This document discusses the prevention of periodontal diseases. It states that prevention is better than cure and cheaper than treatment. It defines periodontal diseases as those affecting the tissues surrounding and supporting the teeth. The main causes are bacterial plaque, host response factors, and reduced tissue repair capacity. Prevention methods include mechanical plaque removal using various toothbrushing techniques, flossing, and oral irrigation. Chemical controls include antimicrobial mouthwashes containing chlorhexidine or essential oils. Professional treatment involves nonsurgical scaling and root planing to remove deposits, as well as antimicrobial therapy. The goal of polishing after treatment is to remove soft deposits with minimal trauma.

1. Prevention of
Periodontal Diseases
Khalid S Hassan
Assist . Prof .
PDS,
Periodontics
Division

2. 
Prevention is better than cure .

Prevention is cheaper than cure .

Prevention of a disease is greater
good in life than its cure .

3. Periodontal Disease


Periodontal diseases: diseases
which affect periodontium.
Periodontium : tissues which
surround and support the
teeth.

4. Etiology of Periodontal Diseases
Bacterial plaque
Host response
Reparative tissue capacity
Factors upset the balance By
Increasing aggression of bacterial plaque
Local predisposing factors
Systemic Factors
1- Calculus
1- Hormonal imbalance
2- Material alba
2- Nutritional deficiency
3- Food debris
4- Food impaction
5- Food retention
6- Faulty dentistry
7- Malocclusion
8- Mouth breathing
9- Trauma from occlusion
Decreasing defense
* Overhanging filling
3- Blood diseases
* Over and under contoured crowns
4- Genetics
* Occlusal disharmony
5- Immunologic
* Orthodontic wires
6- Metallic intoxication
* Rough fillings
7- Debilitating diseases
8- Psychologic

6. Objectives
1- Removal of soft deposits (dental plaque, materia alba and
food debris)
2- Gingival massage
keratinization and improve
circulation
protection against microorganisms
3- Prevention of calculus formation.
Methods
Mechanical
Chemical

7. ** Tooth Brushing Methods:Bass Method:
•Intrasulcular method (Professional method).
•Efficient for removing dental plaque from gingival third and
from shallow gingival sulcus.
•Place the bristles at the gingival margin with angle of 45 degree
to the long axis of the teeth and the bristles pointed to the
crevice.
•Exert gentle vibratory pressure using short back-and-forth
motions without dislodging the bristles tips (horizontal
direction).
•Perform about 10-20 strokes in each position.
•Use a soft brush in this method.

10. Modified Stillman Method:•A soft or medium brush can be used with this method.
• Recommended for patients with gingival recession to
prevent abrasive tissue destruction.
•The sides of the bristles are placed against the gingiva
and teeth with a 45 degrees angle to the long axis
of the teeth.
•Pressure is applied laterally against the gingival
margin to produce blanching.
•Brush is activated by short back-and-forth strokes in
coronal direction.

11. Brushing Methods
Modified Stillman Method

12. Charters Method
•
A soft or medium brush can be used.
• Recommended for temporary cleaning in
areas of healing after periodontal surgery.
• The bristles pointed toward the crown at a 45
degree angle to the long axis of the teeth.
• The bristle tips not move across the gingiva.
•The brush is activated with short back-and
forth strokes in coronal direction.

14. Powered Tooth Brushes
•
Useful for: Children, hand-capped, and patients
with orthodontics treatment.
•
Less abrasive
restoration.
•
Do not require
application.
•
Place the brush head next to the tooth at the
gingival margin and proceed systematically
around the dentition.
to
tooth
special
surfaces
techniques
and
of

15. Adverse effects of
Toothbrushing




Improper toothbrushing.
Toothbrush trauma.
Excessive brushing pressure.
Hard toothbrush bristles.
Gingival abrasion and recession
Dentin hypersensitivity

16. II- Interproximal Cleaning Aids:• 1- Dental Floss:
Effective for flat or convex proximal tooth surfaces with full
embrasures.
• Waxed, unwaxed or tufted types.
• Tufted and waxed are indicated for rough
restoration and tight contact
• Cut about 12-15cm and anchored around one
finger of each hand.
• Gentle placing at the base of gingival sulcus then
moved in an up-and down along the tooth surface
,right and left.

17. 2- Interdental Brushs:
•Small cone-shaped or tapered brushes.
•Used in large open embrasures.
•Inserted interdentally and moved back and forth in faciolingual direction.
3- Tooth Picks:•Made from soft-wood and is triangular in shape.
•Used in open contact.
•Tooth pick moved in-and-out or up-and down direction.
•Tooth pick can be placed in special plastic handles to reach
areas with limited access.

18. III- Oral Irrigation:•With water and antiseptic mouth rinses.
•Supra or sub-gingival irrigation.
•Hand or mechanized irrigation.

19. Chemical Plaque Control
(Mouth-rinsing)

20. Chlorhexidine:* The most effective antimicrobial agent in
gingivitis
plaque and
•Mechanism of action:pellicle formation, alteration of
bacterial cell wall
lysis of bacteria and
bacterial
adhesion to tooth surfaces.
• Has not produced any resistance of oral microorganisms.
•Substantivity: high Substantivity.
•Side effects:- Staining of teeth , tongue and resin
restorations,
- Alter taste sensation (temporary).
•Dose: 0.2%- 0.12% mouth washes Twice/day.

21. 2- Essential Oils
** Contains:Thymol
•Can
Menthol
Eucolyptal
Methyl Salicylate
plaque and gingivitis.
•Mechanism of action: alter bacterial cell wall &
tooth surface.
adherence to
•Substantivity
low substantivity.
•Adverse effects
Burning sensation, Bitter taste.
•Used twice daily.

22. Other Products
H2 O 2
Stannous fluoride
- Anticarious more than
antiplaque formation
Sanguinarine
- Derived from bl. Root
plant
- 0.01% mouthwashes and
dentifrices
-No benefits on
plaque, used in
NUG or
periocoronal
abscess.

23. Dentifrices
•Abrasive agent e.g. calcium carbonate, calcium oxide
or/silicate.
•Detergent agent e.g. sodium lauryl sulfate.
•Thickening agent: carboxymethyl cellulose and amylase.
•Coloring agents.
•Humidifier and water.
•Fluoride.
•Anticalculus agents e.g. zinc citrate, soluble pyrophosphates.
•Antiplaque agents e.g. chlorhexidine and triclosan.
•Antibiotics eg. Pinicillin.

24. Triclosan





Active ingredient agent of dentifrices.
Is a synthetic phenol derivative in a nonionic
form.
Compatible with other components of
toothpaste.
The formulation used in toothpaste contains
0.3% triclosan with 2% copolymer(added to
substantivity of antimicrobial).
Antiplaque activity for at least 12 hours.

25. Professional Care


Necessary to control the
Subginigival biofilm.
Is an example of secondary
prevention.

26. Mechanical Nonsurgical
Periodontal Therapy



Scaling: removal of hard deposits
on the tooth.
Root planing: removal of necrotic
cementum.
Curettage: removal of necrotic
soft tissues.

27. Antimicrobial Adjunct Therapy

Systemic Delivery of Antibiotics.

Local Delivery of Antibiotics.

28. POLISHING (Oral Prophylaxis)
•Upon the completion of Scaling & root
planing, you should polish the teeth when it
is necessary

29. GOAL OF POLISHING

To remove soft
deposits and
extrinsic stain with
minimal trauma to
hard and soft
tissues and minimal
discomfort for
patient

30. Disclosing Agents
•Used to stain the teeth for patient education and
motivation for oral home care.
•Used to locate areas with plaque accumulation.
•Available in tablets and liquid forms.
•Produce, blue, purple or red stains when
attached to plaque on tooth surface.
•Examples: Bismark Brown solution, erythrosine
and sodium fluorescein dye.