7 Physiotherapy in Periodontology

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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

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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

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7 Physiotherapy in Periodontology