7 physiotherapy in periodontology
TRANSCRIPT
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Lecturer:
Levkiv Mariana O.
Department of Therapeutic
Dentistry
TSMU
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General plan of periodontal
diseases treatment
General principles:
Aetiological treatment
Pathogenetic treatment
Symptomatic treatment
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Local treatment
Removal of local irritation factors-
Is aimed to remove local factors of irritation-dental deposits, carious cavities, traumaticocclusion.
Elimination of traumatic occlusion - selectiveteeth grinding, temporary or permanent teeth
splinting.
Removal of dental deposits
Oral hygiene
Treatment of caries and its complications Orthodontic treatment
Prosthetic treatment
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Anti-inflammatory treatment
Pharmacotherapy of microcirculatorydisorders
Influence on tissue metabolism
Stimulation of regeneration processesAntibacterial treatment
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Physiotherapy treatment
Electropathy
Hydro-treatment
Massages
Laser-treatment
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General treatment
To stimulate immune defense oforganism
General-strengthening treatment
General treatment of major diseases ofthe body
Diet-therapy
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Oral hygiene
The main goal of treatment is to controlthe infection. The number and types of
treatment will vary, depending on the
extent of the gum disease. Any type of
treatment requires that the patient keep
up good daily care at home. The doctor
may also suggest changing certain
behaviors, such as quitting smoking, asa way to improve treatment outcome.
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1.Before conducting professional hygiene
2. After conducting professional hygiene
1 2
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Deep Cleaning (Scaling and Root
Planing)
The dentist, periodontist, or dental hygienistremoves the plaque through a deep-cleaningmethod called scaling and root planing.
Scaling means scraping off the calculus fromabove and below the gum line. Root planinggets rid of rough spots on the tooth root wherethe germs gather, and helps remove bacteriathat contribute to the disease. In some cases
a laser may be used to remove plaque andcalculus. This procedure can result in lessbleeding, swelling, and discomfort comparedto traditional deep cleaning methods.
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Dental Deposits removing with
the help of scaling
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Tooth Cleaning by
ultrasoundThe ultrasound method is based on the
effect of cavitation: the tip of the tool,
pulsates with a frequency of 30000 cycles
per second: it is richly moistened withwater, is foamy and penetrates into
inaccessible areas, removing dental
deposits without damaging enamel ortissues.
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The hygienist closes the session with a
reminding on hygiene rules as well asbrushing and flossing methods with the
support of a model.
Porcelain recommends a tooth cleaning
every 3 to 6 months. In the presence ofa bracket system, orthodontics plates,
implants or crowns, its frequency should
be every 3 month.
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The tip of the scaler is thin. When held againstthe tooth, sound waves bounce off the tooth
and cause the calculus and plaque to breakup. The sound waves work so well that evenhardened plaque, also called calculus, breaksup. The water coming from the scaler thenwashes the broken debris away.
The Air-Flow (soda under pressure), air-abrasive system contains water and soda. Amixture of air, water and baking soda strikesthe surface of the tooth through a pressure
nozzle and removes plaque. Each particle ofthe abrasive polymer is used which allows fortreatment without mechanical damage.
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Medicamental treatment
Is aimed to treat symptomatic gingivitis(catarrhal, ulcerative,
hypertrophic), periodontal pockets, elimination ofpathological microflora, to stimulate reparative processes in
periodontal tissues.
Anti-bacterial treatment (local) is conducted, taken into
consideration the resistance of microflora.
Anti-inflammatory treatment - includes-etiotropic,pathogenetic, symptomatical treatment:
Etiotropic treatment- consists in selecting, removing or
depressing the reasons that cause inflammation process.
Pathogenetic treatment- envisages influence of the
medications on the patho-physiological aspects ofinflammation process.
Symptomatically treatment- includes removing or
depressing main inflammatory symptoms.
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Stimulation of reparative processes-is aimed at restoration
of damaged and affected tissues of periodontium, healing
ulcers of periodontium tissues, and ulcers of the bottom of
periodontal pockets. Means directed on improving metabolic processes in
affected periodontal tissues and stimulation of reparative
regeneration are used, in addition, they normalize the
dystrophic processes in the periodontium.
Keratoplastic drugs are used to improve epithelializationprocesses, which completes scarring and regeneration of
periodontal pockets and ulcers.
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Medications
Medications may be used with treatmentthat includes scaling and root planing, butthey cannot always take the place ofsurgery. Depending on how far the disease
has progressed, the dentist or periodontistmay still suggest surgical treatment. Long-term studies are needed to find out if usingmedications reduces the need for surgery
and whether they are effective over a longperiod of time. Here are somemedications that are currently used:
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Medications What is it? Why is it used? How is it used?Prescription antimicrobial
mouthrinseA prescription mouthrinse
containing an antimicrobial
called chlorhexidineTo control bacteria when
treating gingivitis and after gum
surgeryIt's used like a regular
mouthwash.
Antiseptic "chip" A tiny piece of gelatin filled withthe medicine chlorhexidine
To control bacteria and reduce
the size of periodontal pocketsAfter root planing, it's placed in
the pockets where the
medicine is slowly released
over time.Antibiotic gel A gel that contains the
antibiotic doxycyclineTo control bacteria and reduce
the size of periodontal pocketsThe periodontist puts it in the
pockets after scaling and root
planing. The antibiotic is
released slowly over a period
of about seven days.
Antibiotic microspheres Tiny, round particles thatcontain the antibiotic
minocyclineTo control bacteria and reduce
the size of periodontal pocketsThe periodontist puts the
microspheres into the pockets
after scaling and root
planing. The particles release
minocycline slowly over time.
Enzyme suppressantA low dose of the medication
doxycycline that keeps
destructive enzymes in check
To hold back the body's
enzyme response -- If notcontrolled, certain enzymes
can break down gum tissue
This medication is in pill
form. It is used in combination
with scaling and root planing.Oral antibiotics Antibiotic tablets or capsules For short term treatment of an
acute or locally persistent
periodontal infectionThese come as tablets or
capsules and are taken by
mouth.
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Physiotherapy
Electropathy
Direct current-electrophoresis, vacuum-
electrophoresis
Pulsed current of low frequency and
low-voltage diadynamic, fluctuarization.
Pulsedcurrent of high, ultra and ultra
high frequency - darsonvalization,diathermy, diathermocoagulation, UHF-
therapy, microwave therapy.
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Ultrasound therapy.
Electro-phototherapy - UV - lasertherapy.
Vacuum therapy.
Hydrotherapy. Massage.
Heat, and cold treatment.
Magnetic therapy. Oxygen therapy.
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Physiotherapy is used in all forms and
stages of periodontal disease. Some of the
physical treatments are executed at thebeginning of treatment and reinforce the
effect obtained after therapy (removal of
dental plaque, closed curettage of gingival
pockets, scaling, Vector-therapy) andsurgical (open curettage, scrappy and
plastic surgery on the periodontium).
A distinctive feature of physiotherapy is a
gradual, profound effect on the tissues, that
provides long-term positive results.
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In the acute phase of inflammation,
Porcelain prescribes infra-laser methods
which soften the gum while having an
analgesic and sedative effect. Infrared raysimprove local blood circulation and thus
accelerate the process of tissue
regeneration. Microwave therapy which is
based on the non thermal intensity of
electromagnetic waves is used for the rapid
removal of inflammation. EHF-therapy has
a strong bactericidal effect and reduces theswelling of tissues and stimulates the
regeneration of tissues.
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Infrared laser is an equally effectivemethod, prescribed in the treatment of
acute gingivitis, while electrophoresis ofcalcium chloride, vitamins, ascorbic acidis particularly effective in the chronicphase of the condition. Electrophoresis
is a low current electrical drugadministration method through the skinand mucous membranes of the oralcavity. It is particularly effective in the
rapid administration of antibiotics,vitamins and enzymes into thebloodstream and lymph systems.
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In the chronic stage of gingivitis, Porcelain
recommends 2 to 3 sessions of physical therapy
annually spread across to 5 visits to the dentist. For
the treatment of periodontitis in its chronic course,Porcelain uses d'arsonvalization which is a form of
electrophoresis with vitamins C and P. This is a high-
frequency procedure which alternates between high
voltage and low power current. This methodcontributes to the regulation of metabolic processes,
normalizes the excitation processes and removes the
feeling of pain. Electrophoresis of calcium chloride
and sodium fluoride and d'arsonvalization are also
used in the treatment of periodontitis. Physiotherapy
treatment have minimum of side effects are easy to
use and often rely on a variety of natural factors.
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The Vector System
This is a specialized ultrasound system
for the treatment of periodontal
diseases. The unique features of the
system prevents painful surgicalprocedures.
Vector - therapy is an effective
preventive and therapeutic agent in theearly stages of periodontal disease
gingivitis and periodontitis.
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The distinguishing feature of the Vector
system lies in the tool used and the tasks it
performs, such as the cleansing of cingulumsinflamed tissues and microbes. But, unlike the
manual curettage method, the principle of
vector is based on hydrodynamic effects: the
ultrasound energy is gently fed into thepocket through the water jacket. The
combination of water pressure and ultrasonic
treatment washes and handles a pocket while
removing plaque with a water softening effect.
This non-contact tool also insures a safe and
secure procedure.
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The energy of tool gently served to
periodontic pocket through water layer,
inflamed area intensively treated andwashed down to the bottom without the
formation of aerosol (spray).
During this process the particlesuspension work as toothpaste
removing plague from most complex
areas.
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The Vector therapy system's
unparalleled performance results in
smooth and clean root surfaces and in asignificant reduction of bacteria that
leads to the formation of new
periodontal ligament of the tooth. The most stable result is achieved in the
combination of the Vector therapy with
physiotherapy methods.
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Surgical treatment
Curettage- open curettage, closedcurettage, vacuum curettage, cryo-curettage
Gingivotomy Gingivoectomy-simple, radically
Flap operations
Operations for the formation ofvestibulum oris-frenulotomiya,frenulektomiya, plasty of vestibulum oris.
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Prosthetic treatment
With the help of various constructions of
splints and splint- dentures, stability of
movable teeth is provided, which
contributes to the effectiveness oftreatment of periodontal diseases.
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The combination of different
therapeutic, surgical, prosthetic,
medication and physiotherapy methods
of treatment insure best results.
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Thank you for you r at tent ion