Discipline of Oral and Dental Prevention

PROFESSIONAL
PERIODONTAL DISEASE
PREVENTION
Periodontal risk assessment using Risk
Previser
Inflammatory diseases of the periodontium are
caused by particular bacterial flora that originates
in the oral biofilm, combined with risk factors.
Periodontal risk factors:
 Bacterial factors:
• Bacterial flora – oral biofilm;

 Behavioral factors:
• Oral hygiene and regular monitoring;
• Smoking;  Systemic factors:
• Systemic disorders: diabetes, osteoporosis,
HIV infection;
 Local factors:
• Genetic factors, race (afro-americans);
• Untreated caries;
• Sex (male);
• Inadequate dental restorations;
• Abnormal tooth position;
 Psychological factors
Risk assessment - the qualitative and quantitative
estimation of the probability for a disease to occur
as a result of exposure to risk factors or from lack of
beneficial influences. Risk assessment helps predict
a patient’s health status at a given moment in the
future or a current disease progression rate.

Periodontal risk assessment involves a series of

methods, some of them being very complex and
expensive: microbiological monitoring, genetic
testing and immunological testing.
In 2002 Page, Krall and Martin - the PreViser system
in order to determine the risk prognostic and staging
of the periodontal disease.
The information required for periodontal risk
assessment using this method is:
• patient history: age, smoking, systemic disorders
(diabetes),
• past dental experience,
• data regarding teeth: past periodontal surgery,
periodontal pocket depth, bleeding at probation,
subgingival restorations, root tartar build-up,
alveolar bone height as seen on the radiography,
furcation lesions, vertical bone loss, oral hygiene

Medical and dental history and panoramic

radiographies are registered in a computer program.
The score is determined using an algorithm that
correlates the severity of the disease with the patient’s
age.
• The risk score is high when the patient presents past
periodontal surgery, smokes more than 10 cigarettes
per day or suffers from a decompensated systemic
disorder.
• Periodontal risk is increased in cases of furcation
lesions, vertical bone loss, subgingival restorations
and tartar.

After data analysis the program provides a report on

the patient’s status. This report will help correctly
diagnosing the patient and drawing a complete and
adequate treatment plan.
 DENTAL SCALING

• Scaling procedures include the removal of plaque,

calculus and stain from the crown and root surfaces of
teeth, either natural or artificial. Scaling can be manual,
ultrasonic and sonic.
• Root planning must be associated with scaling. This
procedure is a specific treatment that removes the
roughened cementum and surface dentin that is
impregnated with calculus, microorganisms and their
toxins in order to obtain a smooth, hard and clean
surface.

https://www.youtube.com/watch?v=O
kZLYwA_qdE
 Scaling – general principles:
• Patient position – relaxed, comfortable, head well
supported in the headrest, slightly in extension
when working the upper jaw and straight when
working the lower jaw;
• Doctor position – keeping in mind the ergonomic
principles, according to the position of the
operating area and the illuminating system;
modern dentistry recommends sitting down while
working;
• Illuminating system – direct for the oral cavity
(light from the scialytic lamp) or indirect (using
the dental mirror) in less accessible areas;
• Soft tissue retraction – using the dental mirror to
protect the soft tissues;
• Hand-support – on steady elements: neighboring
teeth, left hand on the dental arch, chin or other
areas on the face. Precise hand movements are
intended;
• Instruments’ grip – it is essential because pressure
or traction is used to unlock the tartar. Two types
of grips are allowed: pen grip and palm grip.
• Calculus removal – the tip of the instrument is
placed under the calculus and a firm, coronary
stroke is made to detach it from the tooth
surface. No scraping of the enamel or cementum
is to be made. The active movement of the
instrument is controlled by the wrist, finger
joints and forearm. Manual scaling requires
ergonomic use of instruments, such as operating
a tool on parallel neighboring teeth surfaces.
This constitutes an advantage, by working
sequences of dental hemifaces from a quadrant
to another, the other tooth surfaces being scaled
in reverse, by changing the position of the
operator. The scaling tools use pull and pressure
strokes, parallel to the long axis of the tooth.
Bleeding that accompanies the first scaling
sessions disappears once gum inflammation is
reduced and with it the capillary fragility.
• Splinting of loose teeth – it can be made
directly, using the fingers while scaling the teeth
or by applying a dental material at the incisal
edge (lower frontal teeth are usually loose).
• Finishing and polishing the scaled surfaces –
this is very important as it guarantees the
results; the session will end with an antiseptic,
anti-inflammatory mouth rinse. Nowadays, ZnCl2
10% tends to be replaced (due to allergies risk
and unpleasant taste) by anti-plaque agents like
Chlorhexidine 0,2%.
• Number of sessions – this will be established
according to the tartar amount; one session
usually addresses 4-6 teeth. After educating the
patient regarding the correct oral hygiene
procedures, a follow up schedule will be set up,
in order to monitor the results.
 MANUAL SCALING

• Dental scalers are instruments comprised of: working

end, shank and handle. They can be made of carbon
steel, stainless steel or tungsten carbide.

Myrtle Leaf scaler

• It is an unpaired instrument, the working end claw-
shaped, with two cutting edges on both sides of the face
of the blade that detach the coronary tartar, especially
from the proximal areas ;
• The sharp tip of the tool fractures tartar by pressing it;
• The tip is narrow and can be inserted subgingival in
order to remove the calculus using a coronary pull
strokes.
• Indications: supragingival and subgingival scaling of the
upper and lower front teeth, buccal and palatal surfaces
of the upper molars; proximal areas scaling; removing of
hyperplasic gingival papilla or gingival polyps, etc.
Trapeze scalers
•  They have paired working ends (Fig. 40 b): one of them
works half of the crown (buccal or palatal) towards the
proximal space and the other one works the other half
and is oriented towards the opposing embrasure.
•  The working end has trapezoidal shape, with the larger
base sharpened;
•  The trapezoid is slightly asymmetric with the sides
unequal in length so that the larger base is skewed
towards the smaller base. The larger base and one of the
sides form an acute angle, oriented towards the gingival
papilla and interdental space.

• The slightly concave shape of the larger base allows the

instrument to adapt to the buccal-proximal surface or
oral-proximal surface of the tooth.
•  Indications: supragingival scaling.
Sickle scaler (universal instrument)
•  The working end is sickle-shaped, sharp and active on
the concave edge (oriented towards the handle) as well
as on the convex edge.
•  The pointed tip can be used to fracture calculus
deposits from the surface of the crown; it can also be
inserted into the sulcus with the face of the blade
"closed" or flattened to the tooth surface. Once in the
depth of the pocket or sulcus, pull strokes are
performed.
•  Indications: it is an universal instrument because it can
be use on all tooth surfaces, supra- and subgingival.

Complex shank sickle scalers

•  They have paired working ends. They allow calculus
removal from the proximal surface of the last molars,
where access is difficult
Other instruments:
Chisels
•  Their use has become limited. They are indicated for
removing heavy supragingival calculus from the proximal
and lingual surfaces of lower anterior teeth.

Periodontal hoes
•  They have a cutting edge beveled in a 45° angle.

•  They are used to crush large supragingival calculus

deposits and finish the root surface during periodontal
surgery procedures.
Periodontal files
•  Their working ends have different shapes and
dimensions.
•  They are used in areas difficult to approach using other
instruments (furcation area, deep proximal periodontal
pockets, etc).
Curettes
•  A curette is a periodontal instrument used to
remove calculus deposits from the crown and
roots of teeth.
•  The working end of a curette has a rounded
back and a rounded toe and is semi-circular in
cross-section, much like a spoon. They are also
used for finishing tooth surfaces.
•  The most common instruments of this type are
the Gracey curettes.
•  They are considered surgical instruments. The
original series contained 7 double ended
instruments. The opposing ends of the double
ended instruments have mirror image blades, to
properly access different areas of the dentition.
• The curette number is written on the handle or
on a band placed on the handle, from ½, to
13/14 (17/18 for mini-series).
•  They are used as following:
• o ½ pair: frontal teeth, buccal and half of the
proximal aspects (mesial and distal);
• o ¾ pair: their action is complementary to 1/2;
• o 5/6 pair: used for the premolars;
• o 7/8 and 9/10: used for premolars and buccal and
lingual aspects of molars;
• 11/12: for the mesial aspects of molars and
premolars and furcation areas;
• o 13/14: for the distal aspects of molars and
premolars and furcation areas.
https://www.youtube.com/watch?v=Arp_2bZo26I

https://www.youtube.com/watch?v=cXWDg01Nyjk
Gracey mini-series contains 4 curettes with the
working end smaller versus the classical kit.
Advantages:
• - They allow minimally invasive and atraumatic
scaling and planning;
• - The chance to damage soft tissues is minimal;
• - Better adaptation in deep, narrow pockets and
on various root anatomies;
• - Better adaptation in furcation areas;
• - Great access to all the dental surfaces.
 ULTRASONIC SCALING

Ultrasounds - mechanical vibrations with a very

high frequency that cannot be perceived by the
human ear as sounds (16000 Hz). The frequencies
used in dentistry range from 25000 to 46000 Hz.

Ultrasonic scalers can be:

•  Piezoelectric – the vibration is generated by
changes in the dimension of a quartz crystal
caused by the application of an alternating
current;
•  Magnetostrictive - the vibration is generated by
variation in length of ferromagnetic materials
due to changes in the magnetic field.

• The main difference between the two types of

scalers is the oscillation mode of the scaler tip. It
is elliptical (8-shaped) for magnetostrictive
scalers and linear for piezoelectric devices
US scalers consist of:
•  US generator;
•  Handpiece, provided with insulating jacket,
water cooling system and a device for tools
attachment;
•  Inserts, provided with a water circuit that
attaches to the handpiece by a core of fine metal
strips .
• Ultrasonic scaling disadvantages:
•  The procedure must be interrupted frequently
• cavitation effect due to water accumulation (if a saliva ejector is
not used);
• Ultrasonic scaling benefits: •  It can cause pain in hyperesthesia areas;
•  less hand and wrist fatigue; •  It requires finishing because the surface of the
•  it is easily tolerated by patients, if they don’t enamel remains rough, especially on subgingival
and proximal areas;
present hyperesthesia areas.
•  Ultrasonic instruments don’t completely
exclude hand instruments but replace them in a
beneficial way for most of the maneuvers.
Ultrasonic scaling should be alternated with
manual scaling.
SONIC SCALING
https://www.youtube.com/watch?v=vpUHQcpFTv8

https://www.youtube.com/watch?v=98PP2nf-71w