Treating gum disease with homemade remedies
Inflammation with tissue destruction is a common but not invariable sequel to chronic gingivitis there is wide individual variation for unknown reasons. isolated from periodontal pockets, but individual roles in tissue destruction are uncertain. Some (e.g. Actinomyces species) produce bone resorbing factors. A defensive immune response (antibody production and cellular immunity) to plaque bacteria is detectable. Evidence of immunologically mediated tissue destruction is speculative only and not consistent with histological findings. Periodontal destruction is accelerated in immunodeficient patients but host factors affecting prognosis of periodontal disease have not been identified in otherwise healthy persons. Rg. 37 Chronic periodontitis. Note inflammatory infiltrate locafizad to vicinity of plaque. Rg. 37 Chronic periodontitis. Note inflammatory infiltrate locafizad to vicinity of plaque. fig. 39 Chronic periodontitis inflammation-free zone between floor of pocket and bony crest....
Periodontal disease, also known as gum disease, is inflammation of the gums and other tissues surrounding the teeth that is caused by a bacterial infection. The disorder affects as many as 75 percent of adults over age 35. It is the main cause of tooth loss in adults. The earliest stage of periodontal disease is called gingivitis. The main symptom of gingivitis is gums that bleed when you brush or floss your teeth. At this stage, gum disease is both preventable and reversible because the plaque buildup has not yet extended below the gum line to the roots. Brushing your teeth daily is not enough to prevent gingivitis. The only way to stop gingivitis and to prevent further inflammation is to brush your teeth consistently twice a day, floss your teeth daily, and have a professional tooth cleaning at least twice a year. You should also maintain a balanced diet and avoid smoking or chewing tobacco. Warning Signs of Periodontal Disease Periodontal disease, also known as gum disease, is the...
A typical diagnosis will condense the information obtained during the clinical history taking and examination. For instance, a diagnosis could read as follows 28-year-old male, no significant medical history vital signs normal. Chief complaint Mesio-lingual cusp fracture on tooth 30. Teeth 1, 16, 17, 19, and 32 missing. Patient reports significant postoperative discomfort after previous molar extraction. High smile line. Caries 6, mesial 12, distal 20, mesio-occlusal and 30, mesio-occlusal-distal. Tooth 8 has received previous endodontic treatment. Generalized gingivitis four posterior quadrants, with recession noted on teeth 23, 24, and 25. 5-mm pockets on teeth 18, 30, and 31. Radiographic evidence of periapical pathology tooth 30. Tooth 30 tests nonvital.
The method is particularly fitted for detection of substance in gingival crevices for the diagnosis of periodontal disease. IgG against cachectin or interleu-kin-1 is chemically grafted to carboxyl groups. The magnetic particles are introduced in the cavity with a microdispenser. A magnetic field applied with a device anatomically compatible with the body cavity and adapted for the magnetic dispersion used then collects the magnetic particles.
The relief of discomfort accompanying an acute condition is a priority item in planning treatment (Fig. 3-31). Discomfort can be due to one or more of the following a fractured tooth or teeth, acute pul-pitis, acute exacerbation of a chronic pulpitis, dental abscess, an acute pericoronitis or gingivitis, and myofascial pain dysfunction.
The second phase of treatment involves stabilizing conditions such as dental caries or periodontal disease by removing the etiologic factors, increasing the patient's resistance, or doing both. Periodontal Disease. Chronic periodontitis with continuing irreversible bone loss should be treated as early as possible by effective daily plaque control. The proper removal of plaque is possible only if the teeth are smooth and their contours allow unimpeded access to the gingival sulci. Therefore, the following are essential (Fig. 3-33)
Documenting the level of attachment helps the clinician determine the amount of periodontal destruction that has occurred and is essential when rendering a diagnosis of periodontitis (loss of connective tissue attachment) 1617 This measurement also provides the clinician with more detailed and accurate information regarding the prognosis of an individual tooth. The clinical attachment level (CAL or AL) is determined by measuring the distance between the apical extent of the probing depth and a fixed reference point on the tooth, most commonly either the apical extent of a restoration and or the cemen-toenamel junction (CEJ). This measurement can be documented on modified periodontal charts (Fig. 1-18) and incorporated with the standard periodontal documentation (see Fig. 1-17) to complete the clinical periodontal examination. When the free margin of the gingiva is located on the clinical crown and the level of the epithelial attachment is at the CEJ, there is no loss of attachment,...
In 1971 Shipman investigated the effects on the gingiva of an 11 carbamyl peroxide gel solution over a period of one month (11 hours of tissue contact time) and pronounced the material safe.13 Kashck evaluated the effect of brushing a carbamyl peroxide into the gingiva in order to deliver the material into the sulcus.14 The 45 hours of tissue-contact time over three months significantly reduced plaque scores when compared to brushing with a control toothpaste. In 1976, a recommendation was made that carbamyl peroxide should be considered as a routine oral hygiene adjunct.15 In another study, sixty orthodontic patients rinsed with carbamyl peroxide over a period of three nronths (90 hours of tissue exposure). Significant plaque reductions were observed and no adverse reactions were noted.16 Carbamyl peroxide played a significant role in reducing gingival inflammation and gingivitis in a study which involved a tissue contact time of 33 hours over twenty days.17 No side effects were...
Healthy periodontal tissues are a prerequisite for all fixed restorations. If the abutment teeth have normal bone support, an occasional lapse in plaque removal by the patient is unlikely to affect the long-term prognosis. However, when teeth with severe bone loss resulting from periodontal disease are used as abutments, there is very little tolerance. It then becomes imperative that excellent plaque-removal technique be implemented and maintained at all times. If anterior bone loss has been severe, as can happen when teeth are lost due to trauma or periodontal disease, there may be a ridge defect (Fig. 3-27). In these patients, a removable partial denture should be considered, especially when the person has a high smile line, since a fixed partial denture generally replaces only the missing tooth structure, not the supporting tissues. Again, a provisional restoration may help the patient determine the most appropriate treatment. A surgical ridge augmentation procedure37 may also be...
The general term periodontal disease is used to describe any condition of the periodontium other than normal. It covers such pathologic states as gingival hyperplasia, juvenile periodontitis (also known as periodontosis), and acute necrotizing ulcerative gingivitis-all distinct clinical entities that warrant specific treatment. For information concerning these disease states, refer to any of the standard peri-odontal texts. Periodontal disease must be recognized and treated before fixed prosthodontics so that the gingival tissue levels can be determined to proper margin placement, esthetics, and gingival displacement (with an AICl3-impregnated or plain cord, see Chapter 14). Only when the gingiva and periodontium are in an optimal state of health can these determinations be made with ease or predictability. This discussion is limited to the etiology and progression of the inflammatory gingivitis-periodonti-tis lesion, which affects the majority of adults 13 and constitutes the bulk of...
Chronic inflammatory periodontitis results in the loss of osseous tissue, destruction of osseous architecture, and creation of an intrabony lesion. The osseous tissue has no predictable or simple pattern of loss the resorption may take the form of craters, hemiseptal defects, or well-like (troughlike) shapes. Craters in the interproximal areas (Fig. 5-24) are the most common type of lesion.
Classification Anti-infective oral rinse Action Kinetics Chorhexidine is absorbed onto the tooth surface, dental plaque, and oral mucosa allowing for a sustained reduction of plaque organisms. Poorly absorbed orally, 30 retained in the oral cavity and slowly released. Uses Treatment of gingivitis between dental visits. Non-FDA Approved Uses Acute aphthous ulcers, denture stomatitis. Special Concerns Efficacy not established in children 18 years of age, lactation, not intended for periodontitis.
In this mesiodistal section, an overcontoured connector crowds the gingiva. Pressure ischemia and poor access for plaque removal promote gingivitis. Fig. 15-8. In this mesiodistal section, an overcontoured connector crowds the gingiva. Pressure ischemia and poor access for plaque removal promote gingivitis.
After horizontal bone loss from periodontal disease, the PDL-supported root surface area can be dramatically reduced 32 Because of the conical shape of most roots (Fig. 3-23), when one third of the root length has been exposed, half the supporting area is lost. In addition, the forces applied to the supporting bone are magnified because of the greater leverage associated with the lengthened clinical crown. Thus potential abutment
Under most circumstances a crown should duplicate the contours and profile of the original tooth (unless the restoration is needed to correct a malformed or malpositioned tooth). If an error is made, a slightly undercontoured flat restoration is better because it is easier to keep free of plaque however, increasing proximal contour on anterior crowns to maintain the interproximal papilla23 (see Chapter 5) may be beneficial. Sufficient tooth structure must be removed to allow the development of correctly formed axial contours (Fig. 7-14), particularly in the interproximal and furcation areas of posterior teeth, where periodontal disease often begins. Margin Placement. Whenever possible, the margin of the preparation should be supragingival. Subgingival margins of cemented restorations have been identified as a major factor in periodontal disease, particularly where they encroach on the ep Margin Adaptation. The junction between a cemented restoration and the tooth is always a potential...
An improperly prepared tooth may have an adverse effect on long-term dental health. For example, insufficient axial reduction inevitably results in an overcontoured restoration that hampers plaque control. This may cause periodontal disease or dental caries. Alternatively, inadequate occlusal reduction may result in occlusal dysfunction, and poor margin placement may lead to chipped enamel or cusp fracture.
The poor appearance of some metal-ceramic restorations is often due to insufficient porcelain thickness. On the other hand, adequate porcelain thickness is sometimes obtained at the expense of proper axial contour (such overcontoured restorations almost invariably lead to periodontal disease). In addition, the labial margin of a metal-ceramic crown is not always accurately placed. To correct all these deficiencies, certain principles are recommended during tooth preparation that will ensure sufficient room for porcelain and accurate placement of the margins. Otherwise, good appearance would be achievable only at the expense of peri-odontal health.
Gingivitis, stomatitis, glossitis photosensitivity multiple sun exposures leading to dry, scaly, well-marginated plaques, resembling chronic eczema, affecting preferentially the forehead, cheeks, periorbital regions, dorsal surface of the hands, and other light-exposed areas vesiculobullous eruption with exudation sometimes occurs hypopigmentation and or hyperpigmenta-tion that is intensified with further sunlight exposure intermittent cerebellar ataxia with wide-based gait, spasticity, delayed motor development, and tremulousness, all reversible with niacin therapy diarrhea attacks sometimes provoked by a febrile illness, poor nutrition, sulfonamides, and possibly emotional stress
The first studies evidencing a certain degree of CoQ deficiency in myocardial tissue date to the first half of the 1970s78 and show that 75 of patients undergoing cardiac surgery were affected by this deficiency. This finding was obtained through the enzymatic assay of succinate dehydro-genase-CoQ reductase of mitochondria prepared by intraoperatory biopsies. Thanks to the same technique, similar results were concomitantly obtained in the heart muscle of rabbits fed with a vitamin E deficient diet,9 in the heart muscle of mice affected by hereditary muscle dystrophy,10 in human gingiva of subjects affected by periodontal disease,11 and in human muscle of patients affected by muscular dystrophy.12 Later in 1984, it was found, through HPLC analysis conducted on endomyocardial biopsies, that patients in NYHA classes III and IV had lower cardiac CoQ concentration
Without a careful all-inclusive diagnosis and well-designed treatment plan, the chances of success are minimal. Patients who require a removable prosthesis (Fig. 21-1) usually have sustained extensive damage as a consequence of caries, periodontal disease, or trauma. They also may exhibit acquired or congenital intraoral defects. As a result of prolonged loss of arch integrity, there may be drifting or tipping, and the occlusion is often less than ideal. Fig. 21-1. A to E, This patient presented with extensive periodontal disease several posterior teeth were removed. F to J, Restoration completed. A combination of fixed and removable prostheses was used. Fig. 21-1. A to E, This patient presented with extensive periodontal disease several posterior teeth were removed. F to J, Restoration completed. A combination of fixed and removable prostheses was used.
Other difficulties associated with chronic cocaine use include weight loss, dehydration, nutritional deficiencies (particularly of vitamins B6, C, and thia-mine), and endocrine abnormalities. Neglect of self-care may be evident, including dental caries and periodontitis exacerbated by bruxism. Addicts may medicate their pain with cocaine or other mood-altering drugs and seek medical attention only after prolonged existence of their problem(s).
Increasing the faciolingual width of a complete crown is a common fault in practice and is a leading cause of periodontal disease associated with restorations. Adequate chamfer width (minimum 0.5 mm) is important for developing optimum axial contour. However, on small premolars it may be advantageous to prepare a slightly narrower chamfer to conserve tooth structure and retention form. This requires increasingly careful manipulation of the wax pattern during fabrication of the restoration and careful assessment to ensure that the crown is not excessively contoured.
Having a clean mouth is good for you in many ways. Not only does it give you fresh breath and a nice smile, but it also gives your self-esteem a lift. Thorough daily cleaning of your teeth and gums helps prevent tooth decay and periodontal disease (gum disease). Keeping your teeth and gums healthy also can improve your overall health. Periodontal disease may be a factor in the development of chronic conditions such as heart disease. The best way to ensure oral health is to brush your teeth at least twice a day and to floss them daily. Brushing and flossing remove the thin sticky layer of bacteria that grows daily on your teeth. This layer of bacteria is called plaque, and it is responsible for both tooth decay and periodontal disease. When you eat, the bacteria in plaque produce acids that attack the teeth and irritate the gums, making them inflamed. Over time, the gums may bleed and pull away from the teeth. Bacteria and pus accumulate in the pockets that form in the Flossing your...
With oral application for gum disease, review proper care of site(s), foods to avoid, and proper cleaning while avoiding floss or toothpicks for the entire length of therapy. Symptoms that require immediate reporting include pain, abnormal discharge, fever, swelling, expulsion of fiber return as scheduled for removal and follow-up.
Following skin abrasions, minor cuts, wounds, or burns. Tetracycline fiber Adult periodontitis. Non-FDA Approved Uses Pleural sclerosing agent in malignant pleural effusions (administered by chest tube) in combination with gentamicin for Vibrio vulnificus infections due to wound infection after trauma or by eating contaminated seafood. Mouthwash (use suspension) to treat nonspecific mouth ulcerations, canker sores, aphthous ulcers. Possible drug of choice for stage I Lyme disease.
Previous radiographs may prove helpful in judging the progress of dental disease. They should be obtained if possible, because it is generally better to avoid exposing the patient to unnecessary ionizing radiation. Dental practices will usually forward radiographs or acceptable duplicates promptly upon request. In most instances, however, a current diagnostic radiographic series is essential and should be obtained as part of the examination.
There is no convincing evidence that chronic periodontal disease is caused directly by occlusal overload. However, a widened peri-odontal ligament space (detected radiographically) may indicate premature occlusal contact and is often associated with tooth mobility (Fig. 4-23). Similarly, isolated or circumferential periodontal defects are often associated with occlusal trauma. In patients with advanced periodontal disease who
Have extensive bone loss, rapid tooth migration may occur with even minor occlusal discrepancies. Tooth movement may make it difficult for these patients to institute proper oral hygiene measures, and the result may be a recurrence of periodontal disease. Precise adjustment of the occlusion is probably more critical in patients with a compromised crown root ratio than in those with better periodontal support (see Chapter 32).
The progress, course, and outcome of gingival and periodontal disease are critically dependent on the patient. Without the ability and desire of the patient to maintain his or her teeth and periodontium, any treatment will ultimately fail. Determining a prognosis for the teeth and periodontium debilitated from moderate disease is therefore quite difficult. Unfortunately, failure is often the best teacher.
A periodontal examination should provide information regarding the status of bacterial accumulation, the response of the host tissues, and the degree of irreversible damage. Because long-term periodontal health is essential to successful fixed prosthodontics (see Chapter 5), existing periodontal disease must be corrected before any definitive prosthodontic treatment is undertaken. spaces. Any deviation from these findings should be noted. With the development of chronic marginal gingivitis (Fig. 1-15, B), the gingiva becomes enlarged and bulbous, loss of stippling occurs, the margins and papillae are blunted, and bleeding and exudate are observed. Fig. 1-15. A, Healthy gingivae-pink, knife-edged, and firmly attached. B, Gingivitis-plaque and calculus have caused marginal inflammation, with changes in color, contour, and consistency of the free gingival margin. Inflammation extends into the keratinized attached gingiva. Fig. 1-15. A, Healthy gingivae-pink, knife-edged, and firmly...
The preparation for a metal-ceramic crown requires significant tooth reduction to provide sufficient space for the restorative materials. To achieve better esthetics, the facial margin of an anterior restoration is often placed subgingivally, which increases the potential for periodontal disease. However, a supragingival margin can be used if significant cosmetic concerns do not prohibit it or if the restoration incorporates a porcelain labial margin (see Chapter 24).
After the teeth are prepared and a provisional restoration has been made (see Chapter 15), the health of the surrounding soft tissues must be reevaluated. Careful preparation will result in minimal tissue damage however, if a subgingival margin is needed, some tissue trauma in the sulcular area may be unavoidable. The effects of this trauma can be transient as long as the patient receives a properly made provisional restoration and maintains adequate oral hygiene. However, if the provisional is poorly contoured, not polished, or has defective margins, plaque retention will lead to a localized inflammatory response. The combination of such tissue trauma in the presence of preexisting periodontal disease can produce disastrous results. Periodontal disease must be treated and resolved before fixed prostheses are placed.
Because of unforeseen events (e.g., laboratory delays or patient unavailability), a provisional restoration may have to function for an extended period. On the other hand, a delay in placing the definitive restoration may be deliberate (e.g., because the etio-logic factors of a temporomandibular disorder or periodontal disease must be corrected). Whatever the intended length of time of treatment, a provisional will have to be adequate to maintain patient health. Thus it should not be casually fabricated on the basis of expected short-term use.
The pathogenesis or sequence of events in the development of a gingivitis-periodontitis lesion is very complex. It involves not only local phenomena in the gingiva, PDL, tooth surface, and alveolar bone but also a number of complex host response mechanisms modified by the bacterial infection and behavioral factors.21 Implicated in the pathogenic mechanism are phagocytic cells, the lymphoid system, antibodies and immune complexes, complement and clotting cascades, immune reactions, and the microcirculation. Detailed descriptions of host response in the gingivitis-periodontitis lesion can be obtained by referring to standard periodontal texts . Fig. 5-6. Early lesion of gingivitis-periodontitis. The predominant inflammatory cells are lymphocytes subjacent to the junctional epithelium. The epithelium is beginning to proliferate into rete ridges. (Redrawn from Schluger S et al Periodontal disease, ed 2, Philadelphia, 1990, Lea & Febiger.) Fig. 5-6. Early lesion of...
A, An intracoronal cast restoration (inlay) can act as a wedge during cementation or function. If the cusps are weakened, fracture will occur. B, A cuspal-coverage onlay provides better protection but often lacks retention. C, A complete crown provides the best protection against fracture. It also has the best retention, but it can be associated with periodontal disease and poor esthetics. (Redrawn from Rosenstiel SF In Rayne J, editor General dental treatment, London, 1983, Kluwer Publishing.) Fig. 7-25. A, An intracoronal cast restoration (inlay) can act as a wedge during cementation or function. If the cusps are weakened, fracture will occur. B, A cuspal-coverage onlay provides better protection but often lacks retention. C, A complete crown provides the best protection against fracture. It also has the best retention, but it can be associated with periodontal disease and poor esthetics. (Redrawn from Rosenstiel SF In Rayne J, editor General dental treatment, London,...
Abnormally large proximal contact areas make plaque control more difficult and can lead to periodontal disease. Very small (point) contacts may be unstable and cause drifting. Deficient contacts can also lead to food impaction although this is not a direct cause of chronic periodontal disease, it can be very uncomfortable and painful to the patient.
The margin should have a chamfer configuration and should ideally be located supragingivally. Sometimes crown lengthening is indicated to obtain a supragingival margin, rather than risk future periodontal disease (see Chapter 6). The chamfer should be smooth and distinct and allow for approximately 0.5 mm of metal thickness at the margin. Typically it will be an exact replica of half the rotary instrument that was used to prepare it. (The recommended dimensions for reduction are shown in Figure 8-4.)
Most gingival and periodontal diseases result from microbial plaque, which causes inflammation and its subsequent pathologic processes. Other contributors to inflammation include calculus, acquired pellicle, materia alba, and food debris. 14 Microbial Plaque. Microbial plaque (Fig. 5-4) is a sticky substance composed of bacteria and their by-products in an extracellular matrix it also contains substances from the saliva, diet, and serum. It is basically a product of the growth of bacterial colonies and is the initiating factor in gingival and periodontal disease. If left undisturbed, it will grad-
Contraindications for the metal-ceramic crown, as for all fixed restorations, include patients with active caries or untreated periodontal disease. In young patients with large pulp chambers, the metal-ceramic crown is also contraindicated because of the high risk of pulp exposure (see Fig. 7-4). If at all possible, a more conservative restorative option such as a composite resin or porcelain laminate veneer (see Chapter 25) is preferred.
Patients with cast restorations should be recalled at least every 6 months. Less frequent recall may lead to oversight of recurrent caries or the development of periodontal disease. Patients who have been provided with extensive fixed prostheses (Fig. 32-6) will need more frequent recall appointments, particularly when advanced periodontal disease was present. The appointments can be coordinated by the restorative dentist or the periodontist. To ensure treatment continuity, establishing in advance who will assume primary responsibility for coordinating recall appointments is imperative.
At the original treatment-planning stage, retreat-ment should be considered. This consideration may need to be general rather than specific because of difficulties in accurately predicting the pattern of future dental disease. Occasionally, however, a prosthesis is designed to accommodate the eventual failure of a doubtful abutment (Fig. 32-31). With a little foresight, survey contours can already be incorporated in the retainers of an FPD to accommodate a future removable partial denture (RPD) in the event of a terminal abutment loss. Similarly, accommodations can be made for future occlusal rests by deliberately increasing occlusal reduction during
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