5 prevention of periodontal disease

1. Dr. AHMED ALSHAWI
PREVENTION OF
PERIODONTAL
DISEASE

2. eriodontal disease is the affection of the periodontium or the
supporting tissues of the teeth.
t may range in the same mouth from mild inflammation of
the gingival margin (marginal gingivitis) to a severe
destruction of the periodontal ligaments and the
supporting alveolar bone.
pidemiological surveys and clinical studies demonstrate a
direct association between the prevalence and severity of
periodontal diseases and the accumulation of bacterial plaque
and debris.
Personal care results in the resolution of the inflammation

3. ormal gingiva has been defined as pink, firm, stippled ,
with well-formed papillae and gingival sulci (crevices)
shallow in depth and without exudate.
Three areas are distinguished clinically in the gingiva,
namely the interdental papilla , the gingival margin which
forms the soft tissue wall of the gingival crevice/and the
attached gingiva which is firmly bound down to the
underlying cementum and alveolar bone.

4. he initiating factor leading to periodontal disease is the bacterial component
of the plaque around the teeth or overlying the calculus on the teeth.
he prevention of plaque accumulation or its regular removal is the best
method of avoiding periodontal disease, and therefore the most important
preventive measure is the effective use of the toothbrush and other devices
when necessary.
Today, only the mechanical action of the brush has been regularly shown to
remove the bacterial and other soft deposits.
There is sufficient evidence from Controlled clinical studies to suggest that
keeping the teeth clean is an effective means of controlling periodontal
disease.

5. hen the gingiva is inflamed , there is increased hyperemia, which shows
as a deepening of the normal pink color to red, this is usually associated
with bleeding either on brushing or spontaneously.
The gingival margin and the interdental papillae are usually swollen and
edematous.
his results in shiny appearance of the surface with loss of stippling.
Mild gingivitis is very prevalent among children often being limited to
loss of stippling, swelling and slight redness.

6. n more advanced cases, however, marked redness with frequent bleeding
may occur accompanied sometimes by soreness and etching, where
inflammation has been present for a long period there may be an over growth
of connective tissue specially in the anterior region where the gingivae
become rough and irregularly enlarged.
In more severe cases, destruction of the periodontal ligaments will occur, this
may be accompanied by resorption of the alveolar bone, pocket formation,
loosening and tooth migration.
t puberty there is sometimes a pronounced gingivitis showing more swelling
and discoloration than usual but after a time this may tend to improve
although frequently treatment is also required.

7. CAUSES OF
PERIODONTAL
DISEASE:

8. Causes Of Periodontal Disease:
hese may be conveniently divided into local and
systemic predisposing though naturally.
Any particular patient may be affected by more
than one etiological factor.
Local factors:

9. I. LOCAL
FACTORS:

10. Local factors:
1. The consistency of the diet:
is considered important on the basis of functional stimulation
derived from mastication which is an essential requirement
for the normal metabolic activity of the gingiva and
underlying tissues.
Soft foods are detrimental to the periodontium, first because
they do not afford functional stimulation, and second , they
faster accumulation of irritating food debris at the gingival
margin.
Bacterial activity in the food debris around the teeth and gums
can cause damage to the underlying gingival tissues and
initiate gingivitis.

11. Local factors:
2. Calculus:
Although important in the adult is hardly an etiological
factor in children since relatively few exhibit it .

12. Local factors:
3. The process of shedding of deciduous teeth and
eruption of permanent teeth :
are probably responsible for much of the gingivitis seen
during the mixed dentition period.
The child will avoid chewing on a loose or painful tooth
allowing deposits to be left on and around the affected
site.

13. Local factors:
4. Untreated caries:
especially in cases of interproximal and cervical caries duedue
to increased impaction or lodgment of food debristo increased impaction or lodgment of food debris.
Poorly contoured restorations and overhanging
cervical edges are also a cause of periodontal disease.

14. Local factors:
5. Occlusal abnormalities
e.g. crowding of teeth, open bite, proclined maxillary
incisors, and incompetent lips, are common cause of
gingivitis by interfering with normal function and
allowing food stagnation.
Early extraction of a first permanent molar will prevent the
normal cleansing effect of mastication and allow food
stagnation around the tooth opposite the space.

15. Local factors:
6. Prosthetic and orthodontic appliances :
constitute a significant local irritating factor particularly
when poorly fitting or incorrectly designed.

16. II . SYSTEMIC
FACTORS:

17. Systemic factors:
1. Endocrinal disorders:
Diabetes often permits an increased inflammatory gingival
response, particularly if there is neglected oral hygiene.
At puberty there are often hormonal changes and
temporary upset in the gingival condition characterized
by a rather swollen hemorrhagic appearance.

18. Systemic factors:
2. Drugs:
The administration of certain drugs on long term basis may
give rise to gingival alterations.
The anticonvulsant drug "Dilantin" (Phenytoin ) causes
characteristic gingival hyperplasia starting at the
interdental papillae and spreading over other areas too,
occasionally completely covering the teeth.
In some cases the gum is rather firm and shows little
tendency to bleed , in others a superadded gingivitis is
present as well.

19. Systemic factors:
3. During acute fevers :
such as typhoid and measles, deterioration of the gingiva
may occur due to the concomitant poor oral hygiene butbut
an improvement should be shown on recovery from the
fever.

20. Systemic factors:
4. Blood dyscrasias, such as agranulocytosis, leukemia
and purpura often exhibit gingival changes and these
may even be the first symptoms experienced by thefirst symptoms experienced by the
patient.patient.

21. Systemic factors:
5. Avitaminosis
may affect the gingiva; particularly the lack of vitamin C,
which gives rise to scurvy .

22. PREVENTIVE
MEASURES:

23. Preventive Measures:
1. Dental prophylaxis:
It is more important in the control of periodontal disease than it is in the
control of caries. This is because deposits of calculus are highly
conductive to periodontal disease and cannot be removed by the
patient in the course of home care. Patients with a tendency to
gingivitis must be observed until it is known in how many months the
accumulation of hard deposits upon the teeth will pass beyond the
control of home care.
Many periodontal patients must receive dental prophylaxis every 3 months
or every 4 months, in addition to whatever more extensive treatment
may be necessary at the hand of the dentist.
Posterior bite-wing X-ray films should be taken at annual intervals and
studied for any alveolar bone loss.
If calculus forms in a child's mouth, a thorough prophylaxis should be
carried out and repeated at intervals; in addition, the child's brushing
habits should be checked to try to prevent any recurrence.

24. Preventive Measures:
2. Good oral hygiene:
The stressing, from an early age, on the importance of good oral hygiene
in assisting the natural cleansing action of the mouth is valuable;
in addition, it should be recommended that children eat some hard, fibrous
and fresh foods in addition to the rather soft diet prevalent today.
It must be stressed also that the toothbrush is really a mouth brush and
the care of the gingivae is just as important as that of the teeth.

25. Preventive Measures:
3. Tooth brushing:
It is the most commonly recommended measure for the removal of
food debris and plaque from the teeth mechanically.
On the basis of the motion, methods of brushing are different, from
vertical, horizontal, roll, circular to scrub method , None of
them has been shown to be superior to others.
The thoroughness of plaque and debris removal depends upon the
careful and correct application of any brushing method rather
than the applied methods itself.
The roll technique mentioned before can be suggested, other
techniques are beneficial particularly when periodontal disease
is existing; these are:

26. Brushing Methods
A. Charter's method:
The end of the bristles is placed in contact with the enamel of
the tooth surface and the gingival tissue with the bristles
pointing occlusally at an angle of 45 degree .
Much lateral and downward pressure is then placed upon the
brush and the brush is vibrated gently back and forth a
millimeter or so.
This gentle vibratory procedure forces the ends of the
bristles between the teeth and cleans the interproximal
tooth surfaces very well.
This technique also massages the interdental tissues as
well.

27. Brushing Methods
B. Stiliman's method:
• The brush is placed in approximately the same position as
required for the beginning stroke of the roll method, except
that it is nearer the crowns of the teeth.
• The handle is vibrated gently in a rapid but slight
mesiodistal movement. This technique forces the bristles
into the interproximal spaces and handle the teeth in that
area very well. It also adequately massages the gingival
tissues.
• As a final step of brushing, it is recommended to brush the
dorsum of the tongue with brush.
• This will increase its circulation and removes bacteria
and waste products .

28. Preventive Measures:
4. Devices for entering individual crevices:
Dental floss, tooth picks, rubber tips etc. are sometimes recommended for
cleaning areas inaccessible to the toothbrush.
They are beneficial in massaging the gingival tissues and cleaning the
interproximal spaces. (The uses of these devices are discussed before).

29. Preventive Measures:
5. Oral irrigation:
(discussed before).

30. Preventive Measures:
6. Early -treatment of carious cavities:
To avoid gingival inflammation, caries should be treated as soon as a cavity is
spotted. There is no urgent "big cavity" to cause wary and non-urgent "little
cavity" warrants no such interest. Caries is caries in both conditions.
Cervical cavities and interproximal cavities cause irritation of the neighboring
gingival tissue, whereas an open occlusal cavity causes decreased function
of the same side and results in the accumulation of debris.
• The use of bite-wing films in the early detection of interproximal lesions is
advisable because such early cavities may be missed on clinical
examination only.
• New restorations should be carefully inserted, contoured and polished to
avoid food impaction and gingival damage. Old restorations should be
checked for . improper contact, overhanging margins and defect at the tooth
restoration junctional line.

31. Preventive Measures:
7. Disorders of occlusion:
Early diagnosis of occlusal disorders and early treatment
by preventive or interceptive measures will save the
gingiva .

32. Preventive Measures:
8. Mouth breathing: This should be treated either by
clearing the air passages (oro-nasal part) by surgical or
medical specialists, or by orthodontic means as oral
screen.

33. Preventive Measures:
9. Systemic diseases:
Such as blood dyscrasias, endocrine disorders and vitamin
deficiencies will need medical attention in addition to local
treatment.
Proper oral hygiene will add to the health of oral and periodontal
tissues.