describe the various types of nonsurgical periodontal therapy

• Describe the short- and long-term goals of nonsurgical periodontal therapy. Plaque biofilm is the primary causative agent in gingival and periodontal diseases. Air powder polishing removes most extrinsic stains and soft deposits from the exposed surfaces of the teeth. As the understanding of plaque biofilm as the pathologic agent has grown, various periodontal diseases have been identified with specific microbial organisms. Anatomic and iatrogenic plaque traps, such as overhanging restorations and malposed teeth, must be considered during nonsurgical therapy. 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 effects of nonsurgical periodontal therapy. If the non-surgical therapy effectively eliminates the gum disease, the only further requirement will be periodic maintenance every 3-4 months. Dental hygienist performing nonsurgical therapy in the contemporary clinical setting. 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. Nonsurgical treatments. This rationale has been questioned for many years and the procedure is no longer considered standard treatment. Your periodontist is best trained to determine if this treatment approach will help your specific condition. 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. Rationale for Nonsurgical Periodontal Therapy. It is now known that the presence of plaque biofilms does not interfere with the uptake of fluoride by tooth structures. In particular, it shows the most promise for root surface treatment and is safe and efficient for use in periodontal bone surgery when used with concomitant water irrigation. However, the roughness associated with calculus and poor restorations is far greater than the slightly granular texture of calculus-free root surfaces. The nonsurgical endodontic therapy or root canal removes the inflamed or infected pulp, carefully cleans and shapes the inside of the tooth, then fills and seals the space. The concept of selective polishing emerged when research on enamel and root surfaces after polishing revealed changes in the hard tissues. Calculus adheres to tooth surfaces through pellicular attachment, mechanical locking, and intercrystalline forces. It may also contain dislodged calculus and plaque bacteria. 3. Eventually, they will be much better understood so that therapies directed toward the specific plaque bacteria in each individual can be used, including the use of more antimicrobial and antiseptic agents. In these instances, root planing, commonly referred to as “deep cleanings”, becomes necessary. Mission Viejo, CA 92691 Local anesthetics are also used to numb the area for greater comfort. 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. 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. These procedures are demanding technical activities that require a large share of each therapeutic treatment appointment. A specific plaque bacterium, Actinobacillus actinomycetemcomitans, was identified in these lesions. Removal of endotoxins would require the planing away of diseased cementum. 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. Peri-implantitis: Nonsurgical therapeutic approach 6. J Clin Periodontol. Animal studies provide strong evidence that these destructive diseases occur in the presence of microbes, but not in animals raised in germ-free environments. True or false: nonsurgical therapy is typically done prior to surgical therapy? Laser periodontal therapy should never be considered as a substitute for conventional non surgical therapy or as a replacement for periodontal surgery. Periodontal disease is a common gum inflammation that affects 3 out of 4 adults, but it can be prevented or treated with regular periodontal exams. After periodontal debridement is performed (unless there are systemic complications) periodontal pockets, alveolar bone, periodontal ligament, and epithelium will heal. The American Dental Association states that the treatment is aimed to prevent further advancement of the disease, and it is a lifelong plan for treatment. The cycle may take as long as 6 months to complete.8 Repopulation can be expected to vary for many reasons, one of which is clinician differences in complete removal of plaque biofilm and calculus. This practice supports the old notion of “necrotic” root surfaces. Clinical trials have consistently demonstrated that scaling and root planing reduce gingival inflammation and probing depths and result in gains of clinical attachment in most periodontal patients. Kepic and colleagues18 demonstrated residual calculus on most teeth after 45 to 60 minutes of treatment time per quadrant. setting. These new microbiota are similar to those found in, 17: Periodontal Maintenance and Prevention, 5: Calculus and Other Disease-Associated Factors, 10: Treatment Planning for the Periodontal Patient, 18: Prognosis and Results After Periodontal Therapy, Periodontology for the Dental Hygienist 4e, Oral hygiene instruction for daily plaque biofilm control, Significant component of periodontal debridement biofilm, Supragingival and subgingival plaque biofilm removal, Instrumentation techniques to remove or disrupt subgingival biofilm, Identification of plaque-retentive factors, Referral for treatment of plaque-retentive conditions such as poorly fitting restorations and malpositioned teeth, Instrumentation techniques to alter the environment of the pocket wall, if necessary, Identification of occlusion-related factors affecting the periodontium, Selective procedure for supragingival plaque and stain removal, Locally or systemically delivered antimicrobial, antiseptic and antiinflammatory medications, CALCULUS AND BIOFILM REMOVAL (PERIODONTAL DEBRIDEMENT), Provide technique instruction and reinforcement, Ensure adoption of adequate daily oral hygiene procedures, Regular removal of new deposits at subsequent visits. They receive up to three additional years of specialized training in periodontal disease treatment in both non-surgical treatments and periodontal plastic surgery procedures. Periodontists are dentistry's e xperts in treating periodontal disease. This is why regular visits to your periodontist are important especially if other health problems are present, like heart problems or diabetes. 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. The term nonsurgical therapy is often considered a misnomer because the procedures performed require the application of sharp blades to cut tissues, which is a form of surgery. The definitions of procedures must be clear and consistent. Rough surfaces mechanically irritate gingival tissues. 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. Explorer-detectable root roughness may not be calculus but merely the texture of the root. This chapter defines the technical procedures applied by dental hygienists and the instruments used for treatment. The rationale for nonsurgical periodontal therapy is to remove the etiologic agent of disease—bacterial plaque biofilm—and its associated factors. Early studies that used visual appraisal of deposits or colony counts on surfaces showed. Experience suggests that the roots in an individual patient’s mouth will feel equally smooth after thorough instrumentation. Typical treatment for periodontal disease is scaling and root planing (SRP), which is a non-surgical method of cleaning the surfaces of the teeth and their root which may be exposed due to gum recession. Here’s a quick look at the different types of dentists and these dental terms. Abrasives used during polishing can scratch amalgam, composite resin, and gold restorative materials. Your dentist will first start with nonsurgical … With non-surgical periodontal therapy, many patients can be treated and maintained without the need for surgical intervention. 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. 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.24 In this era of increased emphasis on nonsurgical therapies, removal of disorganized granulation tissue and ulcerated epithelium from pocket linings remains appealing to many clinicians, even if data do not show improved healing. nonsurgical coverage of recession-type defects, treatment of suprabony defects and papilla reconstruction techniques. 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. Some residual calculus is likely to remain after dental hygiene treatment, especially in deeper pockets, but patients can probably tolerate some small amount. Achieving root smoothness is important for evaluating short-term goals during treatment appointments. Nonsurgical therapy remains the cornerstone of periodontal treatment. diagnosis and treatment of periodontal diseases. including the communities of Newport Beach, The dental hygienist must develop a tactile sense that permits detection of obvious calculus on the teeth. Scaling and root planing causes some removal and disruption of the epithelial attachment to the tooth, junctional epithelium, and deeper connective tissue. There was no difference in the healing of the differently treated areas; cementum removal through root planing did not improve healing beyond that achieved by calculus removal and polishing. The power and powder-to-water ratio is controlled with a foot pedal and can be increased or decreased as needed. Nonsurgical Periodontal Therapy Appointment Procedures, This chapter defines the technical procedures applied by dental hygienists and the instruments used for treatment. Plaque biofilm is the primary causative agent in gingival and periodontal diseases. 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. Several other concerns about polishing exist. It works by mechanical abrasion using a slurry of sodium bicarbonate and water. 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. The term selective polishing has been clarified to mean that the clinician selects the appropriate agent based on the presenting needs of the patient. The dental hygienist has many patient treatment options available for nonsurgical periodontal therapy, including the use of injected local anesthetics for pain control. 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. Animal studies provide strong evidence that these destructive diseases occur in the presence of microbes, but not in animals raised in germ-free environments. Collectively, these methods represent the fundamentals of non-surgical periodontal therapy. Smooth surfaces promote gingival healing. However, in periodontology, the term, 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. twilight sedation & 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. 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. However, subgingival plaque is not effectively altered by supragingival oral hygiene procedures, especially in deeper pockets of 5 mm or more. These products are not effective as standalone treatment and are also not effective for long term control of advanced periodontal disease or with patients who have chronically deep gum pockets. Replacement restorations or orthodontic movement of the teeth can simplify plaque biofilm control and help the patient achieve periodontal health. The thoroughness of calculus removal by instrumentation has been studied and shows surprising results. Areas in the periodontium that do not respond to therapy, even after retreatment and evaluation, may benefit from long-term subgingival antimicrobial treatment or surgical intervention. This practice supports the old notion of “necrotic” root surfaces. Unfortunately at the current time, and according to our doctors, there is inadequate research available to recommend laser therapy for the treatment of periodontitis. Connective tissue fibers are disrupted and lysed beneath the epithelium. Bacteria repopulate in a specific order, starting with Streptococcus and Actinobacillus species, followed by Veillonella, Bacteroides, Porphyromonas, Prevotella, and Fusobacterium species. 2008;35(Suppl 8):29-44. Scaling and Root Planing. Animal studies, the landmark study on human experimental gingivitis, and much additional evidence prove that plaque biofilm removal is a major part of nonsurgical periodontal therapy. NONSURGICAL PERIODONTAL THERAPY Instructed by Kelli R. Illyes, R.D.H, M.D.H. 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. Step 1. After 6 weeks, the dentist will schedule an appointment to examine the patient’s response to the treatment. The alternatives to non-surgical periodontal therapy are: Surgical periodontal therapy; No treatment It is important to understand that periodontal disease is not curable. Studies evaluating plaque biofilm formation on rough root surfaces are equivocal. To do so, the patient uses oral hygiene procedures and the dental hygienist performs coronal polishing. Calculus adheres to tooth surfaces through pellicular attachment, mechanical locking, and intercrystalline forces. The cornerstone of management of chronic periodontitis is the non-surgical periodontal treatment. Periodontal diseases present similar symptoms, but they likely have different bacterial origins that are not yet fully defined. A periodontal infection that can’t be fixed through ordinary periodontal therapy techniques may require surgery and will likely fall into 1 of 4 categories. Providing information about performing effective plaque biofilm control is more valuable than performing what is primarily a cosmetic procedure. 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. 30200 Agoura Road, Suite 270 Agoura Hills, CA 91301 (818) 889-0400 admin@agourahillsida.com In 1976 Wilkins, in her fourth edition of. In some cases, it could be non-surgical or surgical. 1981, Serino et al. Cortney Annese, RDH, says attention to detail, patient compliance, and proper selection of adjunctive antimicrobial agents for sustained plaque control are important elements in achieving successful long-term results. This chapter discusses the biologic basis and rationale for nonsurgical therapeutic procedures performed in the dental office. 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