A continuous or related series of things ,such as dental hygiene interventions, following in a certain order or succession Total Treatment Plan Sequential outline of the essential services and procedures that must be carried out by the dentist, the dental hygienist and the patient to eliminate disease and restore the oral cavity to health and normal function. The traditional design of brush head operates with a side-to-side or back and forth motion. They receive up to three additional years of specialized training in periodontal disease treatment in both non-surgical treatments and periodontal plastic surgery procedures. Bundles of bristles are arranged in rows in a rectangular head or in a circular pattern mounted in a round head. Homecare, plaque control programmes and hygiene phase therapy are crucial components of non-surgical periodontal therapy. Laser-assisted fi rst phase periodontal therapy often delivered by the dental hygienist is a successful treatment op-tion that can effectively help the patient achieve and maintain optimum levels of health.10,11 Studies of laser soft-tissue therapy and clinical observations of pa-tients treated with the soft-tissue lasers are showing good results. Bristles are arranged in tufts, and round-ended bristles cause fewer scratches on the gingiva than flat-ended bristles do. Contemporary designs of powered toothbrushes have a number of special features that enhance their use: easy start features which increase the brushing force over the first few occasions of use. Also consider tapping into the talents of your dental assistant. In the first phase of your treatment, special instruments will be used to carefully and thoroughly clean (debride) and polish each tooth and its root surfaces. All Rights Reserved.Eirini Georgiou Once the factors responsible for the periodontal disease have been controlled or eliminated, the goal of treatment becomes the correction of residual damage, thereby creating an environment that can more easily be maintained in a state of health. sidered primary procedures of the hygienic or presurgical phase of periodontal treat- ment. Further, as the job situation continues to deteriorate and more people lose their jobs along with dental benefits, the scenario of people refusing definitive periodontal treatment is expected to worsen. Results of various modalities of periodontal therapy were studied in 90 subjects (mean age 45 years) with moderate to severe periodontitis. periodontal therapy is to reduce the burden of pathogenic bacteria and thereby reduce the potential for progressive inflammation and recur-rence of disease. A. With use, toothbrushes show signs of wear and flattening of bristles, and should be replaced approximately every three months. It is now more generally accepted that powered brushes may be advantageous for a much wider group of patients who might otherwise be unable to achieve an “acceptable” standard of plaque control. Softer bristles have greater flexibility, and have been shown to reach further interproximally and subgingivally. chlorhexidine) may be added to toothpastes. Thus, in many senses this term is misleading in that while this phase does occur at the beginning, what this phase Chemotherapeutic agents (e.g. Plaque control refers to the removal of plaque from tooth surfaces and gingival tissues, and prevention of new microbial growth. 1988 Summer;43(3-5):92-4. Scaling and Root Planing. Programmes should be based on individual patient needs in order to achieve a level of plaque control that is compatible with a stable periodontium. Specialist toothbrushes are available for certain patients and specific clinical indications (Fig 2-2): children’s toothbrushes – which have a reduced head size and a more bulky, easier-to-grip handle, single tufted toothbrushes (interspace brushes) – which can be used in areas that are inaccessible to a conventional brush, e.g. Both, the time at which the laser will be applied during the periodontal treatment and the type of laser to be used – and in which way – are individually chosen by the periodontist. IV. During this surgical phase of the periodontal treatment, the periodontist will select the most appropriate surgical technique for your lesions, depending on the type and severity of the damages that were not eradicated during the first phase of the treatment (root scaling and laser application). Patients who have deep pockets (gaps between gum and teeth) or have need for crown lengthening are good candidates for this first phase of surgical treatment. For this purpose ultra sounds and curettes are utilized. The clinic has at its disposal three different wave spectrums and therefore can handle the whole range of possible laser applications during periodontal treatment. Parental assistance. At the conclusion of the hygienic phase, the therapist has the opportunity to eval- uate the patient's tissue response and oral hygienic effectiveness. Materials and methods: Forty-four patients with severe periodontal disease were randomly allocated to a test or a control group. Without such vigilance it is likely that the patient will not achieve an adequate standard of daily dental hygiene and the tissues will become re-infected with dental … 4. Phase II: Correction of damage that has resulted from the periodontal disease. Smokers’ toothpastes and tooth powders contain significantly higher proportions of abrasives and their use is not recommended. This role often necessitates significant behavioural and attitude changes with respect to oral healthcare practices. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health. Other more subtle systemic and environmental issues ma… Many adjunctive treatment modalities have been clinically used and investigated for their efficacy. Abrasives (approximately 20–40% of the content) enhance plaque removal, but may result in damage to the tooth surface if there is overzealous brushing. Some are under the patient’s control, and may, therefore, require lifestyle changes to achieve significant modification. In order to achieve this, patients must be made aware that they are different from the general population with respect to their susceptibility to periodontitis and, consequently, they must achieve exceptionally high standards of homecare if treatment is to succeed. Keep in mind that the diagnosis is key. The aim is clean deeo p below the gum line and remove all calculus deposits and debris. programmable pacers that provide feedback to signal the amount of time that has been spent in one part (quadrant) of the mouth. Fig 2-3 Three powered toothbrushes with different handle and brush head designs. • Systemic phase of therapy including smoking counseling • Initial (or hygiene) phase of periodontal therapy, i.e. Mechanical plaque control is performed using toothbrushes, toothpaste and other cleaning aids. All patients go through this stage after having completed their periodontal treatment. Know when to refer. Circular heads have an oscillating motion. However, the technique and the force applied when brushing are more important determinants of plaque removal capability and gingival trauma than the hardness of the bristles themselves. Learn more about the periodontist Dr. Eirini Georgiou ►. To be more specific, the need for surgical correction of periodontal lesions after laser treatment in our clinic is contained to be less than 1% of the cases. Emerging evidence of possible perio-systemic links further reinforces the need for good periodontal health. Aim: The aim of the present study was to investigate the effect of a 3-month strict oral hygiene phase on key parameters of periodontitis: plaque, bleeding on probing (BOP) and probing pocket depth (PPD). and ≥ 7 mm prior to treatment were compared to their posttreatment scores. Patients refuse treatment for a variety of reasons, but one of the main ones is finances. phase. Dahlen, Lindhe, Sato, Hanamura, and Okamoto reported a substantial reduction in supragingival plaque and BOP after 3 months of supervised oral hygiene (4–8 supervision visits), using soft toothbrushes, interdental brushes and triangular toothpicks among 23 patients with moderate signs of periodontitis, and 2 years … 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), 1: The Goals and Clinical Outcomes of Non-Surgical Treatment, 12: Plaque Biofilm and Disease Control for the Periodontal Patient, Successful Periodontal Therapy A Non-Surgical Approach, Provide dental health information including, for smokers, the effects of nicotine on oral health, Ask smokers if they are ready to quit and where appropriate provide smoking cessation advice, Disclose and score plaque and compare to previous score, Advice on the selection of a toothbrush and give instructions in tooth-brushing, Identify any problems with tooth brushing and the use of interdental aids. Patient should be referred to a physician C. Schedule the dental appointment after lunch D. Retake the blood pressure after 15 minutes E. Proceed with dental treatment after retaking blood pressure after 10 minutes e.Preservation of the treatment result (supportive periodontal therapy). The efficacy of bone replacement grafts in the treatment of periodontal osseous defects. To prevent engaging in malpractice, and to treat your patients with their best interests in mind first, we need to be attentive to each phase of dentistry. [Hygienic phase of the treatment of periodontal disease]. After reading this chapter the practitioner should: be aware of the range of toothbrush designs and interdental cleaning aids that are available, understand the indications for using chemical plaque control. These agents are discussed in more detail later in this section. The majority of patients use a “horizontal scrub” technique, which does not clean effectively around gingival margins and can lead to tooth wear. If necessary, reinforce or change advice, Professional prophylaxis to remove residual stained plaque, Always be positive and praise the patient’s efforts. The gingival pathology is caused by the dental plaque due to poor oral hygiene . Scaling, root planing, instruction in oral hygiene and occlusal adjustment were completed during four to six sessions for each patient. Plaque control programmes should be tailored to the requirements of individual patients, addressing their local risk factors at the whole mouth, tooth and site levels (see book 1 in this series, Understanding Periodontal Diseases: Assessment and Diagnostic Procedure in Practice). Becker W, Becker B. Periodontal regeneration: a contemporary re-evaluation. 1. Powered by Leader School. The test group completed a 3-month strict oral hygiene phase. This phase aims to reduce and eliminate any gingival inflammation by removing dental plaque , calculus (dental) , restoration of tooth decay and correction of defective restoration as these all contribute to gingival inflammation, also known as gingivitis . fluoride). Conventional, manual toothbrushes vary in design and size, and the type of brush used is a matter of personal preference (Fig 2-1). Patient Plaque Control. Today, laser periodontal treatment is easily the single most effective way to fight serious gum disease. © 2020 PerioExperts.com. Periodontal or gum disease is a bacterial infection that affects the teeth supporting structures such as: gingiva, periodontal ligaments and alveolar bone. Annals of Periodontology 1996;1:621-666. A. The non-surgical phase is the initial phase in the sequence of procedures required for periodontal treatment. 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