DISEASE OF TEETH & PERIRADICULAR .pptx.

Irrigate the site with saline.
Remove the tissue tags and granulation tissue from the soft tissue of the site.
Compress the alveolar bone with finger pressure.
Suture if necessary at the papillae bordering the extraction site and across the middle of the site.
Stop the bleeding by placing a guaze pack covering the socket and the instruct the patient to apply gentle and continous presure by bitting on the guaze for at least 30 minutes.
Irrigate the site with saline.
Remove the tissue tags and granulation tissue from the soft tissue of the site.
Compress the alveolar bone with finger pressure.
Suture if necessary at the papillae bordering the extraction site and across the middle of the site.
Stop the bleeding by placing a guaze pack covering the socket and the instruct the patient to apply gentle and continous presure by bitting on the guaze for at least 30 minutes.
Irrigate the site with saline.
Remove the tissue tags and granulation tissue from the soft tissue of the site.
Compress the alveolar bone with finger pressure.
Suture if necessary at the papillae bordering the extraction site and across the middle of the site.
Stop the bleeding by placing a guaze pack covering the socket and the instruct the patient to apply gentle and continous presure by bitting on the guaze for at least 30 minutes.
Irrigate the site with saline.
Remove the tissue tags and granulation tissue from the soft tissue of the site.
Compress the alveolar bone with finger pressure.
Suture if necessary at the papillae bordering the extraction site and across the middle of the site.
Stop the bleeding by placing a guaze pack covering the socket and the instruct the patient to apply gentle and continous presure by bitting on the guaze for at least 30 minutes.
Irrigate the site with saline.
Remove the tissue tags and granulation tissue from the soft tissue of the site.
Compress the alveolar bone with finger pressure.
Suture if necessary at the papillae bordering the extraction site and across the middle of the site.
Stop the bleeding by placing a guaze pack covering the socket and the instruct the patient to apply gentle and continous presure by bitting on the guaze for at least 30 minutes.
Irrigate the site with saline.
Remove the tissue tags and granulation tissue from the soft tissue of the site.
Compress the alveolar bone with finger pressure.
Suture if necessary at the papillae bordering the extraction site and across the middle of the site.
Stop the bleeding by placing a guaze pack covering the socket and the instruct the patient to apply gentle and continous presure by bitting on the guaze for at least 30 minutes.
Irrigate the site with saline.
Remove the tissue tags and granulation tissue from the soft tissue of the site.
Compress the alveolar bone with finger pressure.
Suture if necessary at the papillae bordering the extraction site and across the middle of the site.
Stop the bleeding by placing a guaze pack covering the socket and the instruct the patient to apply gent

1. DISEASE OF TEETH

2. Disease of the hard tissue of the teeth is disease which affect the enamel , dentin and cementum part of the teeth Classified as :-Carious :- Non carious disease

3. Carious disease

4. Dental caries :- a progressive irreversible , microbial disease affecting the hard parts of tooth exposed to oral environment, resulting in demineralization of inorganic constituents & dissolution of organic constituentes ,there by leading to a cavity formation

5. Mechanism of caries formation   Oral cavity + sugar from diet + oral flora   Plaque formation     Acid from metabolism of dietary carbohydrates   Decrease the ph of the oral cavity     Dissolving of the enamel and calcium and phosphate ions diffuse out from enamel       Cavity or caries formation.

6. Classification of dental caries A )Based on severity & progression of lesion 1)Incipient/initial/primary carious lesion first attack on the tooth surface white spot lesion enamel is intact but demineralised can be remineralised shape & progression depend up on location

7. 2)Recurrent/secondary caries Under or around the margins or surrounding walls of restoration Causes-improper cavity preparation unable to remove all the decay -inadequate cavity restoration open margins -old restoration microleakage

8. 3)Acute/Rampant caries rapidly progressing caries that usually involves several teeth multiple light colored lesion frequently accompanied by pulp reaction demineralisation exceeds r emineralisation

9. 4)Chronic caries are of variable depth ,long standing & fewer more localized hard in consistency dark in color remineralisation exceeds demineralisation

10. 5)Arrested caries progression of decay has stopped & is inactive softened dentin has been worn away -discolored ,sound , hard dentin remains Formation advancing bacteria dissolves mineral in Inter Tubular Dentin tubule fluid saturated with Ca,Mg,Po4 salt precipitate in to large crystals tubules temporarly blocked odontoblasts secret collagen & Ca+ hydroxyappatite will block tubule effectively

11. 6)Active caries progressive carious lesion of the tooth where demineralisation exceeds remineralisation 7)Residual caries unremoved caries during tooth preparation either by accident,intention,neglect

12. B)Based on pathway of caries 1)Forward caries /pit decay from enamel to dentin caries is more in enamel than dentin 2)Backward /smooth surface enamel is attacked from dentinal side extent of caries is greater at DEJ than enamel

13. C)G.V Black’s classification Tooth surface designation Mesial :- towards the mid line Distal:-away from the mid line Buccal :-towards the cheek Labial:-towards the lip lingual:-towards the tounge Palatal:- towards palate Occlusal :-masticating surfaces of PM,M Incisal :-functional edge of anteriors cervical:-cervix or neck of toooth

14. C)G.V Black’s classification based on treatment & restoration design Class I: it occurs in pits and fissures of posterior teeth (molar and premolar). Class II: caries on occlusal and proximal surfaces of posterior teeth.

15. Class III: proximal caries of the anterior teeth (incisor and canine) Class IV: lesion like class 3 including incisal edge. Class V: caries on lingual or facial surface (smooth surface caries) Class VI: cavity on the tips of cusps or along the cutting edge of incisors.

16. Diagnosis of Dental Caries 1)Visual examination Tooth must be clean ,dry & well illuminated Discoloration gives suspicion of decay 2)Enhanced visual examination Transillumination Fiber-optic Transillumination Magnification

17. 3)Tactile examination Explorer/probes Dental floss/tape 4)Patient complaint during hot , cold or sweet consumption 5)Radiographic examination IOPA / Bitewing radiographs

18. Prevention of Caries proper general health fluoride exposure proper salivary functioning antimicrobial agents balanced diet proper oral hygiene xylitol gums pit & fissure sealants restorations

19. Non carious disease

20. Non carious disease Attrition:-Is a physiologic process resulting The loss of tooth surface structure resulting from direct frictional forces between contacting tooth.

21. Attrition contd … Causes-Physiologic age, proximal contact points -Pathologic abnormal occlusion abnormal chewing habits structural defects in teeth

22. Attrition contd … Effects of attrition Occluding surface attrition loss of vertical dimension of tooth cheek biting, gingival irritation decay, tooth sensitivity Proximal surface attrition increased susceptibility to caries hindering of cleansability drifting of teeth

23. Attrition contd … Mgt. - Occlusal equlibration -Protection of sensitive dentinal areas -Obliteration of carious lesion -Restoration

24. Non carious disease contd.. B)Abrasion:-mechanical wearing away of teeth. :-frequent on incisal & occlusal surfaces :-is a pathologic process usually inseparable with attrition &/or erosion Causes- Tooth brush abrasion -Professional Habits-cutting threads , nails -Iatrogenic-b/n restoration & tooth -Pipe smoking “depression abrasion”

25. Abrasion contd … Tooth brush abrasion occurs cervically , mostly on the facial surface of canines & bicuspids. Extent depends on Direction of brushing size, shape & percentage of abrasive particles In dentrifice diameter of brush bristles type of tooth tissue

26. Abrasion contd … Sign & symptoms linear outline extremely smooth & polished surface V shaped wall w/c meets at an acute angle sensitive to hot , cold, sweets or probing

27. Abrasion contd … Mgt. Preventive correct or avoid ill fitting clasps ,dentures habit breaking Restorative “shoeing” opening the bite

28. Non carious disease contd … C)Erosion:-is the chemical or chemico -mechanical wearing away in such a manner that broad ,shallow , smooth highly polished excavations or depressions are made in the enamel & dentin on surfaces not subject to mastication :- is a pathologic process

29. Erosion contd … Causes-Mechanical factors Actions of muscles of lips & cheeks and of the tooth brush against tooth -Chemical factors Faulty metabolism resulting in excess NaPo4,CaPo4 Extraneous acids like lemon juice, vinger , grapefruit & grapes Acid vapours in the mouth of factory workers Excessive acid , alkaline or lactic acid in saliva

30. Erosion contd … Sign & symptoms no demarcation b/n lesion & adjacent tooth surface glazed surface rate is same for enamel, dentin & cementum PDL is always sound healthy sensative tooth usually non carious

31. Erosion contd … Mgt. regulation of diet increase water intake prevent & cure pdl disturbances avoid stiff toothbrushes & gritty dentrifices restoration

32. Non carious disease contd … D) Florosis :-is discoloration and mottling of the tooth Causes-excess fluoride in the water, >1ppm(I mg F per litter)

33. DISEASE OF PULP

34. Dental pulp consists pulp cavity which found in the inner portion of tooth containing neurovascular CT within the rigid dentinal walls the cavity is divided in to pulp chamber root canal

35. 1)Pulp chamber most occlusal or incisal portion of pulp cavity one per tooth has roof with pulp horn &walls with orifices

36. 2)Root/pulp canals portions within the root tooth opens to the outside of tooth through apical foramen

37. Types of root canal configuration Type I single canal from chamber to apex Type II two separate canals leaving chamber but merges short of apex Type III two separate canals leaving chamber & exit in separate apical foramen Type IV one canals leaving chamber but dividing short of apex in to two separate canals with separate apical foramina

38. Classification of pulp disease Based on clinical feature A)Pulpits B)Pulp degeneration C)Necrosis reversible calcific (radiographic) acute others chronic irreversible acute chronic asymptomatic with pulp exposure hyperplastic Pulpits internal resorption

39. Most common cause of pulpities is bacteria Once damaged rarely reparable Pathways of bacterial invasion of the pulp through open cavity dentinal tubules anachoresis (lymphatic or haematogenous ) gingival sulcus or PDL

40. pulp disease Reversible Pulpits :- a m ild to moderate inflammatory condition of pulp caused by noxious stimuli in which the pulp is capable of returning uninflamed state following removal of stimuli. Etiology-trauma - thermal shock -chemical stimulus -bacteria from caries -excessive dehydration of cavity

41. pulp disease contd … clinical feature pain on cold taking Short , Sharp pain Not spontaneous & continuous Rx prevention of caries early detection & restoration of caries removal of noxious stimuli & restoration desensitizing neck of teeth in gingival recession cavity varnish or base application

42. pulp disease contd … Irreversible Pulpits :-Persistent inflammatory condition of pulp. Etiology:-bacterial invasion from caries - chemical , thermal or mechanical causes -reversible pulpitis

43. pulp disease contd … Clinical features Early stages Pain: severe sharp, piercing or shooting intermittent or continuous may occur by sudden T° change or pressure exacerbation of pain on changing position referred pain

44. Clinical feature contd … Late stage More severe, boring, gnawing or throbbing Pain awakens from sleep pain aggravated by hot & relieved by cold Rx-Root Canal Treatment -Extraction

45. pulp disease contd … Hyperplastic pulpitis (pulp polyp) A productive pulpal inflammation due to an extensive carious procedure of a young pulp Etiology:-Slow progressive carious exposure of pulp :-a large open cavity , young resistant pulp , chronic low grade stimulus are necessary

46. Hyperplastic pulpitis clinical feature symptomless except during mastication children & young adults polypoid tissue. fleshy reddish pulpal mass most of the pulp chamber or cavity or extends beyond the confines of tooth Rx:- Pulpectomy

47. pulp disease contd … 4)Internal resorption an idiopathic slow or fast progressive resorptive process occurring in the dentin of the pulp chamber or root canal of teeth Etiology unknown may be Hx of trauma

48. Internal resorption contd clinical feature asymptomatic pink spot radiographically round or ovoid radiolucent area in the root canal or pulp chamber Rx-RCT

49. pulp disease contd … Pulp degeneration A) calcific degeneration part of pulp tissue is repalced by calcific material i.e pulp stone or denticles calcified material is attached to the pulp cavity referred pain is complained in rare patients

50. pulp disease contd … B) Atrophic degeneration no clinical Dx exists pulp tissue is less sensitive than normal intercellular cell is increased observed histopathologically in older patients C)Fibrous degeneration cellular elements are replaced by fibrous CT pulp appears to be leathery fiber

51. pulp disease contd … D)Pulp artifacts fatty degeneration of the pulp along with reticular atrophy & vacualization of the odontoblasts caused by poor fixation of tissue specimen E)Tumor metastasis metastasis of tumor cells to the pulp is rare except in terminal stages

52. pulp disease contd … 6)Pulp Necrosis death of pulp etiology-any noxious stimulus clinical feature greyish or brownish tooth discoloration tooth lack its brialliance & luster asymptomatic & radiograph is non diagnostic Rx-RCT

53. Disease of Periradicular tissue

54. Periradicular Disease Classification Acute Chronic alveolar abscess C/c alveolar abscess apical periodontitis granuloma vital cyst non vital phoenix abscess

55. Periradicular Disease contd … 1)Acute alveolar/apical/ dentoalveolar / radicular abscess localized collection of pus in the alveolar bone at the root apex of a tooth following death of a pulp with extension of the infection through the apical foramen Etiology trauma , chemical or mechanical irritation bacterial invasion of necrotic pulp

56. Acute abscess contd … Symptoms Local severe throbbing pain with swelling of overlying soft tissue mobile tooth formation of sinus tract General pale irritable,weak , loss of sleep,headache , increased Temprature fever with chills

57. Acute abscess contd … Dx clinical subjective symptoms tender on palpation & percussion mobile or extruded tooth radiographic cavity or defective restoration thickened PDL space evidence of bone breakdown at apex Mgt. Establish drainage + Antibiotics Debridement RCT

58. Periradicular Disease contd … 2)Acute apical periodontitis painful inflammation of the periodontium through the root canal of a vital or non vital tooth Etiology vital over hanging restoration proximal wedging blow to teeth non vital sequela of pulp disease

59. Acute apical periodontitis Clinical feature tenderness slightly sore tooth extrusion may be present Dx - known Hx of tooth under Rx. percussion + ve thickened PDL Rx. Treat the cause RCT

60. Periradicular Disease contd … 3) Acut exacerbation of C/c lesion (Phoenix abscess) an acute inflammatory reaction superimposed on an existing lesion such as a cyst or granuloma Etiology periradicular disease over instrumentation Clinical feature tender to touch superaeruption overlying mucosa erythematous & swollen Mgt. Drainage Debridement RCT

61. Periradicular Disease contd … 4)Chronic alveolar abscess Long standing low grade infection of the periradicular alveolar bone Etiology sequela of death of pulp from preexisting acute abscess Clinical feature generally asymptomatic sinus tract discharge through root canal Rx. Elimination of infection RCT

62. Periradicular Disease contd … 5) Periapical Granuloma A growth of granulation tissue continuous with the PDL resulting from death of the pulp & the diffusion of bacterial toxins from the root canal into the surrounding periradicular tissue through apical or lateral foramina Etiology pulp necrosis irritation that stimulates productive cellular Rxn continuation of C/c alveolar abscess

63. PA Granuloma contd Clinical feature usually asymptomatic except radiograph not tender on percussion & not loose hx of pulpalgia that subsided electric pulp test & thermal test Rx. R emoval of cause of inflamation RCT

64. Periradicular Disease contd … 6) Radicular cyst a slowly growing epithelial sac at the apex of tooth that lines a pathologic cavity in alveolar bone lumen of cyst is filled with low concentration of protenaceous fluid Etiology death of the pulp followed by stimulation of epithelial cell of malassez

65. Radicular cyst contd … Clinical feature painless unless infected swelling ,distortion of face mobile tooth Radiographically oval shaped radiolucency more than 2cm with break in the continuity of lamina dura Rx. marsupialization RCT , Apicectomy