Transcript General treatment

Lecturer:
Levkiv Mariana
Department of Therapeutic
Dentistry
TSMU
General plan of periodontal
diseases treatment
General principles:
 Aetiological treatment
 Pathogenetic treatment
 Symptomatic treatment
Local treatment
 Removal of local irritation factorsIs aimed to remove local factors of irritationdental deposits, carious cavities, traumatic
occlusion.
Elimination of traumatic occlusion - selective
teeth grinding, temporary or permanent teeth
splinting.
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Removal of dental deposits
Oral hygiene
Treatment of caries and its complications
Orthodontic treatment
Prosthetic treatment
Anti-inflammatory treatment
Pharmacotherapy of microcirculatory
disorders
Influence on tissue’ metabolism
Stimulation of regeneration processes
Antibacterial treatment
Physiotherapy treatment
 Electropathy
 Hydro-treatment
 Massages
 Laser-treatment
General treatment
 To stimulate immune defense of
organism
 General-strengthening treatment
 General treatment of major diseases of
the body
 Diet-therapy
Oral hygiene
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The main goal of treatment is to control
the infection. The number and types of
treatment will vary, depending on the
extent of the gum disease. Any type of
treatment requires that the patient keep
up good daily care at home. The doctor
may also suggest changing certain
behaviors, such as quitting smoking, as
a way to improve treatment outcome.
1.Before conducting professional hygiene
2. After conducting professional hygiene
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Deep Cleaning (Scaling and Root
Planing)
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The dentist, periodontist, or dental hygienist
removes the plaque through a deep-cleaning
method called scaling and root planing.
Scaling means scraping off the calculus from
above and below the gum line. Root planing
gets rid of rough spots on the tooth root where
the germs gather, and helps remove bacteria
that contribute to the disease. In some cases
a laser may be used to remove plaque and
calculus. This procedure can result in less
bleeding, swelling, and discomfort compared
to traditional deep cleaning methods.
Dental Deposits removing with
the help of scaling
Tooth Cleaning by ultrasound
The ultrasound method is based on the
effect of cavitation: the tip of the tool,
pulsates with a frequency of 30000 cycles
per second: it is richly moistened with
water, is foamy and penetrates into
inaccessible areas, removing dental
deposits without damaging enamel or
tissues.
The hygienist closes the session with a
reminding on hygiene rules as well as
brushing and flossing methods with the
support of a model.
 Porcelain recommends a tooth cleaning
every 3 to 6 months. In the presence of
a bracket system, orthodontics plates,
implants or crowns, its frequency should
be every 3 month.
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The tip of the scaler is thin. When held against
the tooth, sound waves bounce off the tooth
and cause the calculus and plaque to break
up. The sound waves work so well that even
hardened plaque, also called calculus, breaks
up. The water coming from the scaler then
washes the broken debris away.
The Air-Flow (soda under pressure), airabrasive system contains water and soda. A
mixture of air, water and baking soda strikes
the surface of the tooth through a pressure
nozzle and removes plaque. Each particle of
the abrasive polymer is used which allows for
treatment without mechanical damage.
Medicamental treatment
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Is aimed to treat symptomatic gingivitis(catarrhal, ulcerative,
hypertrophic), periodontal pockets, elimination of
pathological microflora, to stimulate reparative processes in
periodontal tissues.
Anti-bacterial treatment (local) – is conducted, taken into
consideration the resistance of microflora.
Anti-inflammatory treatment - includes-etiotropic,
pathogenetic, symptomatical treatment:
Etiotropic treatment- consists in selecting, removing or
depressing the reasons that cause inflammation process.
Pathogenetic treatment- envisages influence of the
medications on the patho-physiological aspects of
inflammation process.
Symptomatically treatment- includes removing or
depressing main inflammatory symptoms.
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Stimulation of reparative processes- is aimed at restoration
of damaged and affected tissues of periodontium, healing
ulcers of periodontium tissues, and ulcers of the bottom of
periodontal pockets.
Means directed on improving metabolic processes in
affected periodontal tissues and stimulation of reparative
regeneration are used, in addition, they normalize the
dystrophic processes in the periodontium.
Keratoplastic drugs are used to improve epithelialization
processes, which completes scarring and regeneration of
periodontal pockets and ulcers.
Medications
Medications may be used with treatment
that includes scaling and root planing, but
they cannot always take the place of
surgery. Depending on how far the disease
has progressed, the dentist or periodontist
may still suggest surgical treatment. Longterm studies are needed to find out if using
medications reduces the need for surgery
and whether they are effective over a long
period of time. Here are some
medications that are currently used:
Medications
Prescription antimicrobial
mouthrinse
Antiseptic "chip"
Antibiotic gel
Antibiotic microspheres
What is it?
A prescription mouthrinse
containing an antimicrobial
called chlorhexidine
Why is it used?
How is it used?
To control bacteria when
It's used like a regular
treating gingivitis and after gum mouthwash.
surgery
A tiny piece of gelatin filled with To control bacteria and reduce After root planing, it's placed in
the medicine chlorhexidine
the size of periodontal pockets the pockets where the
medicine is slowly released
over time.
A gel that contains the
antibiotic doxycycline
To control bacteria and reduce The periodontist puts it in the
the size of periodontal pockets pockets after scaling and root
planing. The antibiotic is
released slowly over a period
of about seven days.
Tiny, round particles that
contain the antibiotic
minocycline
To control bacteria and reduce The periodontist puts the
the size of periodontal pockets microspheres into the pockets
after scaling and root
planing. The particles release
minocycline slowly over time.
Enzyme suppressant
A low dose of the medication
doxycycline that keeps
destructive enzymes in check
Oral antibiotics
Antibiotic tablets or capsules
To hold back the body's
enzyme response -- If not
controlled, certain enzymes
can break down gum tissue
This medication is in pill
form. It is used in combination
with scaling and root planing.
For short term treatment of an These come as tablets or
acute or locally persistent
capsules and are taken by
periodontal infection
mouth.
Physiotherapy
Electropathy
Direct current-electrophoresis, vacuumelectrophoresis
Pulsed current of low frequency and lowvoltage diadynamic, fluctuarization.
Pulsed –current of high, ultra and ultra
high frequency - darsonvalization,
diathermy, diathermocoagulation, UHFtherapy, microwave therapy.
Ultrasound therapy.
 Electro-phototherapy - UV - laser
therapy.
 Vacuum therapy.
 Hydrotherapy.
 Massage.
 Heat, and cold treatment.
 Magnetic therapy.
 Oxygen therapy.
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Physiotherapy is used in all forms and
stages of periodontal disease. Some of the
physical treatments are executed at the
beginning of treatment and reinforce the
effect obtained after therapy (removal of
dental plaque, closed curettage of gingival
pockets, scaling, Vector-therapy) and
surgical (open curettage, scrappy and
plastic surgery on the periodontium).
 A distinctive feature of physiotherapy is a
gradual, profound effect on the tissues, that
provides long-term positive results.
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In the acute phase of inflammation,
Porcelain prescribes infra-laser methods
which soften the gum while having an
analgesic and sedative effect. Infrared rays
improve local blood circulation and thus
accelerate the process of tissue
regeneration. Microwave therapy which is
based on the non thermal intensity of
electromagnetic waves is used for the rapid
removal of inflammation. EHF-therapy has
a strong bactericidal effect and reduces the
swelling of tissues and stimulates the
regeneration of tissues.
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Infrared laser is an equally effective
method, prescribed in the treatment of
acute gingivitis, while electrophoresis of
calcium chloride, vitamins, ascorbic acid
is particularly effective in the chronic
phase of the condition. Electrophoresis
is a low current electrical drug
administration method through the skin
and mucous membranes of the oral
cavity. It is particularly effective in the
rapid administration of antibiotics,
vitamins and enzymes into the
bloodstream and lymph systems.
In the chronic stage of gingivitis, Porcelain
recommends 2 to 3 sessions of physical therapy
annually spread across to 5 visits to the dentist. For
the treatment of periodontitis in its chronic course,
Porcelain uses d'arsonvalization which is a form of
electrophoresis with vitamins C and P. This is a highfrequency procedure which alternates between high
voltage and low power current. This method
contributes to the regulation of metabolic processes,
normalizes the excitation processes and removes the
feeling of pain. Electrophoresis of calcium chloride
and sodium fluoride and d'arsonvalization are also
used in the treatment of periodontitis. Physiotherapy
treatment have minimum of side effects are easy to
use and often rely on a variety of natural factors.
The Vector System
This is a specialized ultrasound system
for the treatment of periodontal
diseases. The unique features of the
system prevents painful surgical
procedures.
 Vector - therapy is an effective
preventive and therapeutic agent in the
early stages of periodontal disease –
gingivitis and periodontitis.
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The distinguishing feature of the Vector
system lies in the tool used and the tasks it
performs, such as the cleansing of cingulums
inflamed tissues and microbes. But, unlike the
manual curettage method, the principle of
vector is based on hydrodynamic effects: the
ultrasound energy is gently fed into the
pocket through the water jacket. The
combination of water pressure and ultrasonic
treatment washes and handles a pocket while
removing plaque with a water softening effect.
This non-contact tool also insures a safe and
secure procedure.
The energy of tool gently served to
periodontic pocket through water layer,
inflamed area intensively treated and
washed down to the bottom without the
formation of aerosol (spray).
 During this process the particle
suspension work as toothpaste
removing plague from most complex
areas.
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The Vector therapy system's
unparalleled performance results in
smooth and clean root surfaces and in a
significant reduction of bacteria that
leads to the formation of new
periodontal ligament of the tooth.
 The most stable result is achieved in the
combination of the Vector therapy with
physiotherapy methods.
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Surgical treatment
Curettage- open curettage, closed
curettage, vacuum curettage, cryocurettage
 Gingivotomy
 Gingivoectomy-simple, radically
 Flap operations
 Operations for the formation of
vestibulum oris-frenulotomiya,
frenulektomiya, plasty of vestibulum oris.
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Prosthetic treatment
With the help of various constructions of
splints and splint- dentures, stability of
movable teeth is provided, which
contributes to the effectiveness of
treatment of periodontal diseases.
The combination of different
therapeutic, surgical, prosthetic,
medication and physiotherapy methods
of treatment insure best results.
Thank you for your attention