DENT 267: LO4 LS3- Plan Perio Therapy for Mucogingival Deformities

plan perio therapy for mucogingival deformities

-depends on the etiology/severity of attachment loss

-non-traumatic biofilm control

-debridement

-elevate tissues

-perio surgery may or may not be required

what is the goal of perio therapy for mucogingival deformities?

-restore progressive loss of tissue and restore gingival heights to cover exposed root surfaces if possible

when should we refer to a dentist/periodontist for a surgery consult?

-MGI type 1 or 2

-if surgery is indicated (mod to sev periodontitis)

-recession is progressing

-localized areas of advanced recession

-significant root exposure

-potential abutment teeth or teeth receiving intracrevicular restos w/ mucogingival concerns

-frenal concerns

-esthetic concerns

-pre-ortho tx

what are the types of surgery to treat defects?

-grafting

-frenal surgery

-flap surgery

care plan for mucogingival deformities

-ortho movement

-replacement of overhanging or over-contoured restorations

-replacement of impinging prostheses

-occlusal adjustment

-elimination of deleterious habits

client education for mucogingival deformities

-biofilm control and elimination of traumatic toothbrushing

-treat perio disease early

-prosthesis and ortho contraindicated if teeth have inadequate zones of attached gingiva and/or the presence of inflammation

-treat occlusal trauma early

aspects of recession that make it clinically significant

-attachment loss

-susceptible to caries, erosion, abrasion

-dentinal sensitivity

-hyperemia of the pulp

-interprox recession

-esthetics

mucogingival deformities & conditions around teeth: colour change

-abnormal colour

-gingival colour change can be associated w/ metallic pigmentation and systemic factors/diseases

what are some more mucogingival deformities

-melanoplakia

-Smoker's melanosis

-drug induced pigmentation (antimalarial, minocycline)

-amalgam tattoo

metallic pigmentation

-the ingestion/inhalation of metals such as mercury, lead and bismuth in medicinal compounds and through industrial contact can result in oral manifestations

-may also be systemic signs of intoxication if doses are high

-rare condition, more common previously when health conditions treated with heavy metals

metallic pigmentation: results from

-perivascular precipitation of metallic sulfides in the sub epithelial CT

where does metallic pigmentation occur on gingiva

-in areas of inflammation where there is an increase in vascular permeability

how can metallic pigmentation be eliminated?

-by decreasing inflammation

metallic pigmentation: lead

-lead exposure may cause a red or blue linear pigmentation of the gingival margin (Burtonian line)

-lead paint, lead solder in plumbing, contaminated water, soil, handling lead batteries

lead exposure

-coated tongue, spotty macules on mucosa, hypersalivation

-most prominent sign is gray-black lead line along marginal gingiva

-reversible if exposure to lead is eliminated

silver exposure (argyria)

-causes a violet marginal line which may accompany a diffuse bluish-grey discoloration

-silver has anti-bacterial properties and has been used in the past to treat STIs, the common cold, and epilepsy

-rare and most often results from prolonged exposure to silver containing ocular, oral or nasal meds

-nasal inhalation of solution containing silver salts have a propensity deposit on the palatal mucosa

treatment for silver exposure

-withdraw medication containing silver

metallic pigmentation: bismuth

-diarrhea meds which if used for the long-term, results in deposition of the metal in the gingiva

-metallic taste and burning mucosa are common symptoms

-bismuth line is blue-black

metallic pigmentation: mercury

-mercury poisoning can be acquired by absorption, inhalation, or ingestion

-mercury was tx for syphilis in early 20th century

-occupational exposure possible

-mercury poisoning may also cause other symptoms: headaches, burning mouth, abdominal pain, anorexia, abnormal discolourations on the gingiva

care planning for metal pigmentation

-eliminate pigmentation by removing local factors, biofilm, etc. and restoring tissue health, decreasing inflammation, decrease exposure

gingival colour changes associated w/ systemic factors

-melanin pigmentation

-Addison's Disease, Peutz-Jegher's Syndrome, Albright's Syndrome and Von Recklinghausen's Disease may produce areas of oral pigmentation

-certain drugs such as oral contraceptives, antipsychotic agents, anti-malarial agents can cause mucocutaneous pigmentation

-Nevi (mole) melanoma

Addison's Disease

-gingiva may look spotted brown

Peutz-Jegher's Syndrome

-melanotic macules may appear near mouth, lips, genitalia, palms and soles