Dental Terminology Ch. 16

Periodontics

Periodontology

One of the ADA recognized specialties and is the field of dentistry that deals with the treatment of diseases of the tissues around the teeth

What is the periodontium made of

gingival, periodontal ligaments, cementum, and alveolar bone process

Gingival

Fibrous, epithelial tissue surrounding a tooth; may be divided into attached, marginal, and papillary

Attached

The portion that is firm, dense, stippled, and bound to the underlying periosteum, tooth, and bone

Keratinized

(hard or horny) aka masticatory mucosa, there gingiva and mucous membrane unity, is indicated by the color changes from pink gingiva to red mucosa, and is called the mucogingival junction

Marginal

Potion that is unattached to underlying tissues and helps to form the sides of the gingival crevice; aka free margin gingiva and forms the gingival sulcus (groove) approximately 1-3 mm in depth

Papillary

The part of the marginal gingiva that occupies the interproximal spaces, normally this tissue is triangular and fills the tooth embrasure area, aka the interdental papilla

Periodontal ligaments

Bundles of fibers that support and retain the tooth in the alveolar socket; there are 5 principal types of periodontal membrane fibers

Alveolar crest fibers

Located at the cementoenamel junction; assists with the retention of the tooth in its socket and protects the deeper fibers

Horizontal fibers

Attached along the upper side of the root; assists in the control of lateral movement

Oblique fibers

Connects the majority of the root in the alveolar socket; assists with the tooth’s resistance to axial forces

Apical fibers

Arranged in bundles and attaches the apex of the tooth to the alveolar bone; assists with prevention of tipping and dislocation, and also protects the nerve and blood supply to the tooth

Interradicular fibers

Also arranged in bundles and located in the furcation’s of multiple rooted teeth; assists the tipping, turning, and dislocation of the tooth

Cementum

Outer hard, rough surface covering of the root section of the tooth that permits the fiber attachment for tooth retention

Alveolar bone process

Compact bone that forms the tooth socket; supported by stronger bone tissue of the mandible and maxilla and accepts periodontal fiber attachment, the alveolar process makes up the cribriform (sieve-like) plate to form and line the tooth socket, this outline is called lamina dura (lining, thin layer) and is easily viewed on radiographs

Major contributing factors of problems affecting the periodontium

Plaque and calculus

Erythema

The gingiva is red and appears inflamed

Edema

The tissue is overgrown from hyperplasia (excessive number of tissue cells) and hypertrophy (excessive cellular growth) the gingiva looks swollen and irritated hyperplastic gum tissue may be caused by drug reactions, allergies, and hormonal changes, as well as response to local irritants and disease

Loss of stippling

(spotting) Tone or tissue attachment loosens, and puffy gums become smooth and shiny

Pocket formation

Gingiva is unattached, recession occurs, and the root may be observed

Alveolar bone loss with exudate

(passing out of pus) A foul odor is present as supporting bone resorbs; retention is lessening

Mobility

The tooth seems lose and moves under pressure because of loss of attachment, the tooth eventually is lost from lack of support or from extraction

Periodontal diseases can be divided into two main divisions

Gingivitis and periodontitis

Gingivitis

An inflammation of gingival tissue with no supporting tissue loss

Periodontitis

Inflammation of gingival tissue with involvement of other tissues of the periodontium

Dental plaque involvement

(most common) Tissues react to irritants, gingival disease

Dental plaque with systemic factors included

Pregnancy, hormone, medication, or malnutrition may modify and intensify the disease course of action; sometimes called induced gingivitis, gingival disease

Nondental plaque tensions

These are of specific bacterial, viral, fungal, or genetic origin, such as gonorrhea, herpes, HIV, and candida infections, Gingival disease

Allergies

The patient may be allergic to dental-restorative materials and have reactions to food, additives, and so forth, gingival disease

Traumatic lesions, injury

The patient may have been subjected to an external force or have been injured in some way

Chronic periodontitis

Previously termed adult periodontitis, most common type of slowly progressive periodontal disease, may be subdivided according to extent and severity into localized with <30% involvement and generalized with >30% involvement, severity is measured based on the amount of clinical attachment loss (CAL) as slight, moderate, or severe, periodontal disease

Aggressive periodontitis

Previously termed early-onset periodontitis, and is a rapidly progressive disease, subclassifications are localized (used to be localized juvenile periodontitis affecting young adults) and generalized (prepubertal or rapid-progressing periodontitis) periodontal disease

Refractory periodontics

Periodontitis progresses in spite of excellent patient compliance and provision of periodontal therapy; may be applied to all types of periodontitis, tissues that are painful, red, and sloughing are said to be desquamative (shedding or scaling off) periodontal disease

Periodontitis as manifested of systemic disease

Periodontal inflammatory reactions occur as a result of diseases and genetic disorders, such as leukemia, HIV, malnutrition, and hormones, periodontal disease

Necrotizing periodontal diseases

Rapid gingival tissue destruction with bacterial invasion of connective tissue may be a manifestation of systemic disease, such as HIV infection, divided into NUG and NUP, periodontal disease

Necrotizing ulcerative gingivitis

(NUG) With foul odor and a loss of interdental papilla, sometimes called “trench mouth”

Necrotizing ulcerative periodontitis

(NUP) With bone pain and rapid bone loss

Abscesses of the periodontium

Abscesses are classified according to location, such as gingival, periodontal, and pericoronal, periodontal disease

Periodontitis associated with endodontic lesions

This simple classification was added to distinguish between periodontitis and periodontitis with endodontic inflammation involvement, periodontal disease

Developmental or acquired deformities and conditions

Deformities appear around teeth, edentulous ridges, and from trauma

Medical History

Questions regarding diabetes, pregnancy, smoking, hypertension, dedication, substance abuse, and so forth

Dental history

Chief complaint, past dental records and radiographs, complete assessment of restoration condition, tooth position, mobility

Extraoral structure assessment

Exam of oral mucosa, muscles of mastication, lips, floor of mouth, tongue, palate, salivary glands, and the oropharynx area

Periodontal probing depth

Charting and recording findings of probe depths, assessing plaque and calculus presence, soft tissue, and implant conditions

Assessing intraoral findings

Exam for tori platanus or tori mandibularis growths abnormal frenum placement and size, and furcation involvement

Prophylaxis

Scaling, root planting, and polishing of teeth

Index

Measurement of conditions to a standard

Periodontal probe

A round- or flat-bladed hand instrument marked in millimeter increments

Prophylaxis debridement

Removing supragingival and subgingival plaque, calculus, strain, and irritants through tooth-crown and root-surface scaling and root planning (SRP) this treatment usually involves ultrasonic tip scaling and hand instrumentation

Tooth and surface polishing

Polishing surfaces to remove accumulated extrinsic (outer) stains on the tooth surface and endotoxins (absorbed pathogens) on the accessible surfaces, this treatment can be completed using air polishers, abrasive cleansing, and handpiece application of nonabrasive rubber cups and points with polishing paste or powder

Selective polishing

Term applied to the polishing of chosen tooth sites or areas

Prophylaxis

Term applied the combination of debridement and tooth polishing; used for purposes of insurance and scheduling, tooth aids, such as flossing and bridge cleaners, periobrushes, and the like are applied and used in necessary attention areas to complete a thorough cleansing

Patient education

Customized instruction in oral hygiene; the care of teeth and gingival tissue

Antimicrobial therapy

Includes prescription mouthwashes; over-the-counter mouthwashes; systemic antibiotics such as tetracycline, penicillin, clindamycin, erythromycin, and metronidazole medicines; and local delivery systems of the site using a gel pack, syringe insertion, or gelatin chip containing antimicrobial products, a new method called perio protect offers an antimicrobial medicated applicaiton in a custom-made patient tray for patient application

Occlusal adjustment

Selective grinding of occlusal cusps to eliminate premature contact

Tooth stabilization

Splinting, wire ligation, or bonding of teeth to lessen tooth mobility

Occlusal guards

Custom-formed acrylic nightguard to protect from tooth grinding

Mucogingival excision

Used to correct defects in shape, position, or amount of gingiva around the tooth; eliminates the pocket formation and pericoronitis typically found on erupting third molars

Gingivectomy

excision of pocket tissue areas, one end of a pocket marker is inserted the entire depth of pocket and squeezed until the opposite pointed tip penetrates the gingiva, thereby marketing a setting for a surgical template pattern, necrotic tissue is excised and removed

Gingivoplasty

Instrumental or laser surgical contour of gingival tissue to remove excessive tissue or pellical edges

Periodontal flap surgery

A loosened section of tissue is separated from the adacent tissues to enable elimination of deposits and contouring of alveolar bone

Envelope flap surgery

No vertical incision with the mucoperiosteal flap retracted from a horizontal incision line

Mucoperiosteal flap surgery

Mucosal tissue flap, including the periosteum, reflected from the bone; aka full thickness flap

Partial thickness flap surgery

Surgical flap, including mucosa and connective tissue but no periosteum

Pedicle flap surgery

Tissue flap with lateral incisions

Positioned flap surgery

Flap that is moved to a new position apically, laterally, or coronally

Repositioned flap surgery

Surgical flap replaced into it’s original position

Sliding flap surgery

Pedicle flap resituated to a new position

Osseous surgery

Tissue surgery with alteration in bony support of the teeth

Re-entry

Second-stage surgical procedure to enhance or improve conditions from a previous surgical procedure

Vestibuloplastry

Surgical alteration of the gingival mucous membrane in the vestibule of the mouth, including frenum reposition or frenectomy and change in muscle attachment

ENAP

Excisional new attachment procedure, removal of chronically inflamed soft tissue to permit formation of new tissue attachment

Guided tissue regeneration

Placement of a semipermeable membrane beneath the flap to prevent ingrowth of epithelium between the flap and the defect; encourages the growth of new periodontal attachment

Bone grafts

Involve transplants to restore bone from periodontal disease

Allograft

Human bone graft from someone other than the patient

Autograft

Bone graft from another site in the same patient

Xenograft

Graft taken from another species, such as cow or pig bone

Allogenic

Addition of synthetic material to repair or build up bone

Osseointegration

Union of bone and device

Endosteal

Implants of various designs placed within the bone

Subperiosteal

Implant placement beneath the periosteum and onto the bone

Transosteal

Implant placement through the bone

Endodontic

The implant is set within the apex of the root

Crown lengthening

Removal of excessive gingival covering tooth enamel in the sulcus area

Soft tissue graft

Periodontal flap coverage of exposed root areas or repair of pocket damage

Pocket reduction

Eliminate collection area from pocket position; may include bone grafts

Ridge augmentation

bone graft inserts to reshape to the natural contour of gingival and alveolar bone

Sinus augmentation

Raising the floor of the sinus cavity and building bone replacement may be necessary for placement of maxillary implants in cosmetic surgery

Combination procesdures

Union of more than one procedure to achieve cosmetic effect

Periodontal probe

Used to measure the depth of the periodontal pocket by determining the amount of gingival tissue attachment, a probe may be flat or round bladed and is marked in measured increments, automatic periodontal probes are available and are used by inserting the probe wire into the sulcus area to determine and record the measurement on a computer

Explorer

Instrument with a longer, tapered, thin wire tip to determine calculus formation, restoration overhangs, and any root furcation involvement

Scaler

Instrument with a sharpened blade to remove supragingival calculus deposits and stains, scalers are available in various shapes such as sickle for universal use, straight for anterior areas, and contra-angled for posterior areas

Hoe

Instrument with a long shank and a hoe-like tip; used to remover heavy or thick supragingival calculus in posterior areas

Chisel

Instrument with a longer shaft and a chisel-bladed tip; used to break off and remove heavy calculus in the anterior region

Curette

Instrument with longer shaft and working end with a rounded toe and back edge to access and remove subgingival deposits

File

Hand instrument with multiple cutting edges; used to smooth off rough and uneven tissues and remove stubborn calculus deposits

Ultrasonic and sonic instrument tip

Inserted into the ultrasonic handle; sonic forces move the tip in rapid, short waves a speed frequency of 20,000 to 35, 000 vibrations per second to break apart and dislodge deposits from the tooth surface

Periodontal pocket marker

Set of instruments similar to tweezers with a sharp point on one tip for insertion int other depth of the pocket and then compressed to make puncture marks indicating pocket depth

Periodontal knives

Used to make incisions for removal of tissue or to obtain flap design, blade shape may be round or pointed and long edged

Electrosurgery tips/unit

Apparatus using electrical current to incise tissue and coagulate blood at the same time; useful in periodontal flap, tissue grafting, crown lengthening, and other tissue surgeries