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🌹اللهم صل ع نبينا محمد🌹 مرحبـــا بكـم بقناتنا شروحات محاضرات طب الاسنان لكل ما يخص طب الاسنان رابط قناة سنة اولى وثانية @dent_first_and_second @Thirdstagedentistrybot بوت القناة
2⃣type 2 diabetes obesity
hormonal changes in women (such as when menstruation, pregnancy, or menopause occurs), which can make the gums more sensitive conditions that impact your immune system, like HIV or leukemia medications that reduce the flow of saliva in your mouth genetics poor nutrition,
including a deficiency in vitaminC
❌How is periodontitis diagnosed?❌
Your dentist will be able to detect signs of periodontitis at an early stage during a routine dental examination. They can monitor your periodontal status over time to make sure it doesn’t get any worse. This is why it’s important that you visit a dentist on a regular basis for a screening.
2Your dentist may use a tiny ruler called a probe to measure any pockets on your gums. This test is usually painless. If plaque, tartar, or both are found on your teeth, 3your dentist will remove these substances as part of a professional cleaning. They may also take dental X-rays or refer you to a periodontist, an expert in the diagnosis and treatment of gum disease, for further testing and treatment.
🛑What are the complications of periodontitis?🛑
If not treated for periodontitis, the supporting structures of your teeth, including the bones of your jaw, can be destroyed. Your teeth loosen and might fall out or require extraction. Other
complications of periodontitis include:
1⃣painful abscesses
migration of your teeth, which may interfere with eating
receding gums and exposure of the roots of your teeth increased risk of complications during pregnancy, including low birth weight and preeclampsia
increased risk of heart disease, respiratory disease, and diabetes
💯💯How is periodontitis treated?💯💯
Treatment is aimed at removing plaque and bacterial deposits on your teeth and gums.
Oral hygiene practices
Your dental care team will give you instructions on how to reduce the number of bacteria in your mouth, which involves keeping your teeth and gums clean. Your dentist will give you advice on how to use tooth brushes and dental floss properly, and may recommend other oral hygiene products like a water pick or mouthwash.
🛑Here are a few tips for keeping your teeth healthy:🛑
Brush your teeth twice a day with a fluoride toothpaste.
Consider using an electric toothbrush, which may be more effective.
Floss at least once a day to remove plaque.
Visit your dentist at least twice a year for a professional cleaning.
Don’t smoke or chew tobacco.
Professional cleanings
During a professional cleaning, your dentist will remove plaque buildup and tartar from your teeth and their roots, and then polish your teeth and treat them with fluoride.
❌ Any periodontal pockets that have formed could require deep cleaning to enable healing. A deep-cleaning method called ((scaling)) and root planing will help scrape off tartar and also remove any rough spots on the tooth root where bacteria tend to gather.
❌❌Antibiotics❌❌
In some cases, your dentist will prescribe antibiotics to help with persistent gum infections that haven’t responded to cleanings. The antibiotic might be in the form of a mouthwash, gel, or an oral tablet or capsule.
⭕️Follow-up appointments⭕️
Your dentist will want to follow up with you after a few weeks, and then about every three to six months after that to assess your progress. If periodontal pockets are still present, they may recommend other treatment options, like surgery.
⛔️⛔️Surgery⛔️⛔️
If inflammation persists in sites that are inaccessible to brushing and flossing, your dentist may recommend a surgical procedure called flap surgery to clean deposits under your gums. Under anesthesia, your gums are lifted away and the roots of your teeth cleaned. Your gums are then sutured (stitched) back into place.
If you’ve had any bone loss, a procedure known as bone grafting may be done at the same time as flap surgery to regenerate the lost bone
فيدوهات عن طريقة عمل التنضيف و ازالة التكلسات👆
Читать полностью…
#periodontic
الأدوات الي نستخدمها بالبريو وهي
Peridontal probe
Explorers
Periodontal endoscope
Cleansing and polishing instruments
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#periodontic
شرح مفصل عن اانوع الجيوب اللثويه وكيفية معالجتها..
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⏪ ابدي افحص
⏪ حستخدم فى الفحص periodontal probe .. وهذاطبعا لان يكون blunt end ف ما يجرح ال tissues واني داشتغل ..
⏪ أحط البروب vertical ؟
❌ لا .
⬅ نحطه in oblique position ✅
⬅ وبعدين أمشى بالبروب جوه ال sulcus علمود أشوف البوكيت نهايته وين👌
⚠ ملحوظة مهمة ⚠
🔹 البوكيت يعتبر chronic inflammatory lesion .. وييعمل دايما repair مع نفسه ..
🔹 ولكن ال complete healing ما ييصير ودا بسبب الوجود الدائم للبكتيريا
🌟 Pocket Contents :
🔸debris
🔸gingival fluid
🔸food remnants
🔸salivary mucin
🔸purulent exudate , in case of edematous pocket
⚠ ملحوظة هامة جدااااا ⚠
✔ ممكن الانفكشن توصل لل pulp عن طريق البوكيت وهذاحيكون من خلال ال apex Or lateral canal ..
✔وهدا حيؤدى الى pathological changes of the pulp ...
✔ وفى الحالة هاي نسميها ⤵
* Perio-Endo problem *
⏪ كشفنا على البيشنت .. أتأكدنا ان عنده بوكيت related لسنة معينة ..
⏪ حنعالج البوكيت شون ؟؟؟؟
⬅ نركز مع بعض ..
✔ عندنا 3 طرق نقدر نعالج بيهم البوكيت ⤵
🌟 Non-Surgical Treatment :
⬅ وهذا يكون كالتالى :
🔸 Oral hygiene instructions
🔸 Scaling
🔸 root planning ➡ ( smoothens rough root surfaces so , the gum can heal )
🌟 Periodontal medications :
⬅ اريد للبيشنت ادوية تساعد على ال healing .. ؟؟
🔸Tetracycline
🔸metronidazole
🔸 mouth wash : ex. Orovex , Hexitol , chlorohexidine , kenara ,
🌟 Surgical Treatment :
⬅ هنا نحاول نقلل ال pocket depth عن طريق تدخل جراحى .. مثلا :
🔸 Gingival curettage
🔸 Gingivectomy
🔸 Periodontal flap procedures
🔸 Osseous surgery
🔸 Periodontal regeneration proce dures
What's the treatmeant of the periodontal pocket?...
اول شي إزالة السبب... ومن ثم بدء المعالجة...
Remove the cause of the pocket...then you can treatment ...
على حسب حجم البوكت ا...إذا كان مصاحب امتصاص عظمي وحجم الامتصاص..الى اخره
Nonsurgical treatments..👇🏻👇🏻
If the treatment of pocket may involve less invasive procedures...
1-Scaling and root planning..
Scaling removes tartar and bacteria from root surface may be performed using instruments currett or an ultrasonic device...
And smoothes the root surfaces, discouraging further buildup of tartar and bacterial endotoxin with tetracycline irrigation or normal saline irrigation..
2_ Antibiotics.
using topical or oral antibiotics to help control bacterial infection. Topical antibiotics can include antibiotic mouth rinses or insertion of gels containing antibiotics in the space between your teeth and gums or into pockets after deep cleaning. However, oral antibiotics may be necessary to completely eliminate infection-causing bacteria.
Or if it's invasive pocket...
Should be surgical treatment...
1-Flap surgery (pocket reduction surgery).
.👉🏻exposing the roots for more effective scaling and root planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gingiva tissue is sutured back in place.
2-Soft tissue grafts....
This is usually done by removing a small amount of tissue from the roof of your mouth (palate) or another donor source and attaching it to the affected site. This procedure can help reduce further gum recession, cover exposed roots and give your teeth a more pleasing appearance.
3-Bone grafting. ..
The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone.
4-Guided tissue regeneration
. This allows the regrowth of bone that was destroyed by bacteria. That'sdo special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.
5-Enamel matrix derivative application. Another technique involves applying a special gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue
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#periodontic
periodontal pocket
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#periodontic
Treatment of periodontal disease- Scaling and root planing
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#periodontic
🌺 Mucogingival tests
1. Tension (Bleching) test ..
2. Rolling test ..
3. Width of attached gingiva (parameter) ..
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#periodontic
🌺 Grade III fremitus test (TFO)
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#periodontic
🌺 Rolling test ...
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#periodontic
إنحسار اللثة GUM RECESSION
Gum recession
or gingival recession is the process in which the margin of the gum tissue that surrounds the teeth, pulls back, exposing more of the tooth, or leaving part of the tooth's root naked.
gum recessionReceding gums can be scary and uncomfortable for many patients; gum recession can change the look of your teeth (they will appear longer than normal) and can lead to an increased teeth sensitivity to cold, sugar, and brushing
The healthy gum
In a healthy situation, teeth erupt into the mouth with the roots fully centered in, and surrounded by jawbone. The gum tissues operate like an investing curtain covering the bone; they surround the necks of the teeth acting as a seal to prevent food from settling in between the teeth.
types of gingiva
There are two types of gingiva in the mouth:
1⃣attached gingiva: a 2-3 mm band of bright pink tissue firmly attached to the underlying bone (marked with a, image above)
the mucosa, or
2⃣unattached gingiva: a darker, larger area of unattached gum tissue that folds into the cheeks (marked with b, image above)
Gingival recession occurs when the edge of the attached gingiva (called the gingival margin) moves away from the crown of the tooth. Many times, the spaces between teeth can open up as the gum recedes, allowing food to get trapped.
How can we prevent and treat gum recession ?
A lot can be done to prevent and treat gum recession. Many times, gingival recession is a result of a combination of factors and its causes are not always simple to determine.
To figure out why your gums are receding it is best to see your dentist. Your dentist will help you identify the cause and will instruct you on how to address it.
Treatment methods vary according to the type and severity of the recession:
If gum recession is due to excessive or aggressive brushing, a staff member can show you more effective oral hygiene methods. You may also have to re-evaluate your flossing habits, get a mouthguard (in case of bruxism) and buy a softer and better toothbrush.
If recession is due to periodontal disease, the first step usually involves a special cleaning, called scaling and root planing (see gingivitis treatment). For many patients, this treatment along with excellent oral hygiene at home and regular dental checkups can help stop periodontal disease and prevent further gingival loss.
Sometimes gum recession can be caused by crooked or misaligned teeth or an improper bite. If this is the case, your dentist may recommend orthodontic tooth movement to reposition teeth within their bony housing.
Some cases with a more advanced recession may need a surgical approach.
The procedure is called gum graft. A gum graft is a relatively simple surgical procedure which aims to cover an area of exposed tooth root surface with grafted oral tissue.
gum graft
an example of gum graft to cover
an area of exposed tooth root
In any case, when minor recession is ignored, continued recession and bone loss around teeth are likely. Catching the disease in an early stage may reduce the treatment procedure to some simple instructions: gentle brushing and flossing, avoiding trauma, cleaning the gum line gently etc. Therefore, it is best to see your dentist as soon as you notice the first signs of gum recession
What are the causes of gum recession ?
Gum recession is not inevitable. It is true that gum recession can occur as we age, even in a healthy mouth, but a lot can be done to keep this process to a minimum. There are a number of factors that can cause gingival recession:
Periodontal disease
Periodontal diseases are probably the most common causes of gum recession.
Periodontal diseases are
plaque-induced inflammatory conditions that affect one or more of the periodontal structures : gingiva, alveolar bone, cementum, periodontal ligaments.
#periodontic
✅😊Treatment;:
1/Removal of local irritants will reduce the lesion size caused by inflammation.
2\Correction of causative factors causes hyperplasia.
3/Severe cases:( Gingivectomy or gingivoplasty) .
❇Idiopathic gingival en largement
( Hereditary gingival fibromatosis) ❇
👆🏻👆🏻🙄تضخم لثوي مجهول
( تضخم لثوي وراثي )
*It is a rare conditions of
Unknown etiology characterized by enlargement of attached, marginal and papillary gingiva.
⭕Clinical features:;
The gingiva is pink , firm and pebbled with no bleeding tendency. The enlarged gingiva causes formation of pseudopockets.
⭕Etiology:;
It is unknown, but heredity may play a role .
Local irritant may be complicating factor.
✅😊Treatment
1/ Removal of local irritative factors (plaque , calculus, ,,,etc.)
2/Surgical excision of excessive tissue.
3/Regular periodic prophylaxis with rigid plaque control to reduced recurrence rate
as this condition is highly recurrent.
❇Conditioned gingival enlargement❇
🔆1⃣Specific Conditioned Gingival En- largement:;
1/Gingival Enlargement during pregnancy and puberty.
2/Gingival Enlargement associated with Leukemia.
3/Gingival Enlargement associated with VitaminC deficieency.
2⃣Non_Specific Conditioned Enlargement:;
1/Pyogenic granuloma.
نشرح كلا من👆🏻🙄
👇🏻
🔆Specific Conditioned gingival En largement::
It is caused by systemic condition which exaggerates the usual gingival response to local irritation.
🅰Enlargement of gingival during pregnancy:;
*Pregnancy itself does not cause gingival enlargement but the altered tissue metabolism during pregnancy accentuates the response to local irritation.lt ma y be:; marginal gingival enlargement(Pregnancy gingivitis) or tumor_like gingival enlargement(pregnancy tumor) .
⭕Clinical features:;
1_ pregnancy gingivitis
The gingiva is bright red ,soft friable and has smooth shiny surface.
Bleeding occurs spontaneously or upon slight trauma.
2_ Pregnant tumor:;
(It is not true neoplasm)appears as discrete, flattened spherical mass, which protrudes from gingival margin or the interproximal space. This mass may by sessile or with pedicle. It is usually painless unless it has large size interfering with teeth occlusion, which causes painful ulceration of the lesion.
✅Treatment:;
1/Removal of local irritation and/establishment of excellent oral hygiène.
2/Tumors will regress spontaneously after delivery. If no , it should be removed surgically. It should not be removed during pregnancy unless it interfere with esthetic and function.
🅱Enlargement of gingiva during puberty:;
*Both males and females are affected. Marginal gingiva and interdental papillae are enlarged mainly on facial surfaces. The gingiva has features associated with chronic gingival inflammation.
🆑Gingival Enlargement associated with Leukemia:;
*It is caused by à dense infiltration of immature and proliferating leukocytes. True Leukemia gingival enlargement,occurs in acute or sub_acute Leukemia but not in chronic Leukemia.
⭕Clinical features
*Gingival Enlargement may be diffuse or marginal:; Localized or generalized. The gingival color is bluish red and has a shiny surface,Moderately firm in consistency with increased tendency toward bleeding either spontaneously or upon minor trauma. Acut painful ulceration of gingiva can be occurred.
🆎Gingival Enlargement associated with vitamin C deficiency
*Deficiency in vitamin C(scurvy) itself does not cause gingival inflammation but can cause hemorrhage/ collagen degeneration and edema of gingival connective tissue.
*This will modify the response of gingiva to the local factors, which produce massive gingival enlargement. Marginal gingiva is involved and become bluish red soft friable and has smooth shiny surface with increased tendency toward bleeding.
✅Treatment:;
This is carried out through the removaloof the lesion surgically and élimination of local factors. However,recurrence rate is about 15% of the cases.
#periodontic
مــلخــــص لــمــادة الـبــريــو
1⃣Stages
2⃣Symptoms
3⃣Causes
4⃣Diagnosis
5⃣Complications
6⃣Treatment
7⃣Outlook
🅰What is periodontitis?
Periodontitis is a serious infection of the gums. It’s caused by bacteria that have been allowed to accumulate on your teeth and gums. As periodontitis progresses, your bones and teeth can be damaged. However, if periodontitis is treated early and proper oral hygiene is maintained, the damage can be stopped.
🅱What are the stages of periodontitis?
Periodontitis starts as inflammation and gets worse over time.
⭕️Inflammation (gingivitis)
Periodontitis begins with inflammation in the gums known as gingivitis. One of the first signs of gingivitis is that your gums will bleed when you brush or floss your teeth.
You might also notice some discoloration on your teeth. This is called plaque.
📛Plaque is a buildup of bacteria and food debris on your teeth. Although bacteria are always present in your mouth, they only become harmful when conditions allow them to increase dramatically. This might happen if you don’t brush or floss, or get dental cleanings on a regular basis.
1Early periodontal disease❕
In the early stages of periodontitis, your gums recede, or pull away, from your teeth and small pockets form between gums and teeth. The pockets harbor harmful bacteria. Your immune system tries to fight the infection, and your gum tissue starts to recede. You’ll likely experience bleeding during brushing and flossing as well, and possibly some bone loss.
2Moderate periodontal disease
If left to progress to moderate periodontal disease, you might experience bleeding and pain around the teeth and gum recession. Your teeth will begin to lose bone support and become loose. The infection can also lead to an inflammatory response throughout your body.
3Advanced periodontal disease
In advanced disease, the connective tissue that holds your teeth in place begins to deteriorate. The gums, bones, and other tissue that support your teeth are destroyed. If you have advanced periodontitis, you might experience severe pain while chewing, severe bad breath, and a foul taste in your mouth. You’ll likely lose your teeth.
🆎What are the symptoms of periodontitis?
The symptoms depend on the stage of disease, but generally include:
gums that bleed when you brush your teeth or floss
bad breath
changes in the position of your teeth or loose teeth
receding gums
red, tender, or swollen gums
buildup of plaque or tartar on your teeth
pain when chewing tooth loss
foul taste in your mouth
inflammatory response throughout your body
Symptoms in the early stages of periodontitis are often not very noticeable. Your dentist will likely be the first to point them out.
🅾What causes periodontitis?؟
Healthy people normally have hundreds of different types of bacteria in their mouth. Most of them are completely harmless. When you don’t clean your teeth properly each day, the bacteria grow and build up on your teeth.
✅1Periodontitis
is typically caused by poor dental hygiene. When you don’t brush your teeth and clean in hard-to-reach places in your mouth, the following happens:
The bacteria in your mouth multiply and form a substance known as ((dental plaque.))
If you don’t remove the plaque by brushing, the bacteria deposit minerals within the plaque over time.
This mineral deposit is known as ((tartar)) which will encourage more bacterial growth toward the root of the tooth.
Your body’s immune response to this bacterial growth leads to inflammation in your gums.
The attachment of the gum to the root of a tooth is disrupted over time, and a periodontal pocket (gap) may form between the gum and root.
💤Harmful anaerobic bacteria colonize in the pocket and multiply, releasing toxins that can damage the gums, teeth, and supporting bone structures.
Additionally, certain factors put you at a higher risk of periodontitis, including:
1⃣smoking, which is one of the biggest risk factors for periodontitis
#periodontic
manual scalling&root planning
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#periodontic
manual scalling&root planning
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#periodontic
ادوات + مواد البريو
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#periodontic
Gingival overgrowth
Causes : local inflammation due to poor oral hygiene, food debris, or mouth breathing orthodontic appliance
Systemic conditions such as hormonal imbalance, vitamin c deficiency drugs, or tumor invasion into the gingiva
Drug induced gingival enlargement
Most commonly associated with anticonvulsants, Cyclosporine, and calcium channel blockers and which depends on the duration, dose, hygiene and genetic suspectibility of the patient ,
The enlargement might be attributed due to dysregulation of cytokines and growth factors
Hereditary Gingival Fibromatosis
Both autosomal dominant and autosomal recessive patterns are seen. Gingival
fibromatosis that is not associated with syndrome , or other physical or mental abnormalities. Enlargement may be present at birth or soon after with eruption of the deciduous or permanent dentitions. The most common problems caused by the condition are tooth migration, retention
of the primary dentition, and diastemata. Enlargement may completely cover the crowns of the teeth, resulting in difficulty masticating or speaking and poor esthetics.
Other Causes of Gingival Enlargement
Patients with acute myelogenous leukemia (principally acute monocytic [M4] or acute myelomonocytic [M5] leukemia) may present with gingival leukemic infiltrates
Wegener’s granulo-matosis, sarcoidosis, Crohn’s disease, primary amyloidosis,
Kaposi’s sarcoma, acromegaly, and lymphoma.
Clinical Features
There is an increase in bulk of the free and attached
gingiva, especially the interdental papillae when it is due to drug consumption it begins in papilla and spreads across the teeth.Stippling is lost,the margins become rolled
and blunted. The consistency of the gingiva ranges from soft to firm depending on the density and amount of fibrosis. A range of color from red-
blue to pink depending on severity of the inflammation response as well.
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#periodontic
dental instrument pocket guide
#periodontic
The periodontal pocket
🔴Definition
Pathological deepening of gingival sulcus
يعني هو عباره عن زياده في حجم ال gingival sulcus
اما يكون باتجاه ⤴️gingival margin
او تجاه ال crown ⤵️
او يصير نزوح في اللثه في اتجاه الجذر ⤵️
🔴normal gingival sulcus 2_3mm هذا الطبيعي
🔴اذا زاد عن 3mm حيصير عدنا pocket
🔴اذا coronally movement يعني حيكون باتجاه ال crown
🔴اما اذا جانت apical movement يعني باتجاه ال root
🔷الاعراض الي يحس بيها بيشنت
🔷symptoms
🔷عادةً البيشنت يشكي من الم بعد الاكل will localized pain يعني يكدر يحدد مكان الم
🔷itchiness in the gum يعني يحس مثل الحكة وتكون deepفي ال gum 🔷food sticking between the teeth 🦷
يعني الاكل يصير بين الاسنان وهذا شي كلش مزعج
🔷sensitivity to hot and cold يتحسس من حار وبارد
🔷feel looseness of teeth 🦷 البيشنت حيحس انو اسنانه تحرك
🔴clinical sign
🔷
Probing مع gingival bleeding ال
وهاي اول علامه نعرف بيها inflammation
🔷bluish red thickened marginal gingival نتيجه الالتهاب
🔷suppuration(pus)
مو دائما نشوفها
نعرف هاي حاله عن طريق test by index finger
🔷tooth mobility
نجرب نحرك السن by two instruments او finger with instruments
🔴تصنيف periodontal pocket
التصنيف الاول على حسب شكله وعلاقته بالانسجه المحيطه بيه
1️⃣ gingival pocket
راح يكون عباره عن زياده في حجم ال gingiva
بس مراح يصير شي بال alveolar bone
واسمه الخ هو. False or pseudo pocket
2️⃣ periodontal pocket
هنا حيكون عدنا bone distraction
لذلك يسمونه true pocket
💡التصنيف الثاني ال periodontal pocket
الي هو. حيقسم حسب base of the pocket وين القاعده البوكت بضبط
🟢supra-bony pocket
🟣infra-bony pocket
💡يعني
♠️يعني اذا جان base of pocket قاعده فوق او الاصح coronal للcrest of alveolar bone. معناها هذا supra bony pocket 🤷🏻♀️
♠️واذا جان عندي base القاعده apical لل crest of bone يعني حيكون عندي infra bony pocket 🤷🏻♀️
🟥التصنيف الثالث ال periodontal pocket
الي يعتمد حسب عدد السطح according to the involved tooth surfaces
1️⃣simple pocket 🔜involve one surface
2️⃣compound pocket 🔜 involve more than one surface
3️⃣complex or spiral pocket 🔜 originating on one tooth surface and twisting around the tooth to involve one or more additional surface
ال pocket أصلا ? Pathologically deepened gingival sulcus ..
⬅ لازم نكون عارفين أنو وجود البوكيت دليل على وجود periodontal disease ..
⬅ زين أسباب حدوث deepening in the gingival sulcus ؟؟؟
- coronal movement of the gingival margin
- apical displacement of gingival attachment
- Or combination of both processe
🌟 Types of pockets :
نوعين رئيسيين للبوكيت ⤵
💢 Gingival pocket :
↙ وهذا يكون pseudo يعنى مش حقيقى ..
↙ يحصل نتيجة حدوث ⤵
🔹gingival enlargement without destruction of the underlying tissue .
🔹 the sulcus is deepened because of the increased bulk of the gingiva .
💢Periodontal pocket
↙ هذا يكون حقيقى ..
↙ لانه يسبب ⤵
🔹 destruction of the supporting periodontal tissue ..
⏪ شنو أسباب تكون البوكيت اصلا ؟؟
Plaque
⬇
Gingival inflammation
⬇
Pocket formation
⬇
More plaque formation
⏪شنو هى أنواع ال periodontal pocket ؟؟
🌟 Types of periodontal pockets :
💢 Suprabony pockets :
🔹 in this , bottom of the pocket is coronal to the underlying alveolar bone ..
💢 Intrabony pocket :
🔹 in this , bottom of the pocket is apical to the level of the adjacent alveolar bone & the lateral pocket wall lies between the tooth surface & alveolar bone ..
⏪ ممكن نقسم ال periodontal pocket اكتر من تقسيمة وهذا حيكون على حسب :
🔆 The involved tooth structure :
💥 Simple
💥 compound
💥 complex ➡ ( most commonly found in furcation area )
🔆 Nature of soft tissue wall in the pocket :
💥 edematous
💥 fibrotic
🔆 Activity to disease :
💥 active pocket
💥 inactive pocket
🌟 Signs & Symptoms :
bluish red , thickened gingiva
gingival bleeding
tooth mobility
diastema formation
rolled edge separating the gingival margin from tooth structure
localized pain or it may be painless
foul taste
sensitivity to hot & cold tendency to suck material interproximally
feeling etching in gum
#periodontic
Gingivitis and periodontitis - causes, symptoms, diagnosis, treatment, pathology
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#periodontic
Manual scalling
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#periodontic
🌺 HOW TO DETERMINE CLINICAL ATTACHMENT ...
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#periodontic
Fremitus test :
used to check TFO in upper anterior teeth ...
in cases of cross bite 👉🏻 lower anterior teeth ...
الدكاترة يسألو على اسم حركة تسكيرة و فتح على السنون هذي شن اسمها ، اسمها (tipping moveing) ...
For posterior teeth use articulator pepar to check TFO ..
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#periodontic
progression of periodontal disease
Gingival recession is a sign that usually occurs in the later stages of gingivitis. When gum recession is caused by periodontal disease, the gums are normally bright red and swollen, tender or painful to the touch and may be bleeding after brushing or flossing.
As a result, if your oral health habits are questionable, gum recession may be a result of periodontitis.
Abnormal tooth positioning
Crooked or misaligned teeth (or bite) can cause gum recession. Here is the reason:
When a tooth is not in its normal position, it will erupt outside of the protective bony housing. This means that at least on one side, the bone surrounding the tooth is thin or non-existent. Since the gum tissue has to cover the bone, a thin or non-existent bone will result in thin or no gum tissue.
This is an important consideration for orthodontic tooth movement. During orthodontic treatment, if tooth roots are moved outside the bony housing, gum recession is likely to follow.
Genetics
Some people are born with an inherently thicker type of gum tissue, while others have very thin tissues. Another important factor is the band of attached gingiva. If this band is too thin, it can be easily compromised by trauma or periodontal disease, both of which contribute to gum recession.
Moreover, if one or both of your parents have gum recession, you're at a higher risk for receding gum.
Aggressive tooth brushing
Over aggressive tooth brushing can traumatize, inflame and tear gingival tissues, resulting in gum recession. Of course, it is great to be keen about oral care, but remember that it doesn't take force to remove bacterial plaque.
First, use a soft toothbrush and make sure to change it as often as needed (every 4 weeks for a manual toothbrush and every 3 months for an electric toothbrush head). Brush gently and use a toothpaste that is not too abrasive (see tooth brushing technique).
Bruxism or grinding your teeth
Involuntary grinding of the teeth (especially during the night) can cause many dental problems. Clenching or grinding your teeth can put too much force on the teeth, causing gums to recede.
Be sure to inform your dentist right away if you think you are grinding your teeth. Teeth grinding can be treated with a nightguard (you should wear it at night while you sleep) and several other options.
Other causes
Trauma to gum tissue -- The gum tissue may recede when a traumatic injury has occurred on a tooth or teeth.
Tobacco products -- Tobacco users are more likely to have sticky plaque on their teeth that is difficult to remove and can cause gum recession.
Piercing of the lip or tongue -- Piercing can rub the gums and irritate them to the point that gum tissue is worn away
About Miller cllassification of Gingival recession :
🌟 Class I :
⏩ the interdental periodontal support is intact and the gingival recession does not reach the mucogingival line .
▶ Complete root coverage can be achieved..
🌟 Class II :
⏩ the interdental periodontal support is intact and the gingival recession reaches the mucogingival line...
▶ Complete root coverage can be achieved .
🌟 Class III :
⏩there is some interdental attachment and bone loss and the gingival recession reaches the mucogingival line...
▶ Partial root coverage can be achieved...
🌟 Class IV :
⏩bone and attachment loss are so severe that no root coverage can be accomplished.
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🆑Nonspecific Conditioned gingival enlargement(Pyogenic granuloma)
*This is a tumor _like gingival enlargement of unclear etiology and considered as an exaggerated conditioned response to a minor trauma.
⭕Clinical features:;
*Lesion appears as discrete spherical tumor_like mass,with pedicle involving the gingiva . It has bright red or purple color and it is friable or firm depending on its duration. This lesion is similar to pregnancy gingival enlargement and différentiation betmeen them is by the patient's history.
🆎Developmental gingival enlargement.
🔆Appears us bulbous distortion of labial and marginal gingiva during various stages of teeth eurption.
Enlargement persists until complete tooth eruption.
This enlargement can be considered as physiologic condition.
❌Neoplastic gingival enlargement
1⃣Benign
🔴Epulis 🔴Fibroma🔴Myoblastoma🔴Hemangioma🔴Papilloma🔴Peripheral giant cell granuloma🔴Leukoplakia🔴gingival cyst🔴Nevus.
2⃣Malignant
🔴Syuamous cell carcinoma 🔴Malignant melanoma🔴Sarcomas(fibro _ sarcomas, Iympho_sarcoma) 🔴Metastasis.
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#periodontic
تضخم اللثة
Gingival Enlargement
🛑Definition 👇🏻تعريف
It is an increased size of the gingiva which is considered as hyper plastic changes but not hypertrophy.
👉🏻Hyperplasia :;فرط التنسج👇🏻
Is an increase in an organ size or its part , due to increased number of its cellular elements.
👉🏻 Hypertrophy:; زياده التضخم 👇🏻
Is an increased size of thé cells, resulting in an increased organ size.
❇Classification of gingival enlargement❇
تصنيف تضخم اللثه
1⃣According to distribution .
وفقاً للتوزيع .
2⃣According to location
وفقاً للموقع.
3⃣According to etiology
وفقاً للاسباب .
☺الآن نشرح 👆🏻بتفصيل كلاً على حدى👇🏻
🔅According to distribution:;
1/ Localized موضعي
: Limited to gingiva adjacent to single tooth or a group of teeth.
2/ Generalized عام
Whole gingiva throughout mouth is involved.
🔅According to location
1/ Marginal الحواف
confined to marginal gingiva .
2/ Papillary الحلمات بين السنية
confined to interdental papilla.
3/ Diffuse :
involving all gingival parts : marginal attached and interdental papillae.
4/ Discrète:
isolated gingival en- largement , which may .be sessile or has pedicle( pedunculated)
🔅Classification According to etiology
1/ Inflammatoryاللتهابيه
(Chronic or acute)
2/ Non - Inflammatory غير اللتهابيه
( Drug - induced e.g.
phenytoin - cyclosporine
_ Nifedipine) .
3/ Combinedمشتركه ( Inflammatory with non- Inflammatory)
4/ Hereditaryوراثيه gingival fibromatosis
5/ Conditionedحالات مرضيه
(Hormonal _ Leukemic _ Vit C _ deficiency _ Non- specific)
6/ Developmentalتطوري ( Eruptive)
7/ Neoplasticاورام
( Benign and malignant)
❇Inflammatory gingival Enlargement❇
1⃣Chronic
*It is à gingival response to local irritation and starts as swelling in thé interdental papillae and / or marginal gingiva.
It may.be localized or generalized .Its progression is slow without pain unless acute2 infection or trauma complicates it . Thé gingiva can bleed easily , appears deep red or bluish red in color . It has soft and smooth21 shiny surface.
✴Etiology ❓
1/ poor oral hygiene.ض
فقر ( سوء) العنايه الفموية
2/ Food impactions.
الطعام بين الأسنان .
3/ Cervical caries and improper restorations .
4/Badly constructed prosthetic and faulty orthodontic appliances.
5/Bad habits as mouth breathing and pressing tongue against gingiva.
✅Treatment:
1/ proper recognition and elimmination of etiologic factor .
2/ Then , correction of the condition .
2⃣Acute:;
⭕Types:;
1_ Gingival abscess
خراج لثوي
2_ Periodontal bscess
خراج حول الأسنان ( الدواعم)
3_ Pericoronal bscess
خراج حول التاج
❇Non _ Inflammatory( Drug _ induced) gingival enlargement❇
*This group is termed gingival hyperplasia, as it not common condition and its cause is not persistance of local irritation s as in Inflammatory group , but most cases are associated with some drugs as
🛑( Phenytion
Cyclosporine
Nifedipine.)
🔆Clinical featuer:;
1/ The Clinical changes of drug_induced overgrowth are very similar irrespective of the drug involved.
2/ Thé first signs of changes are se en after3_4months of drug administration.
3/ Progress: The interdental papilla become nodular before enlarging more diffusely to encroach upon the labial tissue.
4/ Site:; The anterior part is most severely and frequently involved.
5/ Symptoms;: with à good standard of oral hygiene, overgrowth gingiva is pink_ firm_stipplled, when there is à pré_exiting gingivitis, the enlarged tissues compromise an already poor standard of plaque control. The gingiva then exhibit the classical signs of gingivitis.
✅Treatment:; 😊
1/ Modification or changes of the causative drug.
2/Mild casesتضخم بسيط
oral hygiene instruction, scaling and polishing .
3/ Severe casesتضخم حاد
Surgical removal(Gingivectomy or gingivoplasty ).
4/ À follow _ up program is essential to ensure à high standard of plaque control and to detect an y recrrence of the overgrowth.
❇Combined gingival enlargement❇
*In this condition, the gingival hyperplasia is complicated by an Inflammatory process where this enlargement provide adequate media for more plaque accumulation.
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