dental pocket

dental pharmacology

1. Causes and treatment of periodontal pockets Supervisor : Dr.Ghadeer Al-jader By : Faisal suleiman Khaled Jasser Abdullah Yassin Shahid Ziyad

2. Introdection If your mouth is healthy, your gums should fit snugly around each tooth, with the distance between the gum tissues and its attachment to the tooth only one of three millimeters in depth but gum disease can lead to deeper spaces around the teeth called periodontal pocket , and if it untreated,these pocket can lead to tooth loss. But with early diagnosis and treatment, you can keep your teeth for a lifetime Gingiva and periodontal pocket ( also informally referred to as gum pocket) are dental terms indication the presence of an abnormal depth of gingival sulcus near the point at which the gingival tissue

3. Classification : dental pocket 1)Gingival pocket 2)Periodontol pocket +) Supragingival pocket. +) Infragingival pocket Supragingival pocket Infragingival pocket

4.   Perodontal pocket Gingival pocket   1 _Also know as absolute or true pocket .   2 _Seen in periodontitis . 3_Occurs with destruction of the supporting periodontal tissue and lossening and exfoliation of The teeth   1_Also known as pseudo pocket or Relative pocket or false pocket . 2_Seen in the gingivitis. 3_Formed by gingival enlargment Without extraction of underlying perodontal tissuse 4_The sulcus is deepened because of increased bulk of gingiva .

5.   Infrabony pocket Suprabony pocket   1) Also known as subcrestal or intraalveolar pocket 2) Bottom of the pocket is apical to the crest of the alveolar bone 3)Lateral wall consist of soft tissue and bone 4) Pattern of destruction of bone is vertical   5) Interproximally, transseptal fibers are oblique ( extend from the cementum beneath the base of pocket along the bone and over the crest of the cementum of the adiacent tooth) 6)On the facial and lingual periodontal ligament fibers follow the angular pattern .   1)Also know superacrestal or supraalveolar pocket 2)Bottom of the pocket is coronal to the underlying alveolar bone 3)Lateral wall consist of only from soft tissue alone 4)Pattern of destruction of bone is horizontal 5)Interproximally, transseptal fibers arranged horizontally ( between the base of pocket and the alveolar bone)   6)On the facial and lingual surfaces, periodontal ligament fibers, follow the horizontal _ oblique course

6. Pocket Complex pocket originating on one tooth and twisting around the tooth to involve one or more additions surface Simple pocket Involve one surface compound pocket. involve more than one surface

7. PATHOGENESIS OF POCKET FORMATION : 1_Presence of bacterial plaque on tooth surface 2_ Marginal gingiva become formation 3_Gingiva sulcus deepens due to oedematous enlargemen Of gingiva 4_ formation of Gingiva pocket 5_Anaerobic organisms tend to colonize the subgingiva plaque (Spirochaetes and motile rods) (Due to an aerobic environment created in the pocket) 6_Large number of PMN leukocytes and macrophages migrates to the gingiva tissue in response to bacterial challenge 7-Two mechanism of collagen loss : A-Lysosomal enzymes ( collagenase ) released by PMN leukocytes Destruction of collagen fibers in gingival C.T Collagen …….collegenase…..> matrix metalloproteinases B-Fibroblast phagocytose collagen fibers by extending cytoplasmic process to the ligament cementum interface.

8. 8_When the collagen fibers apical to junction epithelial get destroyed .the epithelial cells proliferate along the root surface in an apical direction until they come in contact with healthy collagen fibers 9_At the same time .. coronal portion of junctional epithelium get detached from the tooth surface 10_PMN cellsmigrates towards the coronal portion of junctional epithelium 11_When volume of PMN leukocytes at the coronal portion of junctional epithelium exceeds 60% , the epithelium cells separate from the toothsurface 12_Pocket formation 13_Plaque removal is diffical or impossiblefrom deep pocket 14_Favoruring growth of pathogenic organism in that protected environment 15_ furher attachment loss 16_Horizontal bone loss 17_If I.F.O. present than verticle bone loss occurs ( angular bone loss)  

9. Clinical features :- Causes Clinical features   ●Due to circulatory stangation . ●Due to Distraction of gingival fiber ●Due to atrophy of the epithelium and edema ●Due to edema and degeneratio Bluish red discoloration of the gingiva wall of pocket . ● Flaccidity ● A smooth, shiny surface ● Pitting on pressure 1 When fibrotic changes predominate over exudation and degeneration Gingival wall may be pink or firm 2 Due to : ● increased vascularity ● - thinning and degeneration of epithelium ● _ the proximity of the engorged vessels to the inner surfac bleeding on probin 3 Due to ulceration of the inner aspect of the pocket wall probing is generally painful 4

10. Content of pocket : 1 Microorganism 2 _ Bacterial products ( enzymes and endotoxin) 3 _ GCF 4 _ remnant of food 5 _ Salivary mucin 6 _ Desquamated epithelial cells 7 _ Leukocytes 8 _ Purulent exudates may be present ( sec. Sign) Eg. Deep pocket may have little or no pus and shallow pocket may have extensive pus formation so pus is not an indication of the depth of the pocket .  

11. Diagnosis / detection of pockets 1.careful exploration with a periodental probe -accurate method 2.radiograph : pockets are not detected by radiographic examination because pocket is a soft tissue change

12. Disadvantages of radiograph Radiograph indicate areas of bone loss where pcket may be suspected they not show pocket presence or depth Radiograph show no difference before or after pocket elimination unless bone has been modified Note : gutta percha point or calibrated silver points can be used with radiograph to assist in determining the level of attachment of periodontal pocket

13. Clinical features of perodontal pocket 1_ Bluish red, thickened marginal gingiva 2_Gingival bleeding 3_ Suppuration 4_ Tooth mobility 5_Diastema formation 6_Symptoms-locaosed pain / pain deep in the bone

14. Histopathological features 1_ circulatory stangation 2_ Distraction of gingival fiber 3_ atrophic of epithelium 4_edema and regeneration 5_fibrotic change 6_ Increased vascularity, thinning and degeneration of epithelium 7_ Ulceration of inner aspect of pocket wall 8 Suppuration inflammation of inner wall.  

15. Treatment surgical Treatmen Nonsurgical Treatmen Pocket depth reduction through different surgical procedures : 1)Gingival curettage . 2)Gingivectomy . 3)perodontal flap procedure 4)osseous surgery 5)periodontal regeneration procedure   1)oral hygiene instruction and their follow through 2_Scaling 3_Root planning 4_periodontal medication _Tetracycline _ Metranidazole  

16. Metronedazole : Mechanism of action of Mtronedazol It inhibits nucleic acid synthesis by disrupting the DNA of microbial cells. This function only occurs when metronidazole is partially reduced, and because this reduction usually happens only in anaerobic bacteria and protozoans, it has relatively little effect upon human cells or aerobic bacteria

17. nausea, vomiting, loss of appetite, stomach pain;diarrhea, constipation;headache;unpleasant metallic taste;rash, itching;vaginal itching or discharge;mouth sores; or.swollen, red, or "hairy" tongue. Side effect Interaction of metronidazole With Alcohol Sesitive to sun Tell your doctor about all prescription, non-prescription, illegal, recreational, herbal, nutritional, or dietary drugs you're taking, especially: Antabuse (disulfiram)Anticoagulants (blood thinners) such as Coumadin (warfarin)Dilantin (phenytoin)Hismanal (astemizole)Lithobid (lithium)Phenobarbital (Luminal and Solfoton)Tagamet (cimetidine)Vitamins

18. Contraindication  should not take Metronidazole? meningitis not due to an infection.low levels of a type of white blood cell called neutrophils.alcoholism.alcohol intoxication.a low seizure threshold.a painful condition that affects the nerves in the legs and arms called peripheral neuropathy.prolonged QT interval on EKG.  

19. Tetracycline

20. Mechanism of action   Tetracycline antibiotics are protein synthesis inhibitors. They inhibit the initiation of translation in variety of ways by binding to the 30S ribosomal subunit, which is made up of 16S rRNA and 21 proteins. They inhibit the binding of aminoacyl-tRNA to the mRNA translation complex.

21.   side effects may include   nausea, vomiting, diarrhea, upset stomach, loss of appetite;white patches or sores inside your mouth or on your lips;swollen tongue, black or "hairy" tongue, trouble swallowing;sores or swelling in your rectal or genital area; or.vaginal itching or discharge.

22. Tetracycline Interactions Tetracycline may reduce the effectiveness of some oral birth control pills. You should use another method of birth control while taking this medication. Calcium supplements, iron products, laxatives containing magnesium, and antacids may make tetracycline less effective   You should take tetracycline two hours before or three hours after taking iron products and vitamins that contain iron.   Anticoagulants (blood thinners), such as warfarin (Coumadin)PenicillinIsotretinoin (Accutane)Tretinoin (Retin-A)Cholesterol-lowering drugs, such as cholestyramine (Prevalite, Questran) or colestipol (Colestid)Any product that contains bismuth subsalicylate, such as Pepto-BismolPhenytoin (Dilantin)Carbamazepine (Tegretol)Barbiturates, such as phenobarbital

23. Contrandication Sulfite hypersensitivity, tartrazine dye hypersensitivity, tetracyclines hypersensitivity. Pregnancy. Children, infants, neonates. Breast-feeding.Renal disease, renal failure, renal impairment.Hepatic disease.Sunlight (UV) exposure. Surgery.

24. Treating Gum Disease With Lasers

25. Lasers in medicine and dentistry are considered cutting-edge technology, but they’ve actually been around for quite a while. The first mention of a possible application in dentistry was almost 50 years ago when Leon Goldman, MD experimented with a ruby laser. Today’s dental lasers are more focused and targeted for specific issues, including treatment of periodontal (gum) disease. This has allowed research to directly compare such innovative laser treatment techniques with traditional treatment regimens — important when you want to know if they really work!Periodontists (dentists who have three years of specialty training in the diagnosis and treatment of diseases and disorders of the supporting structures of the teeth) in particular have found that removing diseased tissue with lasers rather than a scalpel can be more comfortable for dental patients. That’s partly because a laser actually seals the tissue it cuts, rather than leaving a wound that requires stitches; there are no incisions separating the gum tissue from the underlying bone so that it is considered minimally invasive. There are other interesting differences between laser surgery and traditional therapy — both of which are effective in treating gum disease.   But let’s start by exploring why a person may need periodontal (gum) treatment in the first place.  

26. Index 1…introdection 2…classefication 3…pathogenesis 4….Clinical features 5… Content of pocket 6…Diagnosis / detection of pockets 7… Clinical features of perodontal pocket 8… Histopathological features 9…treatment 10 …metronedazole 11..tetracycline 12.index    

27. The end Thank you for reading