Prevention of Periodontal Diseases

• Primary prevention

• Secondary prevention

• Tertiary prevention

Preventive Dentistry can be divided in to three different levels

Three Methods for plaque Control

1- Mechanical plaque control.

2-Chemical plaque control.

3-Professional plaque control.

Mechanical Plaque Control

• A-Patient information• 1-patient motivation to corporate the

treatment

Mechanical Plaque Control

• A-Patient information

• 2-information about the causes & the symptomes of periodontal disease.

• stage 1:-allow the patient to participitate in the examination of his oral cavity

• stage 2:-understanding the patient that the bacteria is the main causes of the periodontal disease

• Stage 3:-location of plaque by using disclosing agent.

Mechanical Plaque Control

• A-Patient information

• 3- Detailes information must be given to the patient.

B-Testing of the aquirment of knowledge

C-Changing the patient attitute by using disclosing agent or by

mirror.D-Changing of the behavior.

•.…

Tooth brush(Design & Function)

Tooth brush : the best tooth brush is: 1 -straight ,with short head

2 -multitufted with medium or soft nylon bristles

3 -rounded end to prevent damage of gingiva

The Objective of tooth brushing

• 1-Removed the plaque .

• 2-Clean the teeth of food debris & stain.

• 3-Stimulate the gingival tissue.

• 4- Apply flouride dentifrice.

Interdental aids

• 1- Dexterity of the patient.• 2-Morphology of the teeth.• 3-Spaces between the teeth

Dental floss Tooth picks interdental brush

Dental Floss

Best used for interproximal plaque when interdental papillae are present

Electric brushes

Electric brushes can motivate some patients to improve their oral hygieneElectric brushes used for patients with poor manual dexterity

Interdental brush

Best used when interdental papilla reduced

Use of gauze to clean distal surface of teeth adjacent to edentulous areas

Control of breath malodor

Plaque control is most predictable way to reduce oral malodor together with daily tongue scarping to reduce bacterial load of oral cavity.

The disadvantage of mechanical plaque control

• 1- depend on the dexterity of the patient• 2-need effort• 3-time consuming• 4-need continuity and follow up.

Frequency of plaque removal

• 1-every 24-48 hrs• 2-improved periodontal health associated

with increase the frequency of the tooth brush up to twice / daily

• 3-cleaning 3 or more/daily do not appeare to further improve periodontal health

• 4-cleaning once a day with all necessary tools is sufficient if it is performed correctly.

Chemical plaque control

• Antiseptic

• Antibiotic

Antiseptic

• Chlorhexidine Chlorhexidine is available in three forms, the diglu-conate, acetate and hydrochloride salts.

Most studies and most oral formulations and products have used the digluconate salt, which is manufactured as a 20% concentrate. Digluconate and acetate salts are water-soluble but hydrochloride is very sparingly soluble in water.

• Chlorhexidine was developed in the 1940s by Imperial Chemical Industries, England, and marketed in 1954 as an antiseptic for skin wounds. Later, the antiseptic was more widely used in medicine and surgery including obstetrics, gynecology, urology and presurgical skin preparation for both patient and surgeon. Use in dentistry was initially for presurgical disinfection of the mouth and in endodontics(1962)

– Brown discoloration of the teeth of an individual rinsing twice a day for 3 weeks with a 0.2% chlor-hexidine mouthrinse.

Brown discoloration of the tongue of an individual rinsing twice a day for 2 weeks with a 0.2% chlorhexidine mouthrinse.

Brown discoloration of the tongue of an individual rinsing twice a day for 2 weeks with a 0.2% chlorhexidine mouthrinse.

Bilateral parotid swelling following a few days of rinsing with a 0.2% chlorhexidine mouthrinse.

Mechansim of action

Both bacteria and tooth surfaces are negatively charged and are bidged by calcium ions.

CHX has a competitive ion for saliva calcium so will prevent bacteria from attachment to the tooth and to each other so it will prevent plaque formation.

Clinical uses of Chlorohexidine

1. As adjunct to oral hygiene and professional prophylaxis.2. Post oral surgery including periodontal surgery and root planning.3. In patient with jaw fixation.4. For oral hygiene and gingival health benefits in mentally and physically handicapped patient as spray of 0.2% solutin.5. In high risk patient chlorohexidine rinse or gel can reduce the streptococcus mutans count and it is synergistic with fluoride.6. In treatment Recurrent oral ulceration.7. In treatment of denture stomatitis.

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