4 - Periodontal disease, charting
PPE
eye protection/face shield
gloves
surgical mask
scrubs/gowns
head cover
shoe covers
patient positioning
lateral recumbency
allows drainage of fluids
good visibility to one side
can’t see buccal aspect of other side
dorsal recumbency
allows drainage of fluids
good visibility of all teeth
may need rolled towel under neck → tilts nose down
patient prep
eye lube q 30 min
Cuffed ETT
pharyngeal pack
rinse teeth with 0.05% Chlorhexidine gluconate solution/oral rinse → reduces bacteremia/aerosolized bacteria
suction
comprehensive dental cleaning steps
conscious oral exam
anesthetized teeth scaling
anesthetized intraoral radiography
periodontal probing/charting
crown polishing
subgingival irrigation
periodontal therapy/extractions
oral mass biopsies
antiplaque sealant application
antibiotic therapy
home care
treatment of periodontal disease
teeth scaling
supragingival cleaning
subgingival scaling - essential for treatment of periodontal disease - removes calculus, plaque, bacteria, byproducts, and toxins from gingigval sulcus
can use ultrasonic scalers and/or hand scalers or curettes
modified pen grasp
maximum control of instrument
wide range of movement
thumb + index finger hold instrument
middle finger guides instrument
periodontal instrument pack
dental mirror
allows proper ergonomics to evaluate teeth
can retract tissue
periodontal probe
use to take measurements
measures periodontal pockets
probe at least 4-6 spots around tooth
dental explorer/shepherd’s hook
allows examination of tooth surface for plaque, calculus, carious lesions, pulp exposure
hand curette
supra- and subgingival cleaning
rounded tip
hand scaler
supragingival scaling ONLY
sharp tip
dental unit
compressor
driving force of dental unit
foot pedal
activates hand pieces
water bottles
water reservoir for high-speed handpiece and air-water syringe
high-speed handpiece
burs are placed here
sectioning of teeth, removal of bone, smoothing bone
low-speed hand piece
polishing
use with disposable prophy angle
ultrasonic scaler
sometimes is separate unit
ultrasonic scaling of teeth
air-water syringe
helps remove debris from mouth during dental cleaning
dials
water control of hand pieces
pressure gague
for high-speed handpiece
25-30 PSI (varies by manufacturer)
power gague
for ultrasonic scaler
medium power for dental cleanings
lower power for root planing
suction unit
optional
clears debris
improves visibility
tray
optional
pharyngeal packing
purpose
keeps debris from going int oropharynx → reduction of aspiration risk
MUST REMEMBER TO TAKE OUT
oral rinse
chlorhexidine gluconate + zinc
antiseptic
apply to teeth/gingiva PRIOR to cleaning
decreases bacteremia/aerosolization of bacteria during cleaning
ultrasonic scalers
magnetostrictive
elliptical motion
all surfaces of tip can be used
generates more heat with prolonged use
piezoelectric
linear motion
only lateral edges of tip used
subgingival scaling
cannot be performed on awake patient safely
charting
periodontal pocket depth (in mm)
gingival recession (in mm)
mobility (grade 0-3)
furgation exposure (grade 0-3)
gingivitis (grade 0-3)
gingivitis
grade 1
gums swollen but do not bleed
grade 2
gums bleed slightly when probed but immediately stop
grade 3
gums bleed easily when probed and continue to bleed
furcation exposure
when probe passes through roots
indicates either or both periodontal pockets or gingival recession is present
stage 1
less than 50%
stage 2
more than 50%
stage 3
all the way through
mobility
how much tooth moves when touched
stage 0
doesn’t move
stage 1
less than 0.5 mm
stage 2
between 0.5 - 1.0 mm
stage 3
more than 1 mm
anatomy
buccal mucosa
palate
pharynx
tonsil
tongue
salivary ducts and flow
lymph nodes
extra-oral
bone/attachment loss presentation
periodontal pocket
gingival recession
add both together for total bone loss
polishing
dispoable prophy angle
prophy paste or pumic → fine grit
apply enough pressure to flare cup
need to polish subgingivally
purpose: decrease depth of microfractures of pumic
spend no more than 5 seconds per tooth (for polish or scaling) → heat damage can cause pulpitis
intraoral regional nerve blocks
maxillary dentition
infraorbital nerve block
infraoribtal foramen
dorsal to distal root of P3
desensitizes incisors to P3 ± M1
deeper insertion of needle may desensitization of P4 + M1
risk rupturing eye
caudal maxillary nerve block
deposit in pterygopalatine fossa → caudal to M2
dorsal direction of needle → insert 1-3 mm → avoid hitting maxillary artery
desensitizes palatine branch of max nerve → entire quadrant
intra- or extra-oral approaches
mandibular
middle mental nerve block
ventral to mesial root of P2 → insert needle into frenulum
desensitizes rostral to P2
inferior alveolar nerve block
llingual aspect of ramus, midway between M3 and angular process
desensitizes rostral to M3
intra- or extraoral approaches → scrape bone
complications
hematoma
intravascular injection
nerve damage
infection → uncommon
globe penetration → infraorbital, caudal maxillary
loss of tongue sensation → inferior alveolar