Convincing experimental evidence that plaque microorganisms cause human gingival disease was presented by Löe and colleagues in 1965.14 The researchers initiated extensive plaque control in a small group of dental students and brought them to a level of excellent periodontal health; then the subjects refrained from oral hygiene procedures for 3 weeks. Scaling and Root Planing. 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 long-term goal of treatment is to restore gingival health. 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. The bacterial plaque shifts from predominantly gram-negative microbiota to one that is gram-positive, with many fewer motile forms, especially spirochetes. Both were effective in removing approximately 67% of the plaque in, Calculus is little more than calcified plaque biofilm. Connective tissue fibers are disrupted and lysed beneath the epithelium. Research has made a drug available called Periostat™ which can be used to help treat periodontal disease but only when combined with conventional non-surgical therapy. These reasons are8 as follows: • Smooth surfaces retard plaque formation. Polishing is the use of polishing agents to remove stains and supragingival plaque biofilm from the teeth. Gingival curettage, also called closed curettage or nonsurgical gingival curettage (truly a misnomer), was traditionally performed to remove inflamed pocket lining for reasons distinct from periodontal debridement. It varies in crystal composition, type of attachment, and degree of difficulty in removal (see. including the communities of Newport Beach, Appearance of the teeth is of great importance to patients, and the polishing procedure can be an excellent way to motivate them to remove plaque biofilm for health as well as appearance. Abrasives used during polishing can scratch amalgam, composite resin, and gold restorative materials. Explorer-detectable root roughness may not be calculus but merely the texture of the root. These local factors are described in. The following information is a summary of evidence supporting the provision of nonsurgical periodontal treatment: plaque biofilm and calculus removal, hand instruments and powered instruments, the relative merit of smooth roots, healing after nonsurgical treatment, laser use, and antimicrobial adjuncts. zt THE INFLUENCE OF NON-SURGICAL PERIODONTAL THERAPY ON SALIVARY MELATONIN LEVELS: A PILOT STUDY Kristina Bertl1, Angelika Schoiber1, Hady Haririan1, Markus Laky1,2, Oleh Andrukhov1, Irene Womastek3, Michael Matejka1, and Xiaohui Rausch-Fan1 1 Department of Periodontology, Bernhard Gottlieb School of Dentistry, Medical University of Vienna, Austria 2 Department of Dental … Discuss the use of lasers in nonsurgical therapy. Healing after scaling, root planing, and gingival curettage occurs as a repair of existing tissues rather than regeneration of tissues lost in the periodontal disease process. Patient plaque biofilm control is a cornerstone of long-term successful nonsurgical therapy. It commonly occurs during nonsurgical periodontal therapy. Selective polishing is choosing the surfaces to polish on the basis of patient concerns and the presence of plaque biofilm and stains that cannot be removed with normal patient oral hygiene practices. The contents of any material used for patient care should be read carefully; this is especially warranted when dealing with the myriad choices available for stain removal. Normal turnover of cells in the junctional epithelium, which migrate from the apical end to the coronal end, takes about 5 days. This end point is best evaluated by explorer detection of smooth surfaces.3 Calculus removal may be considered a subgoal rather than the primary focus.3 The goal at the treatment visit is not to render the roots glassy and hard through extensive planing away of tooth structure. Kepic and colleagues18 demonstrated residual calculus on most teeth after 45 to 60 minutes of treatment time per quadrant. After 6 weeks, the dentist will schedule an appointment to examine the patient’s response to the treatment. This article presents the essential elements of a PTPincluding diagnosis, treatment planning, implementation of therapy, assessment and monitoring of therapy, insur-ance coding, introduction of the patient to periodontal therapy, and enhanced verbal skills. Email: Implant Dentist Dr. Caplanis your Mission Viejo Periodontist and Orange County Periodontist provides a full range of dental implant & periodontal services including dental implants, Abrasives used during polishing can scratch amalgam, composite resin, and gold restorative materials. If the non-surgical therapy effectively eliminates the gum disease, the only further requirement will be periodic maintenance every 3-4 months. The numbers of organisms are reduced dramatically and grow back in different proportions. It varies in crystal composition, type of attachment, and degree of difficulty in removal (see Chapter 5). Studies indicate that endotoxins do not penetrate deeply into cemental surfaces and that retained toxins are associated with missed calculus and plaque rather than diseased cementum. Step 1. Subgingival bacterial plaque biofilm will regrow but, at least initially, it will consist of a younger, less pathogenic bacterial biofilm than that associated with untreated periodontal pockets. For periodontal patients, this goal often requires multiple appointments with the dental hygienist. Describe the short- and long-term goals of nonsurgical periodontal therapy. different types of lasers are used in the dental. Prophylaxis is a preventive procedure to remove local gingival irritants and includes complete calculus removal followed by root planing. The. Collectively, these methods represent the fundamentals of non-surgical periodontal therapy. Can be single-ended or double-ended Many different types of periodontal probes available Inadvertent curettage is a term used to describe accidental and incomplete removal of the pocket lining during scaling and root planing or periodontal debridement procedures. Other concerns include the possibility of creating bacteremia in the patient and possibly damaging the tooth pulps by heat generated from the power-driven prophylaxis angle. In fact, in some studies, gingivae next to root surfaces that were notched for orientation of researchers after tooth extraction healed uneventfully in the mouth. A detailed plan for non-surgical periodontal therapy will always include minimizing the impact of local environmental risk factors.. C. goal 3: to minimize exposure of the systemic factors for periodontal disease 1. For this reason, every patient must participate in treatment by adopting a regular and effective biofilm removal regimen. The dental hygienist has many patient treatment options available for nonsurgical periodontal therapy, including the use of injected local anesthetics for pain control. Definitions of Nonsurgical Periodontal Therapy, This chapter discusses the biologic basis and rationale for nonsurgical therapeutic procedures performed in the dental office. Replacement restorations or orthodontic movement of the teeth can simplify plaque biofilm control and help the patient achieve periodontal health. • Identify the techniques and applications for nonsurgical periodontal therapy procedures. 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. • Rough surfaces mechanically irritate gingival tissues. These local factors are described in Chapter 5. • Describe the short- and long-term goals of nonsurgical periodontal therapy. The concept of selective polishing emerged when research on enamel and root surfaces after polishing revealed changes in the hard tissues. After instrumentation, some roots feel smooth, whereas others have varying degrees of granular roughness. An excellent example of the application of the specific plaque hypothesis is the treatment of aggressive periodontitis in its juvenile form. Specifically, curettage performed by the dental hygienist (legally permitted in some states), properly termed gingival curettage, is limited to closed curettage. Animal studies show that hemidesmosomes begin to reattach from the apical end of the junctional epithelium and are intact after 7 days. Your periodontist is best trained to determine if this treatment approach will help your specific condition. Positive, long-term effects of periodontal therapy are reliably achieved with patient compliance, effective plaque biofilm control, and excellent dental hygiene treatment. Bacteria repopulate in a specific order, starting with Streptococcus and Actinobacillus species, followed by Veillonella, Bacteroides, Porphyromonas, Prevotella, and Fusobacterium species. The question remains whether root surfaces need to be glassy smooth. When treating gum disease, it is often best to begin with a non-surgical approach consisting of one or more of the following: Scaling and Root Planing. Unfortunately at the current time, and according to our doctors, there is inadequate research available to recommend laser therapy for the treatment of periodontitis. Specific definitions accepted in the dental hygiene community, 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.”, Scaling may be accomplished with sharp hand instruments or with, 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.”. The only study that attempted to measure root texture with quantifiable profilometer (Micrometrical Manufacturing, Ann Arbor, MI) readings found that the amount of root roughness did not affect plaque biofilm formation. As plaque biofilm ages, the organic matrix and bacterial cells calcify. 1981, Serino et al. Animal studies provide strong evidence that these destructive diseases occur in the presence of microbes, but not in animals raised in germ-free environments. Learn vocabulary, terms, and more with flashcards, games, and other study tools. A study published in the 1980s compared the performance of hand instruments with that of ultrasonic tips in the removal of plaque in pockets. Scaling and periodontal debridement are effective in reducing the volume of plaque biofilm bacteria in treated sites. Thus, the rationale for root planing to remove root roughness and achieve glassy, smooth root surfaces is no longer valid. ... that describe … Animal studies provide strong evidence that these destructive diseases occur in the presence of microbes, but not in animals raised in germ-free environments. Normal turnover of cells in the junctional epithelium, which migrate from the apical end to the coronal end, takes about 5 days. The terms nonsurgical periodontal therapy or periodontal debridement are used along with the traditional terms of scaling and root planing. There is no evidence that root-planed teeth are easier to maintain or less likely to be associated with periodontal diseases than those that have simply been rendered free of calculus and plaque biofilm.8. Damage to the gums and bone support around the upper front teeth following the use of a laser. Non-surgical periodontal treatment does have its limitations. Nyman and colleagues, These data indicate that toxins are superficially located on root surfaces and easily removed. Plaque biofilm is the primary causative agent in gingival and periodontal diseases. Laser periodontal therapy should never be considered as a substitute for conventional non surgical therapy or as a replacement for periodontal surgery. 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. Early studies that used visual appraisal of deposits or colony counts on surfaces showed that smooth surfaces had less plaque biofilm formation; however, root texture was not measured. Standard cleanings and polishes only deal with the plaque above the gum line, and these procedures aren’t effective on their own to truly treat gum disease. Non-Surgical Treatment. Because the bacteria can firmly attach to the tooth roots under the gum line, regular dental cleanings may be inadequate to resolve the infection. It works by mechanical abrasion using a slurry of sodium bicarbonate and water. twilight sedation & Polishing should be performed selectively.10,11. Polishing may have some aesthetic value for patients and may help motivate them to maintain a clean mouth, but it has no proven therapeutic value. Phone: 949-830-1322 • Fax: 949-830-1383 Nonsurgical therapy includes the procedures listed in. The specific plaque hypothesis was proposed by Loesche in the 1970s.15 This classic study has increased the understanding of periodontal disease and the use of appropriate antimicrobial agents to improve treatment results. Several other concerns about polishing exist. A number of dental hygiene programs in the United States teach gingival curettage because it is a legally sanctioned duty in many states and may be performed by practitioners in the community. Dramatically thinned root surfaces are shown in, Conscientious removal of calculus and plaque biofilm with minimum destruction of cementum, termed. Nonsurgical therapy includes the procedures listed in Table 13-1. Replacement restorations or orthodontic movement of the teeth can simplify plaque biofilm control and help the patient achieve periodontal health. This indicated that roughness itself had no effect on wound healing. 3. The difference between scaling and root planing is a matter of degree; root planing involves a specific effort to instrument every portion of the root surfaces, not simply identifiable calculus deposits. As the understanding of plaque biofilm as the pathologic agent has grown, various periodontal diseases have been identified with specific microbial organisms. Caution must be exercised with this device to prevent damage to exposed root surfaces; thus, its application for periodontal patients is limited. Although more specific gingival and periodontal diseases are recognized, nonsurgical periodontal therapy focuses on total plaque biofilm removal. The effects of nonsurgical periodontal therapy. It takes considerably longer than healing of epithelium—up to several months. Glassy, smooth root surfaces are not end points in treatment. As plaque biofilm ages, the organic matrix and bacterial cells calcify. 3. However, subtle signs such as red or swollen gums, gums that bleed when brushed or flossed, chronic bad breath or loose teeth can alert you to the presence of gum disease and the need to see a periodontist. Because smooth surfaces are clinically associated with the restoration of gingival health, clinicians believe that smooth root surfaces are good. This rationale has been questioned for many years and the procedure is no longer considered standard treatment. Removal of endotoxins would require the planing away of diseased cementum. To do so, the patient uses oral hygiene procedures and the dental hygienist performs coronal polishing. After instrumentation, some roots feel smooth, whereas others have varying degrees of granular roughness. Barnes recommended that the least abrasive paste necessary to remove stains was appropriate and if no stain was present a cleaning agent should be employed. No clinical studies have shown greater pocket reduction, more rapid healing, or more new attachment after gingival curettage has been performed compared with scaling and root planing alone.22 In animal studies, gingival curettage promoted the formation of long junctional epithelium during healing, rather than new connective tissue attachment.23 Clinical trials reviewed by Kalkwarf22 indicated that tissue healed through long junctional epithelium rather than connective tissue attachment can be maintained successfully for years, suggesting that this is a satisfactory treatment result. Studies evaluating plaque biofilm formation on rough root surfaces are equivocal. The technical skill of the dental hygienist is the critical element in successful nonsurgical periodontal therapy. The goal of root planing, leaving the roots clean, has not changed, but the extent to which root tissue is scraped away to create a glassy, hard texture has been under scrutiny. The quality of the plaque is more important than the quantity, but plaque biofilm is still the causative agent in disease. This is why regular visits to your periodontist are important especially if other health problems are present, like heart problems or diabetes. Glassy, smooth root surfaces are not end points in treatment. 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. It was once thought that tooth surfaces had to be plaque-free to absorb fluoride during fluoride treatments, so polishing of teeth was performed routinely before office fluoride applications. Categories: Target Audience: Dental Assistants, Dental Students, Dentists. Periodontal “gum” disease is typically a chronic infection caused by bacteria that works its way under the gum line, destroying the gum and eventually the bone that supports the teeth. The alternatives to non-surgical periodontal therapy are: Surgical periodontal therapy; No treatment It is important to understand that periodontal disease is not curable. Bacteria-specific tests and treatments have been developed and will be more widely used as the understanding of periodontal disease increases.7, It is possible to remove all supragingival plaque effectively. No experimental evidence indicates that rough root surfaces are mechanical irritants and would therefore delay healing. It is most commonly performed by rubber-cup application of polishing agents with a slow-speed handpiece. Very often, early stages of periodontal disease are effectively treated with non-surgical periodontal therapy. The restoration of gingival health is the sum of good plaque control, complete scaling and periodontal debridement, and sufficient time for healing to occur—several months for complete healing of both the epithelium and connective tissue.2,3 These goals are summarized in Table 13-2. Scaling and root planing is the standard of care for nonsurgical and nonpharmacologic treatment of chronic periodontal diseases. This practice supports the old notion of “necrotic” root surfaces. Curettage had been defined by the AAP as scraping or cleaning the walls of a cavity or surface by means of a curette. Your dentist or hygienist may also recommend the simple placement of medications under the gum line to help kill the bacteria that may still exist following a dental cleaning or root planing procedure. 4. 2. Nyman and colleagues20 compared these treatment strategies by testing the healing of quadrants after periodontal surgery. The epithelial lining of the pocket wall is also often disrupted and partially removed through inadvertent curettage. The restoration of gingival health is the sum of good plaque control, complete scaling and periodontal debridement, and sufficient time for healing to occur—several months for complete healing of both the epithelium and connective tissue. Your periodontist is best trained to determine if this treatment approach will help your specific condition. Non- surgical periodontal therapy includes localized or generalized scaling and root planing, the use of antimicrobials and ongoing periodontal maintenance. Some are under the patient’s control, and may, therefore, require lifestyle changes to achieve significant modification. Your dentist will first start with nonsurgical … Peri-implantitis: Nonsurgical therapeutic approach 6. Studies indicate that endotoxins do not penetrate deeply into cemental surfaces and that retained toxins are associated with missed calculus and plaque rather than diseased cementum. Dental hygienists remove the primary etiologic factor of periodontal disease, plaque biofilm, and its associated factors through scaling and root planing, cleaning and smoothing of the roots or, more broadly, periodontal debridement. However, subgingival plaque is not effectively altered by supragingival oral hygiene procedures, especially in deeper pockets of 5 mm or more. The rationale for nonsurgical periodontal therapy is to remove the etiologic agent of disease—bacterial plaque biofilm—and its associated factors. periodontal disease treatment to Southern California and South County, Orange County Although calculus is an inert substance, its role appears to be that of plaque biofilm retention, and its removal is associated with a return to periodontal health, as seen in Figure 13-4. Removal of this tissue was assumed to enhance pocket reduction beyond the results achieved by scaling and root planing alone, providing faster healing and the formation of new connective tissue attachments to the root surfaces. Bacteria repopulate in a specific order, starting with, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window). In the early stages it may not even be noticeable to you. Material and methods: Fourteen CP cases received full-mouth non-surgical treatment and, after 6 months, at least two surgical sessions. 5. Nonsurgical therapy remains the cornerstone of periodontal treatment. If the long-term goal of restoring periodontal health has not been achieved after conscientious nonsurgical therapy, the dental hygienist must first suspect residual calculus (and plaque biofilm) and re-treat nonresponding areas. Describe how the. 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. Air powder polishing removes most extrinsic stains and soft deposits from the exposed surfaces of the teeth. Phyllis L. Beemsterboer and Dorothy A. Perry. However, the roughness associated with calculus and poor restorations is far greater than the slightly granular texture of calculus-free root surfaces. The use of both ultrasonic instrumentation and magnification to improve vision are important components of dental hygiene practice. Dental hygiene procedures with hand instruments or powered scalers adequately accomplish subgingival plaque biofilm removal. The goal of root planing, leaving the roots clean, has not changed, but the extent to which root tissue is scraped away to create a glassy, hard texture has been under scrutiny. J Clin Periodontol. Much has been learned about the penetration and removal of lipopolysaccharide endotoxins. Due to the contradicting findings in the literature, we wanted to evaluate the influence of nonsurgical periodontal therapy on the metabolic control in type 1 diabetes in Malaysian subjects. 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. Chronic periodontitis is the most common form of periodontitis, and aggressive periodontitis causes rapid destruction of the supporting structures of the teeth. Duration: 55:30. Stains on the teeth are generally considered harmless, so their removal is secondary to the therapeutic and preventive goals of the dental hygienist. NONSURGICAL PERIODONTAL THERAPY Instructed by Kelli R. Illyes, R.D.H, M.D.H. Achieving root smoothness is important for evaluating short-term goals during treatment appointments. Periodontists are also experts in replacing missing teeth with dental implants. • Describe the contributions of magnification with use of loupes, endoscopy, and microscopes to nonsurgical therapy. The dental hygienist cannot focus solely on the technical aspects of calculus removal. Other more subtle systemic and environmental issues may … A study published in the 1980s compared the performance of hand instruments with that of ultrasonic tips in the removal of plaque in pockets. In its broadest sense, nonsurgical therapy defines all of the procedures performed to treat gingival and periodontal diseases up to the time of reevaluation, which is when patients begin maintenance care and the need for periodontal surgery to enhance results is determined. 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