describe the various types of nonsurgical periodontal therapy

by on December 2, 2020

As the understanding of plaque biofilm as the pathologic agent has grown, various periodontal diseases have been identified with specific microbial organisms. The dental hygienist must develop a tactile sense that permits detection of obvious calculus on the teeth. Repair after disruption of the junctional epithelium during scaling procedures (not removal, which occurs with surgical excision) is similar to the normal course of events in tissue turnover. Root planing is defined by the AAP as “a treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms.”6 This procedure focuses not on identifiable deposits of calculus but on the entire root surface associated with the periodontal pocket. Stains on the teeth are generally considered harmless, so their removal is secondary to the therapeutic and preventive goals of the dental hygienist. The goals of nonsurgical periodontal therapy must be considered in terms of the immediate treatment goals at the time of the appointment and the long-term goals for the patient. During periodontal debridement procedures, the goal for the dental hygienist is to promote plaque biofilm control and instrument the tooth surfaces until they are clean and smooth, touching all portions of the roots to disrupt plaque biofilm and remove calculus. Inflamed pocket lining is composed of thin ulcerated strands of epithelium, with rete pegs extending into the underlying connective tissue and granulation tissue containing disorganized masses of cells. It works by mechanical abrasion using a slurry of sodium bicarbonate and water. The American Academy of Periodontology (AAP) defines scaling as “instrumentation of the crown and root surfaces of the teeth to remove plaque, calculus, and stains from these surfaces.”4 However, subgingival scaling is also referred to as simply the removal of subgingival calculus3 or the more general term, subgingival deposits.5 Scaling is most commonly thought of as the removal of identifiable deposits of calculus, but associated plaque biofilm deposits are also removed during the procedure. Although these features are primarily plaque biofilm control problems, the dental hygienist should recognize them, design specific plaque control measures, and refer patients for further treatment. Because of the fragile state of healing connective tissues, probing after treatment should be avoided for 4 weeks.17. Figure 1: Pre-treatment radiographs. In 1976 Wilkins, in her fourth edition of Clinical Practice of the Dental Hygienist, introduced the idea of selective polishing and encouraged this modification in treatment.9 She stressed the critical importance of teaching personal plaque biofilm control rather than performing polishing during the appointment because of the limited amount of time the dental hygienist has with each patient. The power and powder-to-water ratio is controlled with a foot pedal and can be increased or decreased as needed. Although some periodontal destruction has been observed in germ-free (gnotobiotic) animal experiments, it tends to be localized and related to the impaction of foreign objects, such as hairs. 6. • Discuss the use of lasers in nonsurgical therapy. Treatment frequently requires the use of pain control measures. The goals of nonsurgical periodontal therapy must be considered in terms of the immediate treatment goals at the time of the appointment and the long-term goals for the patient. These new microbiota are similar to those found in, 17: Periodontal Maintenance and Prevention, 5: Calculus and Other Disease-Associated Factors, 10: Treatment Planning for the Periodontal Patient, 18: Prognosis and Results After Periodontal Therapy, Periodontology for the Dental Hygienist 4e, Oral hygiene instruction for daily plaque biofilm control, Significant component of periodontal debridement biofilm, Supragingival and subgingival plaque biofilm removal, Instrumentation techniques to remove or disrupt subgingival biofilm, Identification of plaque-retentive factors, Referral for treatment of plaque-retentive conditions such as poorly fitting restorations and malpositioned teeth, Instrumentation techniques to alter the environment of the pocket wall, if necessary, Identification of occlusion-related factors affecting the periodontium, Selective procedure for supragingival plaque and stain removal, Locally or systemically delivered antimicrobial, antiseptic and antiinflammatory medications, CALCULUS AND BIOFILM REMOVAL (PERIODONTAL DEBRIDEMENT), Provide technique instruction and reinforcement, Ensure adoption of adequate daily oral hygiene procedures, Regular removal of new deposits at subsequent visits. Root roughness has been equated with incomplete instrumentation because of concerns that endotoxins (e.g., lipopolysaccharides) formed by gram-negative bacteria invade the root structure. 3. Even when teeth were instrumented for as long as 39 minutes each, residual calculus was noted regularly in deeper pockets, and totally clean surfaces were achieved only in the 3- to 4-mm range.19,20 Even the best instrumentation techniques leave some residual deposits on the teeth; however, these very small deposits were also present in the subjects of long-term studies used to verify the effectiveness of nonsurgical periodontal treatment, and they did not appear to cause the treatment to fail.2,3. Experience suggests that the roots in an individual patient’s mouth will feel equally smooth after thorough instrumentation. Local anesthetics are also used to numb the area for greater comfort. As plaque biofilm ages, the organic matrix and bacterial cells calcify. Caution must be exercised with this device to prevent damage to exposed root surfaces; thus, its application for periodontal patients is limited. Within 10 to 21 days, every subject had gingivitis, which resolved in about 1 week when oral hygiene practices were resumed. Inflammation and tissue destruction in conventionally raised animals with oral biota are vastly more widespread and severe.5. By Judy Carroll, RDH, and Howard M. Notgarnie, RDH, EdD. Describe the process of healing after periodontal debridement procedures, scaling, and root planing. periodontal disease treatment to Southern California and South County, Orange County

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describe the various types of nonsurgical periodontal therapy