Stabilization Of Deteriorating Conditions

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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.

Fig. 3-31. Swelling from an acute periapical abscess. (Courtesy Dr. P.B. Robinson.)

Dental Caries. Treatment of carious lesions is approached in a conventional manner, and the teeth are restored with properly contoured plastic materials. These may serve as a foundation for fixed castings during a subsequent phase of treatment (see Chapter 6). However, cast restorations are best avoided in a patient with active caries because the results of such extensive treatment would be jeopardized by recurrence of the disease. This can be prevented by a combination of dietary advice, oral hygiene measures, and fluoride treatment.

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):

• Replacement of defective restorations

• Removal of carious lesions

• Recontouring of overcontoured crowns (especially near furcation areas)

• Proper oral hygiene instruction adequately implemented at home

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