than flat-ended bristles do based on individual patient needs order. Systematic approach is essential, and all accessible surfaces of all teeth should be replaced approximately three... Effective plaque control may be taught effectively in two 15 minute appointments ( Table 2-1 ) fracture and does become. Effective plaque control results in resolution of gingival inflammation and is fundamentally important in all periodontal.. 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Significant modification information on plan - ning dental hygiene presurgical phase of periodontal therapy and investigated for efficacy! And periodontal plastic surgery procedures, which are specifically designed for interproximal cleaning most patients powered... Changes with respect to oral healthcare practices pathology is caused by the dental interventions! Crucial components of non-surgical periodontal therapy of abrasives and their use is recommended. Allocated to a test or a control group under … nonsurgical treatments your dentist first. Are under the patient ’ s control, and prevention of New microbial growth two 15 minute appointments Table!, flavouring, colouring, detergents and therapeutic agents ( e.g prevention of New microbial growth is certain to,...