Part II Periodontal Debridement Routine Prevention or Necessary

Part II: Periodontal Debridement

Routine Prevention or Necessary Treatment? �Dental prophylaxis OR periodontal therapy Removal of deposits from supragingival and subgingival surfaces of the teeth �Uses nonsurgical instrumentation �To prevent OR arrest infection �General anesthesia What does that entail? Risks Cost

Explore the Teeth �Dental explorer – has a slender, wire-like working end that tapers to a sharp point and is used to explore the topography of the tooth surface (crowns) �Explore caries Acid producing bacteria demineralization of enamel and dentin What is the most common surface affected? �Looking for pulp exposure

Check for Attachment Loss �Periodontal probe �Round, blunt instrument �Miniature intraoral ruler measures: 1. Attachment levels (gingival recession and sulcus depths) 2. Loss of bone in furcation areas �Used to assess mobility of teeth and the presence of gingival bleeding. � What is normal sulcus depth for a canine? Feline?

Periodontal Probe � Williams’ markings have millimeter increments at 1, 2, 3, 5, 7, 8, 9 and 10 mm.

Calculus Removers Removes gross calculus, supragingivally Which teeth do you think need this tool the most?

Scaling Above the Gingiva �Hand scaler – used to remove tartar / calculus supragingivally �Modified pen grasp technique Gives precise control of the instrument; limits wrist motion Where should all of your fingers be? Working end Shank Handle

Scaling Below the Gingiva �Curette-used to remove tartar subgingivally �Modified Pen Grasp *Tip is more round/dull than the hand scaler.

Periodontal Debridement Using Machines �Ultrasonic scaler- uses vibrations and irrigation to remove tartar from surface of tooth. Steady stream of water (strong mist) flushes out the sulcus AND can disrupt bacterial cell walls

Ultrasonic Scaler �Water through the tip also acts as a coolant; this machine can get very hot! �Move tip from the sulcus, down the Crown, to the apex. �Time line/tooth?

Ultrasonic Scalers: Two Options 1. Magnetostrictive- magnetic field in the hand piece is created by zinc and nickel, sends vibrations to the tip in an elliptical pattern All surfaces of the tip vibrate! �Most vibrations are on the tip Use least amount of vibrations �Found on the lateral surfaces

Magnetostrictive Scaler INCORRECT Distal third of tip should be held at 0 -15° from long axis of the tooth.

Ultrasonic Scalers: Two Options 2. Piezoelectric- ceramic discs or crystal that produces linear movements Only lateral surfaces vibrate �More skill required More fragile/breakable �Expensive

Periodontal Debridement �Polishing – VERY IMPORTANT The scaler microscopically scratches the tooth surface and creates more surface area quicker bacterial build up � 1 -3 seconds/tooth �Prophy angle- attachment that is connected to the hand piece Removable rubber cup holds polish, or prophy paste

Patient Position/Safety Comfortable for you and the patient �Plenty of light �Elevate neck; nose down �Opening of mouth Oral speculum �Suction/gauze �Preemptive rinse �PPE