Download Prevention of periodontal disease

PREVENTION OF
PERIODONTAL DISEASE
Omar Karadsheh
AIMS
1.
Aetiology
2.
Implications and importance of preventing periodontal disease
3.
Preventive methods
•
•
Mechanical plaque removal
Chemical plaque removal
PERIODONTAL DISEASE
• Group of infections that affect the
supporting structures of the teeth
• Gingivitis – inflammation
restricted to the gingival marginal
• Periodontitis – resorption of the
supporting connective tissue
attachment and apical migration
of the junctional epithelia
WHAT CAUSES PERIODONTAL
DISEASE?
DENTAL PLAQUE
Non mineralized, bacterial
aggregation on the teeth and other
solid structures in the mouth
bacterial cells (70%)
protein
extracellular polysaccharides
epithelial cells
white blood cells
DENTAL CALCULUS?
• Result of mineralization within plaque
(70-90% inorganic content)
• Not in itself causative of periodontal disease
• provides a rough PLAQUE retaining surface
• distorts the gingival crevice and increases stagnation areas – allows
greater bacterial proliferation within the crevice
FACTORS AFFECTING PD
1. Local factors
2. Host factors
LOCAL FACTORS THAT INCREASE
PLAQUE ACCUMULATION
Iatrogenic
• Rough surfaces
• Overhanging restorations
• Removable partial dentures
• Fixed orthodontic appliances
• Space maintainers (band and loop, etc.)
HOST FACTORS MODIFYING THE
IMMUNE RESPONSE
1.
Smoking
Periodontitis is 2 – 5 times more severe
amongst smokers compared to non-smokers
•
2.
Nicotine
Diabetes (type 1 and 2)
2 - 3 fold increase risk of periodontitis
•
related to degree of diabetic control, presence of complications and
duration of the syndrome
AIMS
• Aetiology
• Implications and importance of prevention
• Preventive methods
• Mechanical plaque removal
• Chemical plaque removal
IMPLICATIONS FOR
PREVENTION
• Chronic gingivitis is reversible
if effective plaque control is
introduced
• GINGIVITIS and
PERIODONTITIS can be
prevented by adequate plaque
control
• Preventive strategy should be
customized for each individual
– variation in susceptibility
WHY PREVENTION IS IMPORTANT?
1. Gingivitis is common in both children and adults
Children - 26%- 63%
(UK Children Dental Health Survey, 1993)
Adults – almost 100% 1 mm attachment/bone loss
Prevalence and severity of PD increases with age
WHY PREVENTION IS IMPORTANT
(CONT)
2.
Important cause of tooth loss
Scotland - 55% caries
17% PD
3.
Time-consuming and difficult to treat
4.
Potential source of systemic bacteraemia
•
•
•
•
Infective Endocarditis, coronary heart disease
Stroke
Low-birth weight preterm infants
Diabetes
AIMS
• Aetiology
• Importance of preventing periodontal disease
• Preventive methods
• Mechanical plaque removal
• Chemical plaque removal
MECHANICAL PLAQUE CONTROL
MECHANICAL PLAQUE CONTROL
• Self Care
• Toothbrushing
• Interdental cleaning
• Professional
• Scaling/Root planing
• Polishing
TOOTHBRUSHES
• The first true bristled brush was invented in China in 1498 for
the Emperor using animal hair (pigs)
• By the early 1800’s bristled brushes were in general use
• Nylon bristles were introduced around 1938
• 1960’s – development of power toothbrushes (electric)
REQUIREMENTS OF A
SATISFACTORY TOOTHBRUSH
1. Have good cleaning ability
2. Cause minimal damage to soft and hard
dental tissues
3. Having a reasonable lifespan (good wear
characteristics)
4. Non-toxic
MANUAL TOOTHBRUSHES
• Handle size appropriate
to the user’s age and
dexterity
• Head size appropriate
for the user’s mouth
• Adult – 2.5 cm
• Child – 1.5 cm
• Compact arrangement of soft, end rounded nylon
filaments not larger than 0.009 inches in diameter
• Hard brushes should never be recommended
• lacerate the gingiva, gingival recession and tooth
abrasion
• Diameter is too large to enter the gingival crevice
• Bristle patterns that enhance plaque removal in
approximal spaces and along gum margin
Filaments arranged at different heights and angles
significantly more effective at reducing plaque and
gingivitis than flat trim brushes
(Balanyk et al., 1993)
REQUIREMENTS OF A
SATISFACTORY BRUSHING
TECHNIQUE
1. Technique should clean all tooth surfaces,
especially interdental and gingival crevice
2. Movement of the brush should not injure the
soft or hard tissues
3. Simple and easy to learn
4. Well-organized so that each part of the
dentition is brushed in turn and no area
overlooked
BRUSHING TECHNIQUES
1.
Vertical
2.
Horizontal
3.
Roll Technique
4.
Vibrating (Bass, Stillman, Charter)
5.
Circular
6.
Scrub
BRUSHING TECHNIQUE
Bass technique most recommended by
dentists
BRUSHING TECHNIQUE
4.
Bass technique
•
aims to clean the
gingival crevice
•
brush held at 45° to the
axis of the teeth so that
the end pointing into the
gingival crevice
BRUSHING TECHNIQUES
• Research shows no particular
method superior to any other
• Modify the patients method
• Emphasize need to repeat the
procedure on all tooth surfaces
POWERED TOOTHBRUSHES
• Oscillating, rotating or
counter-rotational
movements
• Oscillating/rotating
(Braun Oral B) more
effective in removing
plaque and reducing
gingivitis than a manual
toothbrush (2003)
ULTRASONIC TOOTHBRUSHES
(SONICARE)
•
high frequency vibration
(30,000 – 40,000 brush
strokes/min)
•
Two mechanisms of
actions
1. Conventional scrubbing effect
2. Vibratory motion –
impact energy to oral
fluid that surround the
teeth – fluid pressure
and shear forces
WHICH TOOTHBRUSH?????
Manual vs. Electric
Which electric???
??????
MANUAL VS. ELECTRIC
• Electric toothbrushes remove more plaque than manual
toothbrushes
• Electric toothbrush is recommended for individuals
who are unable to maintain effective plaque control
• Physical or learning disability
• Fixed orthodontic appliances
• Institutionalized patients depend upon care
providers
• A manual toothbrush is appropriate for most people
WHICH ELECTRIC TOOTHBRUSH?
Oscillating/rotating (Braun
Oral B) performs better than
Ultrasonic (Sonicare)
(Strate et al., 2005)
BRUSHING IN CHILDREN
• Start brushing as soon
as the first tooth
erupts
• Preschool children
need help with
brushing
FREQUENCY AND DURATION OF
BRUSHING
• Effective plaque removal every second day has been shown to prevent gingivitis
(Lang et al., 1973)
• Twice daily brushing is consistent with maintaining good gingival health
• 2 - 3 minute duration is recommended
REPLACING TOOTHBRUSH
• Splaying of the toothbrush is the most obvious
sign of toothbrush wear
• Renewal is usually recommended after 3
months use
INTERPROXIMAL CLEANING
Periodontal conditions are worst in
interdental areas
PLAQUE REMOVAL
INTERPROXIMAL CLEANERS
1.
Dental floss
2.
Interspace brush
3.
Interdental brush
4.
Wood points (toothpicks)
5.
Irrigation devices
DENTAL FLOSS
1. Waxed/Unwaxed
2. Tape
3. Superfloss
4. Flosette
DENTAL FLOSS
1. Waxed/Unwaxed
2. Tape
3. Superfloss
4. Flosette
Flossing technique??
DENTAL FLOSS
1. Waxed/ Unwaxed
2. Tape
3. Superfloss
4. Flosette
DENTAL FLOSS
1. Waxed/Unwaxed
2. Tape
3. Superfloss
4. Flosette
TOOTHPICKS
• Effective only when sufficient
interdental space is available
• Triangular toothpicks are superior
to round or rectangular
• Incorrect use may cause gingival
lesions
INTERSPACE BRUSH
• Used for tipped, rotated or
displaced teeth, teeth with
gingival recession
• Limited value except for
surfaces adjacent to an
extraction space
INTERDENTAL BRUSH
• Superior to floss for
cleaning open spaces
• May be used for
cleaning around fixed
orthodontic appliances
IRRIGATION DEVICES
• A steady or pulsating
stream of water
through a nozzle under
pressure
• Eliminate food residue
accumulated
interdentally
IRRIGATION DEVICE (CONT.)
• NOT A SUBSTITUTE FOR
BRUSHING
• Time-consuming and messy
• Used to deliver chemical
agents to the oral cavity
TO FLOSS OR NOT TO FLOSS?
TO FLOSS OR NOT TO FLOSS?
• Recommended by the federal government in
1979.
• When the federal government issued its
latest dietary guidelines 2015, the flossing
recommendation had been removed, without
notice.
• In a letter to the AP, the government
acknowledged the effectiveness of flossing
had never been researched, as required.
MECHANICAL PLAQUE CONTROL
• Self Care
• Toothbrushing
• Interdental cleaning
• Professional
• Scaling/Root planing
• Polishing
SCALING AND ROOT PLANING
• Scaling sufficient to remove plaque and
calculus from enamel leaving a smooth
clean surface
• Root surfaces - Root planing
• calculus may be embedded in cemental
irregularities
• Contamination of toxic substances in
cementum – biologically unacceptable to
gingival tissue
RECALL INTERVALS
Aim
1. Prevent recurrence and progression of PD
2. Prevent tooth loss
3. Increase probability of diagnosing and treating in a
timely manner other oral disease
1. Reinforcement of oral hygiene instruction
2. Supragingival scaling or root planing as necessary
Frequency?
3 month recall is favoured by most clinical trials
PROFESSIONAL CLEANING - POLISHING
• Polishing enamel – reorientation of surface crystals to create a
smoother surface
• Experimental studies shown polishing inhibits formation of
pellicle, plaque and calculus
• No evidence that periodontal health improves
• Removal of fluoride from superficial layers of enamel is a
significant drawback
MECHANICAL PLAQUE CONTROL IN
SPECIAL NEEDS PATIENTS
• Mental disability
• Physical disability
DENTURE BRUSH AND REGULAR TOOTHBRUSH
HANDLES ENLARGED USING SOFT RUBBER
BALLS TO GIVE IMPROVED HAND GRIP
DOUBLE-HEADED BRUSH FOR
IMPROVED PLAQUE CONTROL IN
PEOPLE WHO WOULD OTHERWISE
REQUIRE ASSISTANCE WITH
TOOTHBRUSHING
DOUBLE-HEADED BRUSH WITH
MODIFIED HANDLE (USING SILICONE
PUTTY) FOR EASE OF GRIP
TEPE INTERDENTAL BRUSH SHOWING
HANDLE FOR EASY HOLDING
BOY WITH ASPERGER’S SYNDROME
USING A LARGE-HANDLED ELECTRIC
TOOTHBRUSH
TOOTHPASTE PUMP AND DISPENSER
CARER CLEANING THE TEETH OF A
PERSON WITH A DISABILITY SUCH
THAT THEY CAN NO LONGER
PERFORM THIS TASK
AIMS
1.
Aetiology
2.
Implications and importance of preventing periodontal disease
3.
Preventive methods
•
•
Mechanical plaque removal
Chemical plaque removal
CONCLUSION
Mechanical plaque removal is the backbone of periodontal disease
prevention
REFERENCE
Prevention of Oral Disease
Murray, Nunn, Steele
4th Edition
2003
THANK YOU