CHAPTER 44-45

PLAQUE CONTROL FOR PERIO PX / SCALING & ROOT PLANING

plaque control

the most essential element of successful periodontal therapy for all patients

the regular removal of microbial plaque and the prevention of its accumulation on the teeth and adjacent gingival surfaces

the most effective toothbrushing technique

used without a scrubbing motion

soft nylon bristled toothbrushes directed at the gingival margin

microbial plaque

the major etiology of periodontal diseases and is related to dental caries

microbial plaque growth

occurs within hours

it must be completely removed at least once every 48 hours in the experimental setting with periodontally healthy subjects to prevent inflammation

brush 2x a day & use floss / interdental cleaners 1x a day

recommendation of American Dental Association (ADA) to effectively remove microbial plaque and prevent gingivitis

interproximal surfaces

where plaque formation begins

sequence of plaque accumulation

molar & premolar areas —> proximal surfaces of the anterior teeth —> facial surfaces of the molars & premolars

lingual surfaces

a surface that accumulate the least amount of plaque

variations of toothbrushes

size & design

length & hardness

arrangement of the bristles

dental floss

can be waxed, unwaxed, thick, thin, or flavored.

a popular tool for removing plaque from proximal tooth surfaces, made from nylon filaments or plastic monofilaments

factors influencing floss choice:

• surface roughness

• tooth contact tightness

• patient's manual dexterity

wooden toothpicks

used on handles improve access to all areas

have been shown to be as effective as dental floss in reducing plaque and bleeding scores in subjects with gingivitis

triangular wooden tips

this design is most useful in the anterior areas when used from the buccal surfaces of the teeth

rubber tips

can be easily adapted to all proximal surfaces in the mouth

conical and are mounted on handles or the ends of toothbrushes

gingival massage

increased keratinization

produces epithelial thickening

increased mitotic activity in the epithelium & connective tissue

classification of periodontal instruments

explorers

periodontal probes

scaling, root-planing, and curettage instruments

periodontal probes

thin probes with an angled shank are ideal

furcation areas can be evaluated with a curved, blunt nabers probe

used to locate, measure, and mark pockets, as well as determine their course on individual tooth surfaces

measure pocket depth and configuration, with a tapered rod-like instrument calibrated in millimeters

explorers

used to locate subgingival deposits and carious areas

check root surface smoothness post root planing

scaling, root-planing & curettage instruments

used for debridement of the soft tissue lining the pocket

for removal of altered cementum from the subgingival root surface

for removal of biofilm and calcified deposits from the crown and root of a tooth

classification of scaling, root-planing, and curettage instruments

curettes

sickle scalers

periodontal endoscope

hoe, chisel, file scalers

ultrasonic & sonic instruments

cleansing and polishing instruments

sickle scalers

heavy instruments used to remove supragingival calculus

have a flat surface and sharply pointed tip, used to remove supragingival calculus

their design makes it difficult to insert a large blade under gingiva without damaging surrounding tissues

2 types of curettes

universal curettes

area-specific curettes / gracey curettes

universal curettes

are dental tools with cutting edges

have a 90-degree angle blade; curved in one direction

can be inserted into most dentition areas by adjusting the operator's finger rest, fulcrum, and hand position

area-specific curettes / gracey curettes

have a 60-degree angle blade; one cutting edge; curved in two directions

designed to adapt to specific dentition anatomic areas making them ideal for subgingival scaling and root planing due to their superior adaptation to complex root anatomy

2 availabilities of gracey curettes

rigid gracey

finishing gracey

rigid gracey

has a larger, stronger, and less flexible shank & blade

allows the removal of moderate to heavy calculus without using a separate set of heavy scalers, such as sickles and hoes

finishing gracey

has enhanced tactile sensitivity on flexible shank

hoe, chisel, and file scalers

their use is limited compared with that of curettes

used to remove tenacious subgingival calculus and altered cementum

ultrasonic and sonic instruments

are used for scaling and cleansing tooth surfaces and curetting the soft tissue wall of the periodontal pocket

periodontal endoscope

used to visualize deeply into subgingival pockets and furcations, allowing the detection of deposits

cleansing and polishing instruments

used to clean and polish tooth surfaces

such as rubber cups, brushes, and dental tape

also, available are air-powder abrasive systems for tooth polishing

offset blade

the term used to describe gracey curettes because they are angled approximately 60-70 degrees from the lower shank

morse scaler

a miniature sickle

was the only mini-bladed instrument available

however, the mini-bladed curettes have largely replaced this instrument

diamond-coated files

are unique instruments used for final finishing of root surfaces

these files do not have cutting edges; instead, they are coated with very-fine-grit diamond

rubber cups

aggressive use may remove the thin layer of cementum in the cervical area

a good cleansing and polishing paste with fluoride should be used to minimize frictional heat

used in handpieces with a special prophylaxis angle, and must be sterilized after each patient use

bristle brushes

available in wheel and cup shapes

used in prophylaxis angles with polishing paste

confined to the crown to avoid damaging the cementum and gingiva

dental tape

this with polishing paste is used for polishing proximal surfaces that are inaccessible to other polishing

Prophy-Jet

the device that is very effective for the removal of extrinsic stains and soft deposits