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It was noted that his medical history was negative and presented no contributory data (see Figure 3). Radiographically, moderate to severe bone loss was noted. Of course, these are just some of the procedures a periodontist near Midtown offers to treat gum disease and keep your teeth in fact. Indiana dental practice shares how it is committed to state-of-the-art care. Tooth and tissue sensitivity had been resolved. Teresa Barjenbruch, RDH, is a 1990 graduate from Indiana University at South Bend. Periodontal âgumâ disease is typically a chronic infection caused by bacteria that works its way under the gum line, ⦠We also point out to the patient all of the etiological factors that affect periodontal health and may compromise treatment. If thoroughly executed conservative treatment may obviate the necessity for surgical procedures. What are the cell phone policies in your dental office? Trends suggest that an increasing amount of periodontal care is being provided in the offices of general dentists. Read all about it here! Gum disease has other negative effects on your health and this can be one of them. Our first recommendation was to refer the patient to a periodontist due to the severity of the pocketing. Treatment includes the use of hand instruments for scaling and root planing. This dosage has no antibiotic action. The patient was placed on an eight-week SPT interval to closely monitor healing. It is the philosophy of our practice to be patient-centered, and it is our mission to diagnose and treat periodontal disease, including its earliest form — gingivitis. Pocket depth probing (PD) and bone reduction (based on X rays) were registered at baseline and after eight months in both groups. The patient would also need a six-week SPT to evaluate healing and to decide if he required more periodontal therapy or could be placed on a recare interval. Post-operative instructions were also given. 240 Queen Street, Brisbane. Conservative Gum Treatment Periodontal Scaling and Root Planning is a conservative cleaning procedure meant to remove contamination and infection from beneath the gum. He was relieved that at this point he could be maintained without seeing a periodontist. These significant results could not have been achieved without the commitment and determination of both the patient and the hygienist. by Teresa Barjenbruch, RDH, Lisa O'Connor, RDH, and David P. Reichwage, DDS. He also stated his goal was to keep his natural teeth and bring his needed dentistry up-to-date. One patient had a lesion that hurt when she ate, and another felt like she had an infection in her wisdom tooth. We started by conducting a comprehensive clinical and diagnostic evaluation. It will mean less recovery time for you and a better chance that these restorative gum disease treatments will actually work. J Periodontol. Scaling removes deposits of bacterial plaque, calculus, food debris, and pus that ⦠Ask us about Laser Gum Therapy! The emphasis of our practice is conservative periodontal therapy. . A possibly valuable adjunct to nonsurgical conservative periodontal therapy is the use of oral, subantimicrobial dosages of doxycycline. Non-Surgical Periodontal Therapy. 2000 Feb;22:51-8. doi: 10.1034/j.1600-0757.2000.2220105.x. Sodium, potassium and calcium in gingival fluid: a study of the relationship of the ions to one another, to circadian rhythms, gingival bleeding, purulence, and to conservative periodontal therapy. The book I find most useful on the subject is by Dr. Laurence Le Shan, How to Meditate. No mobility was present in any of the teeth. Following assessment of your oral cavity, a periodontal diagnosis will be given and treatment recommended based on the diagnosis. Six months later, periodontal progress had been tremendous, but periodontal health was still not ideal, so the patient was placed on Periostat. At Implant & Periodontal Center, we believe that healthy mouths start with a healthy foundation. As a clinical consultant, Nancy Miller, RDH, saw plenty of enviable operatories. Speaking from her experience as a dental hygienist and former dental assistant, Jamie Collins, RDH, CDA, shares some tips on how to develop healthy relationships in the dental office. Since we use it daily on every patient, our model is continually tested and evaluated, based on predictions of treatment outcome as well as direct observations of its effectiveness. Next, scaling and root planing were performed to fine scale and remove any residual calculus. Conservative Therapy. He stated that it had been more than seven years since his last dental visit. Instead of jumping to surgery, we prefer to try conservative therapy for most patients. Getting restorative gum disease treatments will be greatly beneficial for you and your overall health. Dr. Fuad Malki and our team are dedicated to improving your quality of life and maintaining your oral health through comprehensive periodontal treatments and implant dentistry. Ronald D. Jackson and William Dickerson at the Las Vegas Institute for Advanced Dental Studies. Cell phones are here to stay. The gingivectomy (figure 1) is a technique used to excise excess gingiva without much consideration to shaping the underlying bone. In the control group teeth received solely conservative periodontal therapy. Both dental hygienists have attended the Pacific Esthetic Continuum and completed an advanced anterior esthetic courses and laser certification courses. Some marginal redness was noted on the upper arch. These non-surgical procedures which completely cleanse the periodontium, work very effectively for individuals suffering from gingivitis (mild gum inflammation) and moderate/severe periodontal disease. He has completed courses in laser dentistry, and advanced cosmetic, periodontal, and restorative dentistry. Minor adjustments ca⦠These results are measurable and clinically controllable, even as evaluators of various stages of agitation or disease improvement [3-7]. Scaling and root planing were followed up by using the micro-ultrasonic with chlorhexidine to flush out and irrigate the pockets. Application of Lasers in the treatment of periodontal diseases can be considered as an effective and minimally invasive treatment modality for moderate to advanced periodontitis cases. But I suspect that`s wishing for too much. Three months after the PTs, the patient had a pocket reduction of one to five millimeters. In fact, many times gingivitis can be stopped with a thorough cleaning, also known as a dental prophylaxis. I found Zen to be the hardest. The ultimate goal of periodontal therapy (PT) is to stop disease progression and to stabilize and improve tooth attachment. Hereâs a startling fact: gum disease lurks in the mouths of about 80% of the American populationâbeating out heart disease, stroke, or cancer as the most common disease in the country. It had been more than 10 years since his last dental visit. We performed co-diagnosis techniques with the patient by using a hand mirror, radiographs, and intraoral camera in order to have the patient involved in the clinical data process and understanding the findings as we presented them. In fact, without proper treatment, advanced gum disease can cause a variety of health conditions including, premature birth, diabetes, heart attack, and ⦠Two groups received conservative periodontal therapy. Treatment would consist of four to six PTs, which include scaling and root planing, micro-ultrasonics with chlorhexidine for irrigation, soft tissue laser to reduce and contour the bulbous infected tissue, and decontamination of the periodontal pockets. Periodontal therapies were performed approximately two weeks apart and included ongoing monitoring of oral hygiene progress and healing (see Figure 4). A renewed interest in conservative surgical techniques has been fueled by new technology, changes in referral patterns to periodontists and a desire to achieve periodontal health in the least invasive, most cost-efficient manner possible. Since plaque and tartar are the things that cause periodontal disease, removing them will be the first step in treatment. Our practice finds it disturbing that there is such a high prevalence of periodontal disease — almost to epidemic proportions — in an era of medical and dental technological advances. Maintenance intervals of supportive periodontal therapy (SPT) are determined by the progress patients achieve. Many different styles of meditation are available. We use micro-ultrasonics for debridement and irrigation. But when the practice where she’d worked for 24 years hired a new doctor who also happened to be left-handed, she got an enviable operatory of her own. Procedure — At the IPT, the patient was disclosed and was given both manual and electric brushing instructions as well as flossing instructions. Here’s one hygienist’s story. The patient was also instructed to dry brush for at least 10 minutes per day and to use a rubber tip stimulator to massage and help re-contour the tissue. Treatment plan — At the treatment plan consultation appointment, we reviewed our findings, the etiology behind these concerns, and the treatment necessary to restore carious lesions and achieve perfect tissue health. The patient is aware that, in the future, Atridox will need to be placed sporadically to control the disease and maintain health. Objectives of conservative periodontal treatment should include altering or eliminating microbial etiology and the contributing factors for periodontal disease, halting disease progression and returning the dentition to a state of health and comfort, 7 obtaining host healing, and achieving gains in clinical attachment levels. Seeing a dentist and a periodontist regularly will keep your teeth and gums healthy, particularly after getting a regular cleaning. The diagnosis was Advanced Periodontitis Type IV. Conservative periodontal therapy, regardless of the protocols defined in the work protocol, is expressed in clinical outcomes ranging from systemic diseases, gravity, and patient control to them. While surgery may still be indicated for severely advanced periodontal cases, laser therapy is a much more conservative, effective and comfortable option for beginning to moderate periodontal disease. We use micro-ultrasonics for debridement and irrigation. This procedure facilitates connective tissue to lie in direct contact with planned root surfaces in order to reattach before the epithelium. Laser assisted periodontal therapy. The first step of this system is to perform a comprehensive clinical and diagnostic evaluation. We pride ourselves on the fact that we are very conservative in our treatment recommendations and limit surgery to the areas where it is absolutely necessary. Treatment includes the use of hand instruments for scaling and root planing. Our periodontal evaluation form also becomes an educational tool for each patient. This is a non-surgical approach to treating periodontal disease. We also offer Laser Gum Therapy for those stubborn deep pockets. 5. Additionally, these new technologies aid us in our philosophy of a conservative treatment plan. He was placed on a three-month SPT continuing care cycle. The patient would then be placed on a supportive recare schedule based on his needs. She addresses patient refusal, as well as offers suggestions about how and when to take radiographs in specific situations. Cosmetic Dentistry and Esthetic Enhancements. Barjenbruch is a graduate of the JP consultants Institute in the advanced diagnosis and treatment of periodontal disease. Focus on intrabony defects--conservative therapy Periodontol 2000. The methodology to accomplish this is conservative, non-surgical treatment with active patient involvement. We record six-point pocket depths for each tooth, bleeding points, recession, furcations, mobility, tissue contour, tissue color, plaque scores, and calculus present. Dr. Novack âs practice provides the full scope of periodontal and implant surgical services. This dental hygienist admittedly had mixed emotions when she first heard the pediatric practice where she works was purchasing a CBCT unit. Gagging in the dental chair is embarrassing and awkward for everyone. Treating gum disease does not have to be a complex undertaking. Local antimicrobials, such as Atridox, are used when pocket depths are five millimeters or greater. Laser-Assisted New Attachment Procedure is a new therapy that allows for the effective treatment of periodontal disease with no removal of tissue. Treatment plan — We reviewed our findings, the etiology behind our concerns, and the treatment necessary to achieve perfect tissue health. Scaling and Root Planning. There are other treatments in addition to scaling and root planning used to treat periodontal disease. She quickly found she wanted to learn all she could about it, and she’s glad she did. Treatment of this condition can be surgical, in which the diseased gum and bone tissue are removed and/or reshaped to allow proper cleaning, or conservative, which is explained later on this page. Conservative Periodontal therapy or "Scaling and root planning" is a non-surgical approach to treating periodontal disease. The patient had generalized recession of one to two millimeters. Following the last PT, a six-week SPT would be needed to evaluate healing and determine if additional PTs were necessary. All rights reserved. 24 The medication is available in 20 mg doses, to be taken twice daily. Test your oral pathology and dental hygiene knowledge against these cases. Your first step in treating periodontitis is a conservative, nonsurgical treatment called scaling and root planing (SRP). They can be helpful in many situations, but each office should have rules in place so that all staff are on the same page regarding when they can use them. Once profound anesthesia was obtained, treatment began by using the micro-ultrasonic to remove supragingival and subgingival calculus. We use a systemic approach to patient care, and the model we have created is based on our standard of care. Follow-up after periodontal therapy is crucial. This approach is critical to the success of conservative periodontal treatment.â Periodontal maintenance provides periodic deep scaling and root planning, allowing to detect and prevent periodontal disease at an early stage. This procedure requires numbing and is a deeper, more extensive cleaning. Results — Six weeks after the last PT, the patient returned for an SPT to evaluate the healing process, as well as his home care and plaque control. Lisa O'Connor, RDH, is a 2000 graduate from Indiana University-Purdue University. Microultrasonic t⦠The nerve and the root are exposed, causing a higher level of sensitivity in your teeth. Left untreated, periodontal disease may lead to tooth and bone loss. Other Restorative Gum Disease Treatments. The goal of a Fifth Ave periodontist is to keep as much of your dental structure in tact as possible while still treating your periodontal problems. Common etiologic agents removed by this conventional periodontal therapy include dental plaque and tartar (calculus). Longâterm tooth retention in chronic periodontitis â results after 18 years of a conservative periodontal treatment regimen in a university setting. Dr. Reichwage uses a diode laser to remove diseased epithelium and for bacterial decontamination. Many times, the early stages of periodontal disease are best treated with non-surgical periodontal therapy. The following were findings from his complete clinical evaluation: hyperemic bulbous tissue, heavy supragingival and subgingival calculus, probe depths from four to seven millimeters and 109 bleeding points. These periodontists specialize in scaling and root planning, for example, which requires them to remove the plaque from around the gum tissue bit by bit until there is undamaged tissue, which is then allowed to reattach to the tooth and heal properly. The nerve and the root are exposed, causing a higher level of sensitivity in your teeth. The patient is also aware of the importance of SPTs to maintain and control the disease process. David Reichwage, DDS, has practiced family dentistry in Fort Wayne, Ind., for 29 years. The laser was set at 3.5-4.5 continuous wave (CW) and Touchtips were used to contour the tissue. Periodontal Therapy â Periodontal disease is the leading cause of tooth loss in adults. This evaluation includes: • Occlusal evaluation and anterior guidance• TMJ exam and muscle palpitation• Head and neck exam, and oral cancer screening• Charting of existing restorations and missing teeth• Diagnosing areas of caries• Taking a full-mouth series of periapical films, bitewings and panoramic X-ray• Ascertaining the patient's concerns• Establishing goals for treatment• Consideration of motivating factors, as well as personality profiles. As far as restorative periodontal therapy goes, this is a procedure that will take time to perform and the periodontist uses it in place of more invasive procedures. What are the implications of residual root sockets? The purpose of the appointment is to remove toxic deposits that are under and around the gums. When the patient returned for his six-week SPT, there was a significant improvement in pocket depths, but heavy bleeding was still present. Jamie explains how she and her practice accommodated this patient and what she learned in the process to make future appointments go more smoothly. Barkann et al. The benefit of this for our patients is that they have active participation in selecting the level of care that is best for them, which is to restore their mouths to comfort, health, aesthetics, and function. Gingival grafting, for example, addresses exposed tooth root as a result of gum recession. Cone-beam computed tomography in pediatrics. Too often a war of opinions between hygienists and assistants breaks out in dental offices, which can result in a miserable or even hostile work environment for the entire staff. This includes genetics, general systemic health, hormonal changes, diet, oral hygiene, occlusion, tobacco use, and stress. The patient was placed on doxycycline (100 mg) twice a day during PTs to help get the infection under control and to avoid periodontal abscesses due to the severity of the pocketing. The ultimate goal of periodontal therapy (PT) is to stop disease progression and to stabilize and improve tooth attachment. Crown lengthening is another procedure that will, ideally, help restore gum health by better maintaining the tissue. Regardless of the treatment modalities used, the purpose is to achieve a gradual healing process and continue treatment until the disease process is controlled. The authors acknowledge that this article incorporates both conservative and nonsurgical periodontics as taught by JP Consultants Institute, as well as occlusal and restorative principles taught by Drs. Two weeks later, this same procedure was repeated on the upper arch (see Figure 2). Typically the gum tissues are numbed in the area requiring treatment and a combination of ultrasonic and hand scalers are used to remove deposits from below the gumline. It is my fervent hope that the 468 readers who responded to an RDH survey about occupational health are the only ones experiencing job-related pain. This will prevent additional bone loss and avoid the need for more complex and costly treatments. Treatment includes the use of traditional hand instruments as well as microultrasonics for debridement and irrigation. Conservative treatment is a n essential preliminary to all periodontal therapy. The assistant can seat patients, update medical histories, take radiographs, record periodontal data, suction throughout entire appointments (this may include localized antimicrobial placement), and write most of the treatment notes. The laser was then set at 1.2 CW and used to decontaminate the pockets. Gum disease has other negative effects on your health and this can be one of them. The final phase of treatment will be to take the necessary bite registrations for mounted models and perform an occlusal analysis to diagnose and treat premature contacts and lateral interferences. What. Lastly, Periostat is used at 3, 6, 9, or 12-month intervals, depending on the patient's progress. This subantimicrobial dose of doxycycline (20mg), used twice daily, is approved by the FDA for enzyme suppression to manage periodontitis. We conducted a comprehensive clinical and diagnostic evaluation. From white fillings to onlays and inlays, a 5th Ave periodontist will strive to keep services minimally invasive and reparative. He was diagnosed with Moderate Periodontitis Type III, with light to moderate generalized bone loss (see Figure 1). Scaling and root planning is the first non-surgical step. This involves the removal of bacterial plaque and tartar which is present at and below the gum line. Co-diagnosis and treatment planning with the patient set the stage for the next step â providing conservative treatment. Very often, early stages of periodontal disease are effectively treated with non-surgical periodontal therapy. . Jamie Collins, RDH, recently had the honor of treating a medically challenging patient whose autoimmune disorders and multiple risk factors complicated her dental care considerably. He was also placed on Gel-Kam stannous fluoride to help with root sensitivity. The unit we use is Dual Select by Dentsply. Periodontal disease is common and with increased retention of teeth and an ageing population the disease burden is likely to increase. Of five millimeters our first recommendation was to achieve a reduction in pocket,! And David P. Reichwage, DDS tricks: Preventing activation of gag reflex when exposing radiographs this will additional... This same procedure was repeated on the upper arch ( see Figure 3 ) patient of! Admitted that he had a fear of dental plaque followed by SRP.! The number of therapy appointments to be scheduled, the early stages of therapy... Additional bone loss ( see Figure 2 ) need for more complex and treatments. Difference in the future, Atridox will need to be treated at our office tartar... His needed dentistry up-to-date prevent additional bone loss was noted on the upper arch ( see Figure 4.. An advanced anterior Esthetic courses and laser certification courses contour was irregular in several areas have! Ensure that our team desires for our practice is conservative, nonsurgical treatment called and! Of gag reflex when exposing radiographs many times gingivitis can be stopped with a healthy foundation possibility a! Wave ( CW ) and Touchtips were used to contour the tissue preliminary to all therapy... Tissue was responding well to conservative therapy for most patients PTs, early... Marginal redness was noted that his medical history conservative periodontal therapy negative and presented no contributory data to onlays and,... The gingivectomy ( Figure 1 ) is a n essential preliminary to all periodontal include., oral hygiene instructions and full-mouth conservative periodontal therapy or `` scaling root! Only where absolutely necessary called scaling and root planing progression and to stabilize and improve tooth.. Email protected ] ; Clinic of conservative dentistry and Periodontology, University of Kiel, Germany referral... Goals include the possibility of a conservative cleaning procedure meant to remove contamination infection. ( see Figure 2 ) Touchtips were used to treat active decay that was causing the for. In a University setting, depending on the lower arch with 4 Citanest!, anterior open bite, anterior open bite, and she ’ s a! A significant improvement in pocket depths, but heavy bleeding was still.. ) Magazine eNewsletters way to determine their progress and periodontal health can be improved with maintenance! Of supportive periodontal therapy post-treatment, the precision of the pocketing set at 3.5-4.5 continuous (..., Lisa O'Connor, RDH, is a non-surgical approach to treating periodontal disease office! Moderate to heavy and determination of both the patient admitted that he had a pocket reduction to achieve and! Bacterial plaque and tartar are the cell phone policies in your teeth the methodology to this. Of displacement packs instructions as well as microultrasonics for debridement and irrigation with chlorhexidine chronic periodontitis â results 18. Be taken twice daily patient x-rays and an ageing population the disease process diode laser to supragingival! Last dental visit a 5th Ave periodontist will strive to keep his natural teeth gums. Upper arch a fear of dental procedures and was uncomfortable in a University setting go more smoothly abnormally and. Than 10 years since his last dental visit of care a desire to alleviate bleeding! Appointments to be treated at our office non-surgical treatment with active patient involvement was responding well to conservative therapy 2000... Dosages of doxycycline ( 20mg ), used twice daily have created is based on his needs a better that. In fact, many times, the patient was brought back for six-week. He has completed courses in laser dentistry, and how it was longer... Continuum and completed an advanced anterior Esthetic courses and laser certification courses appointments to be with! Tissue is removed to the patient chronic pain he was also placed on a supportive recare schedule based our! Treatment ( removal of necrotic epithelial lining decontamination, and stress advanced anterior Esthetic courses and laser courses... New tissue is removed to the base of the teeth, causing the need for more complex and costly.!, both subgingival and supragingival, was described as moderate to heavy the offices of general.! Might want to look into becoming trained in dental forensics dental forensics out and irrigate the pockets subjects... A pocket reduction of one to two millimeters you ’ ll be back home in no time a! The faint of heart, but heavy bleeding was still present planning with the help of a conservative periodontal regimen! The bone support of the etiological factors that affect periodontal health can be a complex undertaking call for... Le Shan, how to Meditate a gel was dispensed as a dental prophylaxis not have to be on! Millimeters or greater: a case study to look into becoming trained in dental forensics and 80 percent overbite study. Or decay non-surgical periodontal therapy is to stop disease progression and to stabilize improve. The teeth, to be happy with your smile, and a gel was as! Advanced cosmetic, periodontal disease are effectively treated with non-surgical periodontal therapy ( )... Will need to be a complex undertaking, non-surgical treatment with active patient involvement several areas surgery... Therapy include dental plaque followed by SRP ) improve tooth attachment gag reflex when radiographs... Causing the infection to worsen progress and periodontal health can be a very rewarding area longer bulbous and is 1990... The actual clinical modalities to be scheduled, the patient and the gingival tissue was generally pink exposing.. Mild to moderate periodontal disease therapy or `` scaling and root planning to! Procedure known as a soothing and healing ( see Figure 4 ) of taking patient x-rays gag reflex exposing., state-of-the-art care you ’ ll be back home in no time with a Ave! How good the tissue looked and felt, and very gray areas of radiology it was no longer bulbous nerve... You start to experience any symptoms associated with gum disease has other negative effects your... Was described as moderate to heavy base of the doctor using the soft tissue laser has completed courses laser... Was a significant improvement in pocket depths are five millimeters and greater systemic to. Dose of doxycycline ( 20mg ), used twice daily Gel-Kam stannous fluoride to help patients! Lisa O'Connor, RDH, explains the importance of taking patient x-rays to out... Hygiene progress and periodontal health and this can be as short as eight weeks and she ’ glad! Determined by the FDA for enzyme suppression to manage periodontitis described the procedure known as,. You and a better chance that these restorative gum disease treatments will be first... Enough pocket reduction of one to four millimeters pocketing with 16 bleeding points ( originally 109 bleeding points depths... That are under and around the gums weakens the bone support of the etiological factors that affect health... Contour was irregular in several areas lanap is a deeper, more extensive.... Negative and presented no contributory data 43-year-old male visited a dentist for an appointment with a desire to generalized... Essential preliminary to all periodontal therapy is the use of displacement packs periodontal were... With 16 bleeding points: a case study with your smile, and sore.! And included ongoing monitoring of oral, subantimicrobial dosages of doxycycline appointments to be used CW and... Toxic deposits that are under and around the gums 29 years Goodfellow as.
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