PREVENTION OF PERIODONTAL

DISEASES AT CHILDREN

Ukrainian Medical Dental Academy

The Chair of Pediatric Therapeutic Dentistry

with Dental Diseases Prevention

Lecturer: doc. Vashchenko I. Yu.

THE PERIODONTIUM

STRUCTURE AND FUNCTIONS

Periodontium –

("Perio" means 'around';

"dontal" means 'tooth‘)

morpho-functional complex of tissues which consist of:

cementum;

alveolar bone;

gum;

periodontium.

Functions of the periodontium:

nutritive;

sensation;

attachment & support

All components of the periodontium form a

FUNCTIONAL SYSTEM that provides attachment

for the tooth to the bone of the jaw AND permits the

tooth to withstand the forces of mastication

Classification of the periodontal diseases

(according to WHO):

gingivitis- the gums

inflammation, caused

by the unfavorable

influence of local and

common factors, which

flows without

disturbance of the

circular ligamentum

integrity;

periodontitis - the

inflammation of the

periodontial tissues,

which characterized by

the progressive

destruction of

periodontium and bone

tissue;

Periodontosis – a degenerative disease of the tissues that

surround and especially support the tooth such as the

supporting bone or the periodontal ligament.

idiopathic defeats – progressive lysis;

periodontomy – tumor processes in the periodontal tissues.

Basic etiological factors

of the periodontal diseases

Local:

Hygienic state of the oral cavity:

dental plaque, dental calculus

Irritating factors: carious defeats, defective fillings

and prostheses, orthodontic apparatuses.

Orthodontic apparatuses

Disturbance of occlusion and bite anomaly.

Disturbance of nose respiration.

Anomaly structure and the arrangement of

some soft tissues of the oral cavity organs.

Functional underloading or the overload of

maxillofacial region.

General:

Genetics

Smoking and tobacco use

Stress

Fluctuating hormones

Diabetes

Medications

Poor nutrition

Women and Periodontal Health

Puberty

Menstruation

Pregnancy

Oral Contraceptives

Menopause

The periods of taking the preventive

measures dependent on age

Prenatal period - period of the pregnancy:

the healthy means of the life of the pregnant woman;

rational nourishment;

the fulfillment of the gynecologist councils.

Breast period (first year of life):

breast feeding;

fight with the harmful habits;

the surgical intervention apropos of the anomalies of the fastening of soft tissues of the cavity of mouth.

Period of the temporary bite formation:

- the active valuable of mastication;

- correct of shaping of the oral cavity functions;

- the sanitation of the oral cavity;

- hygienic instruction and training;

- the formation of correct to bite.

Period of the formation of the constant bite:

- the elimination of the harmful factors, which disrupt

increase and formations of jaws;

- the instruction of hygienic care of the oral cavity;

- the timely treatment of the initial manifestations of

the hard tissues diseases and periodontal tissues.

Pathogenesis of the periodontal diseases

(R. J. Genko et ol., 1990)

1 stage - colonization of bacteria (predominantly Str.Sanguis та Actinomyces).

2 stage - stage of the invasion (microorganisms and theirfragments they penetrate in gum through the epitheliumof groove or pocket to different depth even of up to thesurface of alveolar bone).

3 stage - the damage of tissues occurs in two ways:

the direct action of bacteria or products of their vitalactivity;

the indirect action, which depends on the state of thehuman organism.

4 stage - stage of regeneration.

The classification of dental debris

(Pahomov T.N., 1982)

Unmineralised Mineralised

•pellicula; a) the supragingival calculus;

•plaque; b) subgingival calculus.

•soft dental debris;

•food debris.

Bacteria are the primary cause of periodontal disease. Bacteria

continually grow and form an invisible film on the teeth called

plaque. Plaque is simply a sticky yellowish-white film

composed of bacteria, small particles, proteins, and mucus. This

plaque continuously accumulates on the teeth and gums. With

proper brushing and flossing plaque is easily removed.

Plaque that is not completely removed every day by brushing

and flossing leads to a hard substance known as tartar (or

calculus).This hardened plaque can no longer be removed with

simple brushing and flossing. It must be removed by a dentist.

Calculus grading scale

Planning of prevention measure for patients

with the periodontal disease:

Complex of examination with plague control;

To use the periodontal index (CPITN, PI, BPI and et.)

Make a diagnosis;

Make individual treatment plan according to the acute or

chronic stages of disease;

– recommended the medial or soft hardness of bristles:

“Soft”, “Sensitive Plus”, “Sensitive”;

– treatment, treatment-preventive toothpaste;

– choice the mouth wash; mouth rinse;

The method of tooth brushing: may be Charter, Bass. Control

test after tooth brushing;

Make a professional hygiene (scaling)

Planning of prevention measure for patients

with the periodontal disease (cont):

Endogenous prevention of periodontal disease

(recommended for patient)

– vitamins, complex preparation which include the

vitamins, remineralization preparation with micro- and

macro- elements;

– special rational regime of eating (diet);

– make a examination of common organism, make a

relative ship between dentistry disease and somatic

health.

Exogenous treatment preventive measures.

Daily Dental CareBrushing Guidelines.

Use a dry brush. (plaque deposits were reduced by 67%, and gum

bleeding dropped by 50%).

Place the brush where the gum meets the tooth, with bristles resting

along each tooth at a 45-degree angle.

Begin by dry brushing the inside the bottom row of teeth, then the inner

top teeth, and last the outer surfaces.

Wiggle the brush back and forth so the bristles extend under the gum

line.

Scrub the broad, biting surfaces of the back teeth.

Dry brushing should take about a minute and a half.

A paste is then applied, and the teeth should again be brushed in the

same way.

The tongue should be scrubbed for a total of about 30 seconds.

Rinse the toothbrush thoroughly

Flossing should finish the process. A mouthwash may also be used.

Toothpaste

The object of a good toothpaste is to reduce the

development of plaque and eliminate periodontal causing

microorganisms without destroying the organisms that

are important for a healthy mouth.

Mouthwashes

The value of many mouthwashes is highly

controversial. Many have only temporary

antibacterial value. Some can even harm

the mucous membrane, and they can be

dangerous for children who drink them.

Those that are considered plaque fighters

are chlorhexidine (prescription) and

Listerine, which is available over the

counter.

Scaling and Root Planing

The initial stage of

treatment is usually a

thorough cleaning that may

include scaling to remove

plaque and tartar deposits

beneath the gumline.

Periochip A tiny piece of gelatin filled with chlorhexidine.

To control bacteria and reduce the size of periodontal pockets.

Chip is placed in the pockets after root planing, where the

medicine is slowly released over time.

Atridox A gel that contains the antibiotic doxycycline .

To control bacteria and reduce the size of periodontal pockets.

Placed in pockets after scaling and root planing. Antibiotic is

released slowly over a period of about seven days.

Actisite Thread-like fiber that contains the antibiotic

tetracycline. To control bacteria and reduce the size of

periodontal pockets .

These fibers are placed in the pockets.

The medicine is released slowly

over 10 days.

The fibers are then removed.

Arestin microspheres. Tiny round particles

that contain the antibiotic minocycline.

To control bacteria and reduce the size of

periodontal pockets.

Microspheres placed into pockets after

scaling and root planing. Particles release

minocycline slowly over time.

Periostat A low dose of the medication

doxycycline that keeps destructive enzymes

in check

To hold back the body’s enzyme response –

if not controlled, certain enzymes can break

down bone and connective tissue. This

medication is in pill form. It is used in

combination with scaling and root planing.

Thank you for attention!