non surgical management of periodontal diseases

Non‐surgical management is effective in treating periodontal disease. Eliminating all plaque and calculus from the root surface is impossible.66 As the probing depth and furcation involvement increases, the effectiveness of SRP decreases.67 In a recent review of non‐surgical management sites of 4–6 mm PD still had 15–38 per cent of the root surface covered with deposits and those over 6 mm 19–66 per cent.66 There were no differences between types of hand instruments or between hand and ultrasonic scaling. In terms of sales, it is the market leader by far. Furcation‐involved teeth do not respond as well a single‐rooted teeth75 and smokers tend to have a poorer outcome than non‐smokers.63, 64 Determining the success of treatment depends on the outcome criteria. Toothbrushes do not clean interproximally and interdental cleaning is poorly performed by people in general.13 Plaque accumulation, gingival inflammation and periodontal disease are more pronounced interproximally than on other surfaces.14 There are many interdental cleaning aids available and are, most commonly, floss (or tape), woodsticks or interdental brushes (Fig 4). Bone sparing agents are used to reduce the amount of bone resorption by inhibiting osteoclastic activity. Microbiological findings, Quadrant root planing versus same‐day full‐mouth root planning III. A fundamental change in the last decade is our understanding that plaque is a biofilm. The application of beneficial bacteria is not new with “probiotics” being applied for gastrointestinal disturbances, otitis media and caries for over 40 years.34. Compared to an ultrasonic scaler, this same group38 showed that the performance of the Er:YAG laser was equivalent. Controlling Systemic Risk Factors.Several risk factors have well established associations with both periodontal and systemic diseases, such as diabetes, smoking, stress, immunodeficiency, medications, obesity, hormones, and nutrition. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health. Non-Surgical Management for Periodontal Disease Prior to introducing the various methods of non-surgical treatments for periodontal disease, it is important to understand calculus and why it is important to remove calculus in the management of periodontal disease. Overview of non-invasive factors (low level laser and low intensity pulsed ultrasound) accelerating tooth movement during orthodontic treatment. This hasn’t changed over thousands of years and is unlikely to change in our lifetimes. The main goals of nonsurgical periodontal therapy (NSPT) are to remove and control supra- and subgingival microbial biofilms, eliminate and control inflammation, and eliminate and control systemic and local risk factors that contribute to disease development and progression. Each successive wave of colonization makes the foundations for the next more pathogenic group eventually resulting in the most pathogenic group, the red complex. Both MMPs and PGE2 are potent activators of bone resorption and their inhibition may reduce the amount of bone loss.53 Bisphosphonates are another group of bone‐sparing agents which have been used as an adjunct to non‐surgical management.54 Lane et al.55 investigated the effect of bisphosphonate therapy against a placebo as adjuncts to conventional periodontal therapy. Deep sites could take up to nine months for their full response to therapy and it is probable that decisions at reassessment, taken only eight weeks after the last SRP visit, have not allowed for the time taken for healing at deep sites. The purpose of this review was to assess recent changes. However, they show a history of significant side effects, most notably thermal damage to the root surface. The average width of a furcation is usually less than that of the average hand instrument.18 In addition, the roof of the furca is usually above the level of the opening. There are similarities between peri-implant diseases and periodontal diseases in terms of aetiology, pathogenesis and management. They showed significant improvement in both groups, but failed to show that FMD produced a better result.23 When the microflora was analysed they could not show that FMD resulted in greater reduction in the bacteria.24 In a third paper, they reported both therapies were associated with a reduction in antibody titre and an increase in avidity, but no significant differences between test and control groups.25 The only difference they reported was that the FMD group reported more post‐SRP pain.23. Results after 30 years of maintenance, The interleukin‐1 genotype as a severity factor in adult periodontal disease, Microbial complexes in subgingival plaque, Dental biofilms: difficult therapeutic targets, Role of mechanical dental plaque removal in prevention and therapy of caries and periodontal diseases. and periodontitis for decades. However, nothing will replace instrumentation. Host modulation is manipulation of the inflammatory or immune response to treat disease and has been used in the management of rheumatoid arthritis, allergy and graft rejection. Where the PD was 4–6 mm there was a decrease in PD of 0.7–1.25 mm and a gain in AL of 0.25–0.8 mm. One suggestion about brushing methods is to modify the patient’s existing technique to make sure it is thorough, methodical and removes as much plaque as possible rather than teaching the patient a completely new technique. In terms of sales, it is the market leader by far. This hasn’t changed and, once disease is established in a patient, probably will not change in the future. Using this system Aoki et al.37 showed effective removal of calculus from the root surface with some surface ablation confined to cementum. Ultrasonic instruments have the advantage of being quicker, less fatiguing, easier to use and the flushing action of the coolant. The initial phase of periodontal treatment should also include removal of caries with temporary or permanent restoration depending on the prognosis of the teeth. Therefore, it is necessary to disturb the biofilm when prescribing antimicrobials to allow greater access, but also to increase the multiplication rate of the bacteria making the antibiotic much more effective. Oral hygiene alone results in some decrease in gingival inflammation, but the majority of the reduction in the swelling is due to subgingival debridement. They needed surgery and antibiotics to achieve a good clinical result and it was suggested the ability of A. actinomycetemcomitans to invade tissue may account for the difficulty in reducing numbers. If the patient cannot use floss, then other aids should be suggested. It is the aim of non‐surgical therapy to demolish as much of the pyramid as possible and of maintenance to keep demolishing the foundations to prevent the formation of the climax population sufficient to cause disease progression. Minimum intervention dentistry: periodontics and implant dentistry. However, most people do not brush well, leaving substantial amounts of plaque behind.10 An increased frequency is recommended and allows regular application of toothpastes containing fluorides or anti‐plaque agents. Effects of air polishing and an amino acid buffered hypochlorite solution to dentin surfaces and periodontal ligament cell survival, attachment, and spreading. Common brands are EMS Piezon (Electro Medical Systems, Nion, Switzerland) and NSK Varios (NSK Tech, Sydney, Australia). This hasn’t changed and, once disease is established in a patient, probably will not change in the future. More recently, in a prospective study, Schwarz et al.40 evaluated its use against hand scaling and root planing finding an equivalent level of subgingival calculus removal. Non-surgical management of peri-implant diseases. Wound biofilms: Lessons learned from oral biofilms. The author has been involved in presenting educational programmes relating to oral health care products for a number of different manufacturers, but has no direct financial interest in these products or the companies which manufacture them. The Er:YAG laser is a solid state laser whose wavelength is more readily absorbed by water than others. Triclosan has been used in both toothpastes, where it is particularly effective, and mouthwashes, where it has been less effective. While the test subjects experienced greater improvements in clinical parameters, the differences were statistically significant, but not clinically significant. Being able to predict the outcome of the initial phase is valuable at the outset for longer‐term patient treatment planning and informing the patient of the probable need for further treatment. Molar sites tend to respond less well than single‐rooted teeth, perhaps due to access issues as well furcation involvement. However, it has been shown that periopathogens can be transmitted intra‐orally from “uncleaned” sites or from reservoirs such as the tongue, tonsils, cheeks and other mucous membranes.19, 20 This led Quirynen et al.21 to suggest that a disinfected site may be recolonized before the completion of treatment and the concept of full‐mouth disinfection (FMD). Tetracycline has been shown to have an anti‐inflammatory effect in clinical and animal studies treating periodontal disease reducing collagenolytic activity.41 Minocycline and doxycycline also demonstrate this effect. The disadvantages may be pain and sensitivity during use, thermal damage to tooth structure, poorer tactile sensation and the creation of an aerosol. Our patients know to brush their teeth twice a day, but most do not do this particularly well. The choice of FMD or QSRP depends on the operator, patient, time required to debride the oral cavity, cost, efficiency and post‐SRP pain as both methods seem equally effective.32 The original FMD protocol is intense and may not be realistic in private practice. Cavitron (Dentsply, Mount Waverly, Victoria, Australia) is a leading brand. Severely advanced periodontitis, The long‐term effect of a plaque control program on tooth mortality, caries, and periodontal disease in adults. What is Non-Surgical treatment? However, use of this type in clinical studies has produced mixed results.36 It seems that calculus may be removed completely or partially without much damage to the root surface, but a number of studies also report surface pitting, crater formation, thermal damage and production of toxic by‐products. There seems to be no difference between hand and ultrasonic instruments in terms of effectiveness of debridement and the amount of tooth surface removed during use. Non surgical periodontal therapy 1. Commonly‐used lasers in clinical dentistry are carbon dioxide, Neodymium:yttrium‐aluminum‐garnet (Nd:YAG), Erbium:yttrium‐aluminum‐garnet (Er:YAG), diode and gas lasers. The more strokes and the greater the force used the greater the loss of hard tissue.71 The amount removed varied from 34 μm after five strokes to 343 μm after 40 strokes. An alternating magnetic field in response to an electrical current causes the movement of the tip in magnetostrictive machines. Patel A. Initially, these devices were applied to hard tissue procedures, such as caries removal and cavity preparation. For optimal treatment results, systemic risk factors must be modified or eliminated. The host response makes a significant contribution to periodontal disease through release of inflammatory mediators, such as IL‐1 and PGE2, recruitment of pro‐inflammatory cells (neutrophils and macrophages) and tissue destruction, through the matrix metalloproteinase group of proteolytic enzymes (MMPs).39 Host modulation has been used as an adjunct to traditional periodontal therapy and consists primarily of three approaches: the anti‐inflammatory effect of antibiotics, the use of non‐steroidal anti‐inflammatory drugs (NSAIDs) and bone‐sparing agents. The frequency of brushing is traditionally twice a day. Examples of the different types of toothbrushes available. Furcation‐involved teeth do not respond as well a single‐rooted teeth75 and smokers tend to have a poorer outcome than non‐smokers.63, 64 Determining the success of treatment depends on the outcome criteria. It has been shown that sites 4 mm or less can be well debrided76 and good patient oral hygiene can influence the microflora in pockets up to 4 mm reducing the build‐up of the periopathogenic microflora.58, 59 Interestingly, Badersten et al.1 reported that the deeper the site, the longer it took to achieve maximal healing. Effects of diode laser application on inflammation and mpo in periodontal tissues in a rat model. Lasers and the treatment of periodontitis: the essence and the noise. A review of antibiotics is outside the scope of this article and will be ably discussed by Heitz‐Mayfield later in this supplement.15 The antiseptics are used in toothpastes, mouthwashes, sprays, gels, irrigators and varnishes. They showed significant improvement in both groups, but failed to show that FMD produced a better result.23 When the microflora was analysed they could not show that FMD resulted in greater reduction in the bacteria.24 In a third paper, they reported both therapies were associated with a reduction in antibody titre and an increase in avidity, but no significant differences between test and control groups.25 The only difference they reported was that the FMD group reported more post‐SRP pain.23. Prostaglandins are arachidonic acid derivatives which are important mediators of inflammation and PGE2 levels in GCF have been linked to increased attachment loss.46 NSAIDs block the production of prostaglandin through their effect on the cyclooxygenase pathway. Both sonic and ultrasonic scalers generate heat during use requiring a coolant, most commonly water. Single‐visit, full‐mouth ultrasonic debridement: a paradigm shift in periodontal therapy? Molar sites tend to respond less well than single‐rooted teeth, perhaps due to access issues as well furcation involvement. The cornerstone of periodontal therapy is non‐surgical management. If you do not receive an email within 10 minutes, your email address may not be registered, Ultrasonic devices can be further divided into piezoelectric and magnetostrictive. The article reports on changes in our understanding of plaque as a biofilm, developments in patient plaque control, chemical plaque control and scaling instruments. The cornerstone of periodontal therapy is non‐surgical management. While the use of chemical plaque control agents in toothpaste is widely accepted by the profession, the use of mouthwashes on a regular basis is less well accepted. Studies have suggested that the time taken to brush one’s teeth may only be about 40 seconds.10 Based on their clinical trials research, van der Weijden et al.12 suggested that two minutes brushing was the optimum for plaque removal with longer being no more effective. Therefore, a laser of an appropriate wavelength that will remove calculus, but not cause thermal damage to the pulp or tooth structure should be used. The largest one that fits into the interproximal space should be chosen. Actualización en medicina de familia: patología periodontal. Higher Intakes of Fruits and Vegetables, β-Carotene, Vitamin C, α-Tocopherol, EPA, and DHA Are Positively Associated with Periodontal Healing after Nonsurgical Periodontal Therapy in Nonsmokers but Not in Smokers. The biofilm is a 3D construction with channels allowing exchange of nutrients, transfer of genetic material and metabolites, quorum sensing and complex bacterial interaction. 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