periodontology and its diseases..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. PERIODONTOLOGY

2. Periodontology ( periodontics )- is the study of the periodontium in health and disease. Peri = around Odontos = tooth Periodontium means tissues around the tooth Periodontist – dental practitioner who have special knowledge and training in the field limits in periodontics . 2

3. 3 PERIODONTIUM Attach the tooth to the bone tissue of the jaw Maintain the integrity of surface of the masticatory mucosa of the oral cavity The periodontium is also known as: The attachment apparatus

4. 4 ORAL MUCOSA The oral mucosa (mucous membrane) is continuous with the skin of the lips and the mucosa of the soft palate and the pharynx. The oral mucosa consists of: 1. Masticatory mucosa 2. Specialised mucosa 3. Lining mucosa

5. 5 MASTICATORY MUCOSA Consists of: 1. The gingiva 2. Mucosa covering the hard palate THE GINGIVA Covers the alveolar process and surrounds the cervical portion of the teeth. It obtains its final shape and the texture in conjunction with eruption of the teeth.

6. 6 THE GINGIVA The gingiva consists of: 1. The free/marginal gingiva 2. The attached gingiva 3.Inter dental gingiva / papila 4.Gingival sulcus

7. Clinical features of gingiva Colour - coral pink / pale pink to darker shades pink to black Size – free gingival margin 1-3 mm coronal to CEJ Contour shape –knife like margins , papilla fills in contact , scalloped to follow bone contours Surface texture – attached gingiva is stippled and dull surface at free gingiva 8

8. Periodontal Ligament The CT that surrounds and attaches the roots of the teeth to the alveolar bone . Average width of PDL is 0.18mm , widest in the coronal aspect Narrower in the apex 9

9. Roles of PDL Mechanical function ( with stand masticatory force ) Formative ( developmental functions) Nutritive function Sensory function 10

10. Periodontal ligament fibers 6 types 1- alveolar crest fibers 2- oblique fibers 3- Horizontal fibers 4-trans septal fibers 5-inter radicular fibers 6-apical fibers 11

11. 12

12. 1-Alveolar crest fiber - attach to the cementum just apical to CEJ run down ward and insert in to the alveolar crest -retain tooth - oppose lateral force - protect deeper structures 13

13. 2-Oblique fibers -most numerous fibers of the PDL -They attach apical to the horizontal fibres - primarily responsible in absorbing the chewing forces on the tooth -oppose axial directed force NB- Main support of the tooth 14

14. 3-Trans septal fibres – run between two adjacent teeth in the same jaw -prevent teeth from loosing contact 15

15. 4-Horizontal fibers –run perpendicularly from the root of the tooth to the alveolar bone attach to the cementum apical to the alveolar crest fiber Function – oppose lateral force 16

16. 5-apical fibers – found at the apex of the teeth - they attach from the cementum and insert to the surrounding bone at the base of the socket Function – prevent tipping and extrusion - protect vessels and blood supply 17

17. 6-Inter radicular fibers - only found between multi rooted teeth such as the Molars they attach from the cementum and insert in to the near by alveolar bone Function –prevent teeth tiping and extrusion 18

18. Defense mechanism of the oral cavity This includes saliva , cervicular (gingival) fluid, polymorph nuclear leukocytes and certain micro-organisms. A. Saliva-flushing action it contain the secretors immunoglobulin A, agglutins , lysozyme , lactoferrin . Which interferes with bacterial adhesion and growth.

19. B. Gingival ( cervicular ) fluid provide continuous flushing effect its production and flow increase in relation to the level of inflammation in the gingival tissue.  C. Polymorphonuclear neutrophils - is a primary and first line defense in bacterial Plaque

20. Developement Of Periodontal Disease

21. Clean tooth pellicle plaque calculus No Oral hygeine 6-8 H No Oral hygeine >14 Days 22

22. Pellicle Glycoprotein layer formed immediately after brushing/ cleaning of teeth Initial phase of plaque formation Found at Soft and hard surfaces of Oral cavity (teeth, prothesis,tissue) 23

23. Plaque firmly adherent mass of bacterial in muco -polysaccharide matrix. It is the root of most dental and periodontal disease. Clinically it is difficult to identify with naked eye at initial stages. When the deposition reached at a certain thickness can be seen as yellowish mass.

24. Development of dental plaque biofilm

25. Calculus (tartar) Is a calcified deposition found on the teeth and is formed by mineralization of plaque deposits. Location-mostly found opposite the opening of the salivary ducts.

26. Periodontal Disease

27. Periodontal disease Is a disease of supporting apparatus or structure 1) Gingivitis - is an inflammatory lesion to the tissue of the marginal gingival. Types - Plaque- induced gingivitis - Gingivitis modified by systemic factor - Drug associated gingivitis - Gingivitis associated with malnutrition - ANUG

28. A) Plaque- induced gingivitis- patient present with gingival bleeding on brushing. Etiology- presence of undisturbed dental plaque which is associated with a Change in flora from gram + ve aerobes to gram – ve anaerobes. Sign- bleeding on probing -edema of the gum -redness of the gum -tenderness of the gum(rare) Treatment- plaque control -administration of antibiotic -OHI(oral hygiene instruction)

29. B) Gingivitis modified by systemic factor e.g - menstrual cycle associated -pregnancy associated -diabetes mellitus associated -blood disorder (leukemia) C) Drug associated gingivitis e.g oral contraceptive phenytoin (seizure control), cyclosporin (immunosuppressive therapy, and nifedipine

30. D) Gingivitis associated with malnutrition e.g ascorbic acid deficiency ( vit . C), protein deficiency E) Acute necrotizing ulcerative gingivitis (ANUG) Is an inflammatory destructive gingival condition. Etiology - bacterial, Mainly - treponema denticola - Fuso bacterium nucleatum - Porphyromonas gingivalis

31. Clinical features – - inter proximal ulcer - Necrosis of papillae (free gingival) - Pain - Easily bleeding - Foetor oris - Lymphadenitis - Fever and malaise Treatment 1) control of the acute phase 2) Management of the residual condition

32. 1) Control of the acute phase - Broad spectrum antibiotics - Scaling and debridement -mouth washing with antiseptic e.g chlorohexidine 0.2% 2) Management of the residual condition - Supra and sub gingival scaling - Root planning and gingivoplasty NB. Patient with recurrence should undergo medical examination and screening for HIV.

33. 2) Periodontitis - it is regarded as a progression of the combination of Infection and inflammation of gingivitis in to the deep periodontium . Clinical features Loss of the connective tissue Apical migration of junctional epithelium result gingival recession. Pocket formation Alveolar bone loss Finally tooth mobility

34. Sign and symptoms Pain on mastication Tenderness of the gum Feeling of elongation of the tooth Percussion positive X –Ray shows –widening of periodontal space and bone loss. Treatment Scaling and root planning Oral hygiene instruction Antibiotic coverage Extraction if hopelessly diseased

35. Classification periodontitis   Adult or Chronic periodontits Aggressive periodontitis Periodontitis as manifestation of systemic disease Necrotizing ulcerative periodontitis progression of ANUG to include the attachment apparatus Abscesses of the periodontium .