Prevention of periodontal diseases

Lecture : for 4th level

Professor/Abdullah Amran

Introduction:

 Periodontal diseases are diseases induced by biofilm (dental plaque)

 Early periodontal disease that is limited to the gingiva is referred to as
gingivitis
 Gingivitis is a common clinical finding that affects nearly everyone at some
time during the life cycle
 Gingivitis can be reversed by the use of primary preventive measures
 Periodontal disease that affects the tooth-supporting structures and
alveolar bone is referred to as periodontitis
 Damage caused by periodontitis usually is not reversible with primary
preventive measures; however, these procedures aid in the control of
periodontitis
 Loss of attachment is the primary clinical and diagnostic difference between
gingivitis and periodontitis
Prevention of periodontal diseases :
This is based on individual level and not on a community Level, we have 3 types
of prevention:
Primary prevention (type 1):- At this type we practice the preventive measure to
prevent a diseases which is anticipated to occur e.g, vaccination and
immunization of children agents many diseases.
 PRIMARY PREVENTION
 Occurs in the clinically pre-pathologic period.
 Involves promotion of oral health concepts, as well as specific
protection.
 Examples: oral health education, water fluoridation, plaque removal
through brushing and flossing, antimicrobials, topical fluorides, pit
and fissure sealants, mouth guards.
 Prevent: caries, gingivitis, trauma to the teeth from occurring.
  As primary prevention is the ultimate goal of the dental profession, it
necessarily follows that the thrust of any comprehensive oral health
program be directed at the child.
 Children must be the foundation of a practice that is focused on
prevention.
Secondary prevention (type 2):-
 In this type the disease is present, but it is reversible (there is no
destruction), so we practice the prevention measures to reverse the
disease process e.g . gingivitis.
 Occurs in the early period of pathogenesis.
 Involves early recognition and prompt therapy.
 Examples: Radiographic examination, Root scaling, conservative
restorative treatment
 Prevent: further deterioration of health that would result in
extensive lesions of the teeth, pulpal involvement, or periodontitis.
Tertiary prevention (type 3):-
 In this type disease has been progressed to a level in which permanent
destruction is present, but measures are taken to prevent the progress or
to rehabilitate the patient e.g periodontitis.
 Occurs later in the period of pathogenesis.
 Involves limitation of disability and rehabilitation.
 Examples: pulpal therapy, periodontal surgery, extractions, fixed
prosthodontics, space maintainers.
Prevent: loss of teeth, disseminated infection, loss of space, occlusal
disharmonies, and other significant oral disabilities
- One of primary factor in planning any program of prevention is to know how to
eliminate the affect of this factor.
It means the control of plaque.
Plaque control :-
There are 3 methods of plaque control :-
- Mechanical plaque control.
- Chemical plaque control.
- Professional plaque control.
 1) Mechanical plaque control:- used for both prevention and treatment , it need
(motivation, instruction and self compliance) so it need a well , motivated patient
him self will practice these measures, so the dental professional should prepare
the patient to accept these measures (i.e. brushing, flossing,……….).
Steps of motivation:-
A--Information :- by using a language that the patient under stand, make the
patient understand the meaning of plaque and it is the main cause of periodontal
diseases.
B--Testing the acquirement of knowledge :- try to test or examine the patient
indirectly to be sure that the understand is what he has been already informed,
the patient is tested by doing an indirect conversation with him.
C-- Change of attitude :- it is found that the patient believe in what he is seeing
but not what he is hearing, so by using a disclosing agent and mirror make the
patient see the plaque, this might help to change the attitude of the patient.
D-- Change of behavior :-
when the patient a acquire all the previous points, his behavior would be
changed to be beneficial after motivation has been finished, the instruction can
be given to the patient.
The most popular method used for mechanical plaque control is tooth brushing,
yet it is not enough, it should be supplemented by inter dental cleaning device
that should be shared in the mechanical plaque control, it is chosed according to:-
* Dexterity of the patient .
* Morphology of the dentition.
* Space between the teeth.
Note :- waxed dental floss used when there is no space between the teeth.
The disadvantage of mechanical plaque control:-
1-Time consuming.
2- Need effort.
3- Depends on the dexterity of the patient.
4- Need continuity and follow up.
For these causes, the other methods was introduced
( like Chemical and Professional plaque control
2- Chemical plaque control
 Chemical plaque control includes:-
@- Antiseptics
@- Antibiotics
@- Enzymes
 Antiseptics :
The problem with antiseptics is that when we use it in enough concentration to
kill the MICROORGANISMS the toxicity would be increased . Although even in low
concentration we can maintain good bactericidal effect by the use of
chlorhexidine in concentration of 0.2% in 10cc for 1 min . in mouth twice daily , it
found that It will have anti-plaque activity 100% but purely for supragingival
plaque .
The problem is that saliva might dilute the mouth rinse so decreasing it’s effect .
It’s important to know that the patient will lost 70% of the mouth rinse and 30%
will be retained in 3 sites :-
- Adsorbed to the oral epithelium
- Adsorbed to the plaque it self
- Affinity to the enamel
Complete release of chlorhexidine in oral cavity will occur within 8-12 hrs after
the use of chlorhexidine mouth rinse , we ask the patient not to rinse his mouth
with water or eating any thing for at least ½ hr , also we should instruct the
patient not to use it immediately after the brushing because the salts in the tooth
paste will inhibit the effect of the chlorhexidine so we can use it after ½ hr . of
tooth brushing . Disadvantage of chlorhexidine :-
1- Exogenous staining of the teeth .
2- Bitter taste in spite of the added flavors
3- Allergy , it cause ulcers similar to aphthus
4- Rarely cause obstructive parotitis .
 Till now , chlorhexidine can’t be sued as a substitute of mechanical plaque
control , but used only when mechanical methods are impossible like :-
- following surgery
- presence of orthodontic appliance .
 - patient with hemorrhagic tendency ( hemophilia )
- people with mental or physical disability .
 note :- in USA the chlorhexidine used in a concentration . of 0.13% so we have to
increases the amount to 15 cc .
Other chemical materials :-
listerine mouth rinse has 30% of the effect of chlorhxidine .
Triclosane with tooth paste or as a mouth rinse
Snagiunaria { Viadent } 30-40 % compared to chlorhexidine
 Antibiotics :-
Can be used only adjunct because of it’s associated problems:
 #- The development of resistant of microorganism .
#- Hyper sensitivity to certain types of antibiotics .
#-The side effects of many antibiotic .
3) Professional plaque control :-
Because of the difficulties in mechanical and chemical plaque control methods , so
professional plaque control was admitted by (Axelsson and lindhe) .
At the beginning they practice plaque control (professional) twice weekly for a
child , this will prevent gingivitis 100% . When they increase the interval for 4
weeks the same results are obtained .
But this program is coasty and need man power to be performed . So , it's usually
used only on the individual level when mechanical and chemical plaque control
are difficult .