One patient had a lesion that hurt when she ate, and another felt like she had an infection in her wisdom tooth. She addresses patient refusal, as well as offers suggestions about how and when to take radiographs in specific situations. Dr. Reichwage uses a diode laser to remove diseased epithelium and for bacterial decontamination. During this appointment, we also re-treated with micro-ultrasonics and chlorhexidine for irrigation. Periodontal therapies were performed approximately two weeks apart and included ongoing monitoring of oral hygiene progress and healing (see Figure 4). It was noted that his medical history was negative and presented no contributory data (see Figure 3). We screen every patient for periodontal disease and provide conservative, non-surgical therapy for those patients for whom it is appropriate, which is called Scaling, Root Planing and Debridement. The book I find most useful on the subject is by Dr. Laurence Le Shan, How to Meditate. Indiana dental practice shares how it is committed to state-of-the-art care. Call today for an appointment with a 5th Ave periodontist if you start to experience any symptoms associated with gum disease or decay. We record six-point pocket depths for each tooth, bleeding points, recession, furcations, mobility, tissue contour, tissue color, plaque scores, and calculus present. Since plaque and tartar are the things that cause periodontal disease, removing them will be the first step in treatment. Both dental hygienists have attended the Pacific Esthetic Continuum and completed an advanced anterior esthetic courses and laser certification courses. Abstract. Laser assisted periodontal therapy. Radiographically, moderate to severe bone loss was noted. It is my fervent hope that the 468 readers who responded to an RDH survey about occupational health are the only ones experiencing job-related pain. This involves the removal of bacterial plaque and tartar which is present at and below the gum line. (2) described the procedure known as curettage, the surgical elimination of the epithelial lining of the pocket. Dr. Sevors practice provides a variety of surgical services. Our clinical findings showed posterior cross bite, anterior open bite, and 80 percent overbite. The aim of this study were (i) to determine prognostic factors of tooth loss in a compliant cohort of patients under a conservative periodontal treatment concept and (ii) to describe long-term trajectories of bone loss (BL) and pocket probing depths (PPD). Our recommendations for this include daily use of a power toothbrush, floss, and a chlorine dioxide toothpaste and rinse, such as Oxyfresh. These periodontists specialize in scaling and root planning, for example, which requires them to remove the plaque from around the gum tissue bit by bit until there is undamaged tissue, which is then allowed to reattach to the tooth and heal properly. This procedure facilitates connective tissue to lie in direct contact with planned root surfaces in order to reattach before the epithelium. The patient was placed on doxycycline (100 mg) twice a day during PTs to help get the infection under control and to avoid periodontal abscesses due to the severity of the pocketing. All rights reserved. It’s made a very positive difference in the practice. Probe depths ranged from 2-12 mm, with heavy, profuse bleeding upon probing. This includes the number of therapy appointments to be scheduled, the sequence in scheduling, and the actual clinical modalities to be used. These results are measurable and clinically controllable, even as evaluators of various stages of agitation or disease improvement [3-7]. The patient was given a Braun 3-D Excel Electric Toothbrush and Oxyfresh toothpaste and fluoride rinse. Linda Meeuwenberg was a 17-year-old high school student when she took a job at a general dental practice in her hometown of Fruitport, Mich. She was hired to type, file, answer the phone, and pay the bills. Teresa Barjenbruch, RDH, is a 1990 graduate from Indiana University at South Bend. Her new setup makes it more comfortable for her to practice, makes it easier to educate patients, and is HIPAA friendly. This includes genetics, general systemic health, hormonal changes, diet, oral hygiene, occlusion, tobacco use, and stress. Patients with mild to moderate periodontal disease can respond incredibly well to conservative therapy. A 26-year-old male patient presented with a desire to alleviate generalized bleeding, inflammation, and sore gums. Long-term treatment goals include the possibility of a referral to a periodontist if there is not enough pocket reduction to achieve health and stability. We use micro-ultrasonics for debridement and irrigation. As a clinical consultant, Nancy Miller, RDH, saw plenty of enviable operatories. All subjects received oral hygiene instructions and full-mouth conservative periodontal treatment (removal of dental plaque followed by SRP). This is a non-surgical approach to treating periodontal disease. The goal of a Fifth Ave periodontist is to keep as much of your dental structure in tact as possible while still treating your periodontal problems. Once the deposits are removed, we place site specific antibiotics under the gums. He stated that it had been more than seven years since his last dental visit. Dr. Reichwage used the soft tissue laser for removal of necrotic epithelial lining decontamination, and then placement of Atridox was performed. The black, white, and very gray areas of radiology. The last step consisted of the doctor using the soft tissue laser. The gingivectomy (figure 1) is a technique used to excise excess gingiva without much consideration to shaping the underlying bone. We use a systemic approach to patient care, and the model we have created is based on our standard of care. Treating gum disease does not have to be a complex undertaking. Treatment includes the use of traditional hand instruments as well as microultrasonics for debridement and irrigation. Barjenbruch is a graduate of the JP consultants Institute in the advanced diagnosis and treatment of periodontal disease. I found Zen to be the hardest. Non-Surgical Periodontal Therapy. Once the laser was completed, vitamin E was placed and a gel was dispensed as a soothing and healing agent. This will prevent additional bone loss and avoid the need for more complex and costly treatments. Conservative Therapy. Of course, these are just some of the procedures a periodontist near Midtown offers to treat gum disease and keep your teeth in fact. All of the data and variables are used as instruments to map the course of treatment. Barkann et al. Dr. Novack ’s practice provides the full scope of periodontal and implant surgical services. An abnormally large and misshapen mandibular tooth was noted during the clinical exam. We also offer Laser Gum Therapy for those stubborn deep pockets. David Reichwage, DDS, has practiced family dentistry in Fort Wayne, Ind., for 29 years. Periodontal Therapy – Periodontal disease is the leading cause of tooth loss in adults. Other Restorative Gum Disease Treatments. They become actively involved in their treatment recommendations. Periodontal therapies and treatments are often exceptionally effective, and as long as you follow the instructions your dentist provides you during the maintenance stage, your risk of recurrence … This tissue is removed to the base of the underlying bone, and the new tissue is allowed to granulate in. We performed co-diagnosis techniques with the patient by using a hand mirror, radiographs, and intraoral camera in order to have the patient involved in the clinical data process and understanding the findings as we presented them. I`d like to add a note about your article on Transcendental Meditation (TM) (March 1999 issue). The ultimate goal of periodontal therapy (PT) is to stop disease progression and to stabilize and improve tooth attachment. . Treatment would consist of four to six PTs, which include scaling and root planing, micro-ultrasonics with chlorhexidine for irrigation, soft tissue laser to reduce and contour the bulbous infected tissue, and decontamination of the periodontal pockets. Once profound anesthesia was obtained, treatment began by using the micro-ultrasonic to remove supragingival and subgingival calculus. Next, scaling and root planing were performed to fine scale and remove any residual calculus. 24 The medication is available in 20 mg doses, to be taken twice daily. It becomes evident to the patient that they can develop a "barometer" to measure their periodontal health and susceptibility to disease. Microultrasonic t… Periodontal disease is a slowly progressing condition that eventually weakens the bone support of the teeth, causing the need for tooth extraction. Scaling removes deposits of bacterial plaque, calculus, food debris, and pus that … Cell phones are here to stay. At that time, a marked decrease in inflammation was noted and the gingival tissue was responding well to the therapy. Gum disease has other negative effects on your health and this can be one of them. The nerve and the root are exposed, causing a higher level of sensitivity in your teeth. We have an in-office laser that we use to treat 5-7 mm pockets that persist after phase one of the deep cleanings. Procedure — At the initial periodontal therapy (IPT), the patient was disclosed and was given manual and power brushing and flossing instructions. The patient had generalized recession of one to two millimeters. Results — The patient was brought back for a six-week SPT. Author N P Lang 1 ... Periodontal Pocket / pathology The unit we use is Dual Select by Dentsply. Our periodontal evaluation form also becomes an educational tool for each patient. Dianne Glasscoe Watterson, MBA, RDH, provides some tips for temping as a dental hygienist. Our method to achieve this identity is to offer each patient customized, comprehensive, state-of-the-art care. He was diagnosed with Moderate Periodontitis Type III, with light to moderate generalized bone loss (see Figure 1). Too often a war of opinions between hygienists and assistants breaks out in dental offices, which can result in a miserable or even hostile work environment for the entire staff. © 2021 Endeavor Business Media, LLC. There are other treatments in addition to scaling and root planning used to treat periodontal disease. Many different styles of meditation are available. Pocket depth probing (PD) and bone reduction (based on X rays) were registered at baseline and after eight months in both groups. A dentist or dental hygienist provides this treatment by scraping and removing the plaque and tartar off of your teeth and root surfaces by scaling, and then smoothing away any roughness on the roots to prevent bacteria from gathering again. Objectives of conservative periodontal treatment should include altering or eliminating microbial etiology and the contributing factors for periodontal disease, halting disease progression and returning the dentition to a state of health and comfort, 7 obtaining host healing, and achieving gains in clinical attachment levels. Gagging in the dental chair is embarrassing and awkward for everyone. We want you to be happy with your smile, and understand how your periodontal health can be improved with regular maintenance. The laser was set at 3.5-4.5 continuous wave (CW) and Touchtips were used to contour the tissue. Dr. Fuad Malki and our team are dedicated to improving your quality of life and maintaining your oral health through comprehensive periodontal treatments and implant dentistry. They can be helpful in many situations, but each office should have rules in place so that all staff are on the same page regarding when they can use them. 1. The identity that our team desires for our practice is one of dedication to excellence. We also point out to the patient all of the etiological factors that affect periodontal health and may compromise treatment. But her dentist’s enthusiasm was infectious. A 43-year-old male visited a dentist for an initial examination and checkup. TM is difficult for some folks, as are many other forms of meditation. Treatment includes the use of hand instruments for scaling and root planing. Tooth and tissue sensitivity had been resolved. Treatment of this condition can be surgical, in which the diseased gum and bone tissue are removed and/or reshaped to allow proper cleaning, or conservative, which is explained later on this page. Our first recommendation was to refer the patient to a periodontist due to the severity of the pocketing. Three months after the PTs, the patient had a pocket reduction of one to five millimeters. The emphasis of our practice is conservative periodontal therapy. Upon disclosing, moderate plaque was present. The treatment recommendation consisted of six to eight PTs at two-week intervals with the repetitive placement of Atridox and the use of the diode laser. Twelve months post-treatment, the patient's tissue is no longer bulbous and is generally pink. The patient was also instructed to dry brush for at least 10 minutes per day and to use a rubber tip stimulator to massage and help re-contour the tissue. It had been more than 10 years since his last dental visit. Results — Six weeks after the last PT, the patient returned for an SPT to evaluate the healing process, as well as his home care and plaque control. A renewed interest in conservative surgical techniques has been fueled by new technology, changes in referral patterns to periodontists and a desire to achieve periodontal health in the least invasive, most cost-efficient manner possible. Our system involves re-evaluation after six weeks and again after three months. Sedation. As far as restorative periodontal therapy goes, this is a procedure that will take time to perform and the periodontist uses it in place of more invasive procedures. Treatment plan — At the treatment plan consultation appointment, we reviewed our findings, the etiology behind these concerns, and the treatment necessary to restore carious lesions and achieve perfect tissue health. Lastly, Periostat is used at 3, 6, 9, or 12-month intervals, depending on the patient's progress. These significant results could not have been achieved without the commitment and determination of both the patient and the hygienist. The nerve and the root are exposed, causing a higher level of sensitivity in your teeth. The patient would then be placed on a supportive recare schedule based on his needs. Seventeen months post-op, Atridox was placed in pockets of five millimeters and greater. In addition to the scaling and root planning, there is also regular periodontal maintenance necessary to make sure your gums remain healthy in the long-term. It is the philosophy of our practice to be patient-centered, and it is our mission to diagnose and treat periodontal disease, including its earliest form — gingivitis. The final phase of treatment will be to take the necessary bite registrations for mounted models and perform an occlusal analysis to diagnose and treat premature contacts and lateral interferences. Two weeks later, this same procedure was repeated on the upper arch (see Figure 2). With the help of a Fifth Ave periodontist, you’ll be back home in no time with a much healthier dental system. Disruptive occlusal patterns and prematurities cannot be discounted as contributing etiologies in this case. But when the practice where she’d worked for 24 years hired a new doctor who also happened to be left-handed, she got an enviable operatory of her own. Periodontal “gum” disease is typically a chronic infection caused by bacteria that works its way under the gum line, … Our practice finds it disturbing that there is such a high prevalence of periodontal disease — almost to epidemic proportions — in an era of medical and dental technological advances. In fact, without proper treatment, advanced gum disease can cause a variety of health conditions including, premature birth, diabetes, heart attack, and … If thoroughly executed conservative treatment may obviate the necessity for surgical procedures. He was also placed on Gel-Kam stannous fluoride to help with root sensitivity. The patient was encouraged with the results. The unit we use is Dual Select by Dentsply. The diagnosis was Advanced Periodontitis Type IV. Sign up for Registered Dental Hygienist (RDH) Magazine eNewsletters. This includes complete and accurate periodontal diagnosis and treatment planning with the ultimate goal of perfect tissues. Treatment recommendations and surgery are employed only where absolutely necessary. Read all about it here! Regardless of the treatment modalities used, the purpose is to achieve a gradual healing process and continue treatment until the disease process is controlled. This includes the number of therapy appointments to be scheduled, the sequence in scheduling, and the actual clinical modalities that are to be used. At each PT, scaling and root planing were performed in conjunction with micro-ultrasonics and irrigation with chlorhexidine. Following assessment of your oral cavity, a periodontal diagnosis will be given and treatment recommended based on the diagnosis. Co-therapy by the patient is critical. It will mean less recovery time for you and a better chance that these restorative gum disease treatments will actually work. He has generalized one to four millimeters pocketing with 16 bleeding points (originally 109 bleeding points). We pride ourselves on our conservative approach to patient care. He was placed on a three-month SPT continuing care cycle. Kristin Goodfellow, AS, RDH, explains the importance of taking patient x-rays. The patient commented on how good the tissue looked and felt, and how it was no longer bleeding. We pride ourselves on the fact that we are very conservative in our treatment recommendations and limit surgery to the areas where it is absolutely necessary. Our typical recommendation is a three-month cycle, but can be as short as eight weeks. While surgery may still be indicated for severely advanced periodontal cases, laser therapy is a much more conservative, effective and comfortable option for beginning to moderate periodontal disease. The ultimate goal of periodontal therapy is to stop disease progression and to stabilize and improve tooth attachment. Tips and tricks: Preventing activation of gag reflex when exposing radiographs. Additionally, the precision of the laser allows us to avoid removing significant tissue. Conservative periodontal therapy, regardless of the protocols defined in the work protocol, is expressed in clinical outcomes ranging from systemic diseases, gravity, and patient control to them. The laser was then set at 1.2 CW and used to decontaminate the pockets. Deep gum pockets form that trap mouth bacteria, causing the infection to worsen. The patient presented with red, swollen gingivae that were tender to the touch and the tissue contour was irregular in several areas. Gingival grafting, for example, addresses exposed tooth root as a result of gum recession. The patient is also aware of the importance of SPTs to maintain and control the disease process. 5. It was noted that his medical history was negative and presented no contributory data. The patient is aware that, in the future, Atridox will need to be placed sporadically to control the disease and maintain health. 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