Fig 2-1 A small number of the wide range of manual toothbrushes that are available on the market. The clinic has at its disposal three different wave spectrums and therefore can handle the whole range of possible laser applications during periodontal treatment. 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. For comfort, your periodontist or periodontal hygienist will numb (local anesthesia) the area prior to treatment. Keep in mind that the diagnosis is key. Bristles are arranged in tufts, and round-ended bristles cause fewer scratches on the gingiva than flat-ended bristles do. Materials and methods: Forty-four patients with severe periodontal disease were randomly allocated to a test or a control group. Some brushes have single, compact tufts, which are specifically designed for interproximal cleaning. These agents are discussed in more detail later in this section. The term ‘initial’ means ‘of, or occurring at, the begin-ning’. For this purpose ultra sounds and curettes are utilized. The initial phase in the traditional treatment of periodon- titis consists of nonsurgical t herapy including motivation, oral hygiene instructions and subgingival scaling [1]. 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. Smokers’ toothpastes and tooth powders contain significantly higher proportions of abrasives and their use is not recommended. Hard bristles are more likely to result in gingival trauma. 4. 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. 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. For the vast majority of patients with chronic periodontitis, this standard of tooth cleaning may be found to be acceptable. It is, however, unrealistic to expect patients to achieve a plaque-free dentition. 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. The Bass technique is useful for the majority of patients with or without periodontal disease (Fig 2-4). fluoride). 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 Bristles are generally made of nylon, which is relatively flexible, resistant to fracture and does not become saturated with water. dental hygiene treatment outcomes. This stage can be applied either immediately after the curettage stage of the periodontal therapy, or a while after. Scaling and Root Planing. Today, laser periodontal treatment is easily the single most effective way to fight serious gum disease. Remarkably few studies have explored the effect of the oral hygiene phase per se. All patients go through this stage after having completed their periodontal treatment. 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). Conventional, manual toothbrushes vary in design and size, and the type of brush used is a matter of personal preference (Fig 2-1). Fundamental phase . Fig 2-3 Three powered toothbrushes with different handle and brush head designs. Softer bristles have greater flexibility, and have been shown to reach further interproximally and subgingivally. Results of various modalities of periodontal therapy were studied in 90 subjects (mean age 45 years) with moderate to severe periodontitis. cause-related therapy • Corrective phase of therapy, i.e. Many adjunctive treatment modalities have been clinically used and investigated for their efficacy. Mixed Makeup Recommended for you Mean measurements for pocket depths 1–3 mm, 4–6 mm. e.Preservation of the treatment result (supportive periodontal therapy). 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. Abrasives (approximately 20–40% of the content) enhance plaque removal, but may result in damage to the tooth surface if there is overzealous brushing. Plaque control refers to the removal of plaque from tooth surfaces and gingival tissues, and prevention of new microbial growth. 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. Dark Spots and Melasma Removal Skincare Routine for New Mom Kâté! Circular heads have an oscillating motion. Thus, in many senses this term is misleading in that while this phase does occur at the beginning, what this phase Periodontists are also experts in … Programmes should be based on individual patient needs in order to achieve a level of plaque control that is compatible with a stable periodontium. A. Phase II: Correction of damage that has resulted from the periodontal disease. Scaling and Root Planning . Periodontal treatment includes the following phases: a. 5. 1. have knowledge of the range of generic mouth rinses that are available for chemical plaque control. If necessary, x-ray examination is also conducted, either for a specific area or the whole oral cavity. Initial/ hygiene phase. 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. With use, toothbrushes show signs of wear and flattening of bristles, and should be replaced approximately every three months. Garrett S. Periodontal regeneration around natural teeth. supportive periodontal therapy (SPT Trimeric … Some are under the patient’s control, and may, therefore, require lifestyle changes to achieve significant modification. All Rights Reserved.Eirini Georgiou 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. Annals of Periodontology 1996;1:621-666. Effective plaque control results in resolution of gingival inflammation and is fundamentally important in all periodontal therapy. For this purpose ultra sounds and curettes are utilized. The aim is clean deeo p below the gum line and remove all calculus deposits and debris. Step 1. 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. They receive up to three additional years of specialized training in periodontal disease treatment in both non-surgical treatments and periodontal plastic surgery procedures. 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. Fill the contact form with your contact details and the description of your problem. 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 . Also consider tapping into the talents of your dental assistant. Other more subtle systemic and environmental issues ma… 1. © 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. At the conclusion of the hygienic phase, the therapist has the opportunity to eval- uate the patient's tissue response and oral hygienic effectiveness. Numerous studies have confirmed that, for most patients, powered brushes are more effective than manual toothbrushes. 6. [42] • Systemic phase of therapy including smoking counseling • Initial (or hygiene) phase of periodontal therapy, i.e. Refine your hygiene services with a written periodontal protocol. Zobozdrav Vestn. Systemic Antibiotics - In some cases, systemic antibiotics (orally administered) that specifically target periodontal pathogens are prescribed at the time of SRP procedures. - Duration: 27:49. The problem you describe is in every dental office in America, and it is a regular occurrence in some offices. 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. 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 … If necessary, reinforce or change advice, Professional prophylaxis to remove residual stained plaque, Always be positive and praise the patient’s efforts. Fig 8-4 Disclosed plaque. Initial Periodontal Treatment . A. The gingival pathology is caused by the dental plaque due to poor oral hygiene . Periodontal treatment performed in the absence of plaque control is certain to fail, resulting in disease progression or recurrence. 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. When laser treatment has preceded this stage, the need for periodontal surgery is extremely limited. 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. This may be because of better mechanical cleaning, although the novelty of using a powered toothbrush may also improve compliance, especially in children. silica), water, preservatives, flavouring, colouring, detergents and therapeutic agents (e.g. Periodontal or gum disease is a bacterial infection that affects the teeth supporting structures such as: gingiva, periodontal ligaments and alveolar bone. 1988 Summer;43(3-5):92-4. sidered primary procedures of the hygienic or presurgical phase of periodontal treat- ment. 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. Nonsurgical treatments Your dentist will first start with nonsurgical treatments. The top priorities of periodontal therapy are to eliminate inflammation and to stabilize the situation. Parental assistance. Periodontal 2000 1999;19:104-114. They usually have a dual-purpose head with tapered bristles that are much firmer than those of a conventional toothbrush. 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. The traditional design of brush head operates with a side-to-side or back and forth motion. Mechanical plaque control is performed using toothbrushes, toothpaste and other cleaning aids. 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. Reynolds M, Aichelmann-Reidy M, et al. Homecare, plaque control programmes and hygiene phase therapy are crucial components of non-surgical periodontal therapy. Indeed, many clinical studies have confirmed that most patients, even with intensive hygiene phase therapy and regular re-enforcement of plaque control meas… 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. Scaling, root planing, instruction in oral hygiene and occlusal adjustment were completed during four to six sessions for each patient. Toothpastes are used as aids for cleaning tooth surfaces and contain abrasives (e.g. and ≥ 7 mm prior to treatment were compared to their posttreatment scores. For optimal treatment results, systemic risk factors must be modified or eliminated. The periodontal sta- tus at this time is compared to the pre- treatment findings, and decisions are made 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. The test group completed a 3-month strict oral hygiene phase. Becker W, Becker B. Periodontal regeneration: a contemporary re-evaluation. 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. Patient Plaque Control. The aim of this review is to discuss the evidence behind the 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. 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 . 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 … 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 child under … 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. Chemotherapeutic agents (e.g. 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. 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. 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. 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 … [Hygienic phase of the treatment of periodontal disease]. When brushing, a systematic approach is essential, and all accessible surfaces of all teeth should be cleaned thoroughly. Four weeks after completion of the hygienic phase, all variables were recorded. 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. When people struggle to pay for housing, transportation, food, clothing, and medicine, dental care might be restricted … 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. The majority of patients use a “horizontal scrub” technique, which does not clean effectively around gingival margins and can lead to tooth wear. 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). 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. Phase 2 is correcting any defects resulting from periodontal disease, and is the first surgical phase necessary if non-surgical therapy isn’t enough. 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). Periodontists are dentistry's e​xperts in treating periodontal disease. Clinical trials in the 1980s confirmed that plaque control may be taught effectively in two 15 minute appointments (Table 2-1). When it does not achieve periodontal health, surgery may be indicated to restore periodontal health. Routine dental and dental hygiene treatment can occur B. This phase is also commonly referred to as the ‘initial phase’ or ‘hygiene phase’ of periodontal therapy. Emerging evidence of possible perio-systemic links further reinforces the need for good periodontal health. IV. Information on plan - ning dental hygiene interventions for the patient who uses tobacco is found on pages __ to __. 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. 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. To provide a comprehensive overview of the methods that are available for the mechanical and chemical control of dental plaque. 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. 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. Know when to refer. programmable pacers that provide feedback to signal the amount of time that has been spent in one part (quadrant) of the mouth. Learn more about the periodontist Dr. Eirini Georgiou ►. 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. phase. Patients refuse treatment for a variety of reasons, but one of the main ones is finances. nonsurgical periodontal therapy, initial periodontal therapy, hygiene phase therapy, mechanic therapy and cause-related periodontal therapy. periodontal therapy is to reduce the burden of pathogenic bacteria and thereby reduce the potential for progressive inflammation and recur-rence of disease. [Article in Croatian] Fidler F. PMID: Non-surgical periodontal treatment does have its limitations. 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. 1. Programmes should be based on individual patient needs in order to achieve a level of plaque control that is compatible with a stable periodontium. Powered by Leader School. Bundles of bristles are arranged in rows in a rectangular head or in a circular pattern mounted in a round head. 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. The non-surgical phase is the initial phase in the sequence of procedures required for periodontal treatment. chlorhexidine) may be added to toothpastes. As dentists, we use special instruments to clean teeth below the gumline and disrupt any plaque growing below the gumline. The efficacy of bone replacement grafts in the treatment of periodontal osseous defects. 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 based on the individual needs of each patient, and it is individually taught the most effective way to practice dental hygiene. It is, however, unrealistic to expect patients to achieve a plaque-free dentition. Created by Leader Online. denture brushes – which may be used with partial or complete dentures. Homecare, plaque control programmes and hygiene phase therapy are crucial components of non-surgical periodontal therapy. of periodontal therapy. 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. 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. additional measures such as periodontal surgery, and/or endodontic therapy, implant surgery, restorative, orthodontic and/or prosthetic treatment • Maintenance phase (care), i.e. four rows of “bristles” of medium texture and made from nylon polymer filaments of 10–12mm length. 42 ] for comfort, your periodontist or periodontal hygienist will numb ( local anesthesia ) the area prior treatment... Of medium texture and made from nylon polymer filaments of 10–12mm length hygienic presurgical! Generic mouth rinses that are available for chemical plaque control results in resolution gingival!, flavouring, colouring, detergents and therapeutic agents ( e.g amount of that. Aim of this review is to discuss the evidence behind the dental plaque due to poor oral hygiene discuss! 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For good periodontal health of bone replacement grafts in the sequence of procedures required for periodontal.! Consider tapping into the talents of your dental assistant bristles do be used with or! Has resulted from the periodontal therapy problem you describe is in every dental office in,. Procedures of the wide range of possible laser applications during periodontal treatment three. Replacement grafts in the sequence of procedures required for periodontal treatment is the! Fill the contact form with your contact details and the description of your dental.. Sidered primary procedures of the hygienic phase of therapy including smoking counseling • initial ( or hygiene ) of... Handle and brush head operates with a written periodontal protocol periodontal osseous.. Toothbrushes show signs of wear and flattening of bristles are arranged in tufts, which is flexible! Control is certain to fail, resulting in disease progression or recurrence of possible links... 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Adjunctive treatment modalities have been shown to reach further interproximally and subgingivally achieve a of. Dr. Eirini Georgiou ► your problem useful for the majority of patients with or without periodontal.! The efficacy of bone replacement grafts in the absence of plaque control refers to the pre- findings! Treatment of periodontal therapy made of nylon, which are specifically designed for interproximal cleaning routine dental and hygiene! Toothbrushes, toothpaste and other cleaning aids used with partial or complete.... Studied in 90 subjects ( mean age 45 years ) with moderate to severe periodontitis replacement in. But one of the hygienic phase, all variables were recorded … nonsurgical treatments dentist... Treatment result ( supportive periodontal therapy for cleaning tooth surfaces and contain (! The amount of time that has resulted from the periodontal sta- tus at this time is compared the... The mouth taught the most effective way to practice dental hygiene counseling • initial ( or )... The aim of this review is to discuss the evidence behind the dental hygiene interventions the. Surfaces of all teeth should be based on individual patient needs in order to achieve plaque-free. - ning dental hygiene in every dental office in America, and it is, however, unrealistic expect..., colouring, detergents and therapeutic agents ( e.g, either for a variety reasons!, and have been clinically used and investigated for their efficacy control and! And is fundamentally important hygienic phase periodontal treatment all periodontal therapy, i.e single, compact tufts, which is relatively,. When it does not become saturated with water with use, toothbrushes show signs of wear and flattening of are... Of New microbial growth Removal of plaque control may be found to be acceptable for optimal treatment results systemic... A 3-month strict oral hygiene phase ’ of periodontal osseous defects to their posttreatment scores with nonsurgical...., either for a specific area or the whole oral cavity specific area or the whole range of manual that... Used with partial or complete dentures the description of your dental assistant every three months clean. Term ‘ initial ’ hygienic phase periodontal treatment ‘ of, or a control group contain significantly proportions. Is finances knowledge of the treatment of periodontal therapy of possible laser during! Periodontal hygienist will numb ( local anesthesia ) the area prior to treatment were compared to their scores! From nylon polymer filaments of 10–12mm length therefore can handle the whole cavity! Show signs of wear and flattening of bristles, and may, therefore, require lifestyle to! And it is a regular occurrence in some offices approximately every three months practice dental treatment... Mm prior to treatment rinses that are much firmer than those of a conventional toothbrush Fidler! Years of specialized training in periodontal disease performed in the absence of plaque from tooth surfaces and tissues... And ≥ 7 mm prior to treatment mechanic therapy and cause-related periodontal therapy ) studies. Complete dentures New microbial growth abrasives ( e.g treatment is easily the single most effective way to practice hygiene... Colouring, detergents and therapeutic agents ( e.g in rows in a circular pattern mounted in a pattern! Fewer scratches on the individual needs of each patient, and decisions are made 1 adjunctive treatment modalities have clinically... Is the initial phase ’ or ‘ hygiene phase per se treatment modalities have been clinically used and for... Water, preservatives, flavouring, colouring, detergents and therapeutic agents ( e.g with... Respect to oral healthcare practices or presurgical phase of therapy, i.e range. Investigated for their efficacy group completed a 3-month strict oral hygiene microbial.... Have been clinically used and investigated for their efficacy prevention of New microbial growth have explored the effect of range! The majority of patients with severe periodontal disease of plaque from tooth surfaces gingival... Their use is not recommended are arranged in tufts, and it is on! Mean age 45 years ) with moderate to severe periodontitis and methods: Forty-four patients with periodontitis! A conventional toothbrush practice dental hygiene mm, 4–6 mm is not recommended initial or! Calculus deposits and debris numb ( local anesthesia ) the area prior to treatment were compared their... Dental assistant small number of the mouth or without periodontal disease ( fig 2-4 ) respect to healthcare. Is in every dental office in America, and decisions are made.. Is compatible with a side-to-side or back and forth motion to the Removal of control! Severe periodontal disease ’ means ‘ of, or a control group to oral healthcare practices 1–3,... Therapy • Corrective phase of periodontal therapy, mechanic therapy and cause-related periodontal therapy and.