Debridement (dental)

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Debridement (dental)
Gingivitis-before-and-after-3.jpg
Teeth before (top) and after (bottom) a thorough mechanical debridement
ICD-9-CM 96.54

In dentistry, debridement refers to the removal by dental cleaning of accumulations of plaque and calculus (tartar) in order to maintain dental health. [1] Debridement may be performed using ultrasonic instruments, which fracture the calculus, thereby facilitating its removal, as well as hand tools, including periodontal scaler and curettes, or through the use of chemicals such as hydrogen peroxide.

Contents

Description

Dental debridement is a procedure by which plaque and calculus (tartar) that have accumulated on the teeth is removed. [1] Debridement may be performed in the process of personal or professional teeth cleaning. Professional debridement techniques include the use of ultrasonic instruments (which fracture the calculus, thereby facilitating its removal), as well as the use of hand tools, including periodontal scaler and curettes.[ citation needed ] Debridement may also be performed using saline solution. [ citation needed ]

Procedures

Periodontal Pockets

Illustration of periodontal pocket on the right side of the tooth causing periodontal disease 202402 Periodontal Disease.svg
Illustration of periodontal pocket on the right side of the tooth causing periodontal disease

A periodontal pocket is formed from a disease process; it is defined as the apical extension of the gingiva, resulting in detachment of the periodontal ligament (PDL). [2] The PDL is a ligament that attaches the root of the tooth to the supporting alveolar bone. This ligament allows for occlusal force absorption. Plaque accumulates within the pocket initiating an inflammatory response due to an increased number of spirochetes. There are different types of bacteria that make up dental plaque. In cases of aggressive periodontitis three major species of bacteria have been identified within the periodontal pocket. These bacteria include Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans. [2] Healthy gingiva consists of few microorganisms, mostly coccoid cells and straight rods. Diseased gingiva consists of increased numbers of spirochetes and mobile rods. Interactions between plaque and host inflammatory response determine the alterations in pocket depths. [3] Bacterial plaque initiates a nonspecific host inflammatory response with the intention of eliminating necrotic cells and harmful bacteria. During this process cytokines, proteinases, and prostaglandins are produced which can cause damage, or kill healthy tissues such as macrophages, fibroblasts, neutrophiles, and epithelial cells. [2] The exposure to connective tissue and blood capillaries, allows microorganisms to gain an entryway to the circulation. This suppresses host protection mechanisms, leading to further destruction of bone. [3]

Periodontal probe Periodontal probe 01.jpg
Periodontal probe

Periodontal pockets may occur from either coronal swelling or apical migration. Pockets that occur due to coronal swelling with no clinical attachment loss are considered pseudopockets. There are two types of periodontal pockets that are determined by the type of bone loss present. A suprabony pocket occurs when there is horizontal bone loss, the bottom of the pocket is coronal to the alveolar bone. An infrabony pocket occurs when there is vertical bone loss where the bottom of the pocket is apical to the alveolar bone. [4]

Clinical signs of periodontal pockets include bluish-red, thickened gingiva, gingival bleeding, localized pain and in some cases exudate. Periodontal pockets can cause the loosening and loss of dentition due to destruction of supporting tissues including the alveolar bone, PDL and gingival tissue. Clinical diagnosis of periodontal pockets is achieved from full mouth periodontal probing performed by a dentist or dental hygienist. [2] [5]

Treatment of periodontal pocketing requires professional and at home intervention. At home treatment for periodontal pockets include meticulous and routine plaque removal by brushing and interproximal cleaning. Professional treatment includes routine dental visits for debridement, scaling and root planing. Clinical treatment goals are set to control the inflammatory disease by removal of coronal and subgingival plaque containing destructive pathogens. With the consistent and complete removal of biofilm, the infection can be arrested and healthy periodontium can be achieved. [6]

Curettes Curettes.jpg
Curettes

Another major risk factor of a periodontal pocket is smoking as it affects the severity and prevalence of pockets. Tobacco cessation is a necessary intervention to motivate patients to quit smoking and achieve periodontal health. [5] Smoking also delays the healing process once debridement, scaling, root planing and adequate home care has been completed.

Healing of periodontal pockets are shown by a reduction in pocket depth. Although pocket depths can be reduced by decreasing inflammation, large changes will not occur. Two ways in which periodontal pocket reduction can occur is by either non-surgical periodontal therapy (NSPT) or surgical periodontal therapy. NSPT includes but is not limited to initial debridement, scaling, root planing, antibiotic treatment, and oral health education. If periodontal pocket depths are not controlled and maintained with NSPT during a re-evaluation appointment then surgical periodontal therapy is necessary. [2] Surgical periodontal therapy creates a stable and maintainable environment for the patient by eliminating pathological changes in the pockets. The overall purpose of surgical therapy is to eliminate the pathogenic plaque in pocket walls to get a stable and easily maintainable state. This can promote periodontal regeneration. [2]

Periodontal Scalers

Professional periodontal therapy includes initial debridement, scaling and root planing with specific periodontal instruments. These instruments include files, curettes, after fives and mini fives used for mechanical debridement. The shank of periodontal instruments can either be rigid, which works better with heavy and tenacious calculus or flexible for fine tuning and light deposit. [7]

Periodontal files are used to crush larger, tenacious deposits to prepare them for further debridement with a scaler, curette or ultrasonic scaler. They have a series of blades on a base, therefore they are not suitable for root planing and fine scaling. [7] Universal curettes are double-ended instruments with paired mirror working ends and a rounded toe. These instruments can be used on all surfaces of the tooth including root surfaces in a periodontal pocket. [8] Gracey curettes have a stronger, rigid shank and angulated working blades that are area specific. They are best for subgingival scaling and root planing because the offset blade allowing for greater adaptation. [7] After fives are similar to gracey's except they have an extended shank to allow extension into deeper pockets (>5mm). They also have a thinner blade for heavy or tenacious calculus. [7] Mini fives are a modification of after fives as their blades are half the length to allow for easier insertion and adaptation into deep pockets, furcations, developmental grooves and line angles. They also contribute to a reduction in tissue trauma. [7] Ultrasonic scalers move in an elliptical motion and do not have a cutting edge. They operate at a frequency of 3,000–8,000 cycles per second and use magnetostrictive or piezo-electric technology, thus helping remove plaque and calculus while reducing operator wrist fatigue. [9]

See also

Related Research Articles

<span class="mw-page-title-main">Periodontal disease</span> Disease of the tissues surrounding the teeth (periodontium)

Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen and red and may bleed. It is considered the main cause of tooth loss for adults worldwide. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out. Halitosis may also occur.

<span class="mw-page-title-main">Calculus (dental)</span> Form of hardened dental plaque

In dentistry, calculus or tartar is a form of hardened dental plaque. It is caused by precipitation of minerals from saliva and gingival crevicular fluid (GCF) in plaque on the teeth. This process of precipitation kills the bacterial cells within dental plaque, but the rough and hardened surface that is formed provides an ideal surface for further plaque formation. This leads to calculus buildup, which compromises the health of the gingiva (gums). Calculus can form both along the gumline, where it is referred to as supragingival, and within the narrow sulcus that exists between the teeth and the gingiva, where it is referred to as subgingival.

<span class="mw-page-title-main">Gums</span> Soft tissue surrounding the roots of the teeth

The gums or gingiva consist of the mucosal tissue that lies over the mandible and maxilla inside the mouth. Gum health and disease can have an effect on general health.

<span class="mw-page-title-main">Toothache</span> Medical condition of the teeth

Toothaches, also known as dental pain or tooth pain, is pain in the teeth or their supporting structures, caused by dental diseases or pain referred to the teeth by non-dental diseases. When severe it may impact sleep, eating, and other daily activities.

Periodontology or periodontics is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament. A periodontist is a dentist that specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants.

<span class="mw-page-title-main">Gingival sulcus</span> Space between a tooth and gums

In dental anatomy, the gingival sulcus is an area of potential space between a tooth and the surrounding gingival tissue and is lined by sulcular epithelium. The depth of the sulcus is bounded by two entities: apically by the gingival fibers of the connective tissue attachment and coronally by the free gingival margin. A healthy sulcular depth is three millimeters or less, which is readily self-cleansable with a properly used toothbrush or the supplemental use of other oral hygiene aids.

<span class="mw-page-title-main">Crown lengthening</span> Dental procedure

Crown lengthening is a surgical procedure performed by a dentist, or more frequently a periodontist, where more tooth is exposed by removing some of the gingival margin (gum) and supporting bone. Crown lengthening can also be achieved orthodontically by extruding the tooth.

<span class="mw-page-title-main">Gingival and periodontal pocket</span> Abnormally deep space between a tooth and the gums


In dental anatomy, the gingival and periodontal pockets are dental terms indicating the presence of an abnormal depth of the gingival sulcus near the point at which the gingival (gum) tissue contacts the tooth.

<span class="mw-page-title-main">Scaling and root planing</span> Dental procedure

Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is a procedure involving removal of dental plaque and calculus and then smoothing, or planing, of the (exposed) surfaces of the roots, removing cementum or dentine that is impregnated with calculus, toxins, or microorganisms, the agents that cause inflammation. It is a part of non-surgical periodontal therapy. This helps to establish a periodontium that is in remission of periodontal disease. Periodontal scalers and periodontal curettes are some of the tools involved.

<span class="mw-page-title-main">Gingival enlargement</span> Increase in size of the gums

Gingival enlargement is an increase in the size of the gingiva (gums). It is a common feature of gingival disease. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. The treatment is based on the cause. A closely related term is epulis, denoting a localized tumor on the gingiva.

Gingivectomy is a dental procedure in which a dentist or oral surgeon cuts away part of the gums in the mouth.

The periodontal curette is a type of hand-activated instrument used in dentistry and dental hygiene for the purpose of scaling and root planing. The periodontal curette is considered a treatment instrument and is classified into two main categories: universal curettes and Gracey curettes. Periodontal curettes have one face, one or two cutting edges and a rounded back and rounded toe. They are typically the instrument of choice for subgingival calculus removal.

<span class="mw-page-title-main">Periodontal scaler</span> Dental tool

Periodontal scalers are dental instruments used in the prophylactic and periodontal care of teeth, including scaling and root planing. The working ends come in a variety of shapes and sizes, but they are always narrow at the tip, so as to allow for access to narrow embrasure spaces between teeth. They differ from periodontal curettes, which possess a blunt tip.

<span class="mw-page-title-main">Gingivitis</span> Inflammation of the gums

Gingivitis is a non-destructive disease that causes inflammation of the gums; ulitis is an alternative term. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms that are attached to tooth surfaces, termed plaque-induced gingivitis. Most forms of gingivitis are plaque-induced.

Chronic periodontitis is one of the seven categories of periodontitis as defined by the American Academy of Periodontology 1999 classification system. Chronic periodontitis is a common disease of the oral cavity consisting of chronic inflammation of the periodontal tissues that is caused by the accumulation of profuse amounts of dental plaque. Periodontitis initially begins as gingivitis and can progress onto chronic and subsequent aggressive periodontitis according to the 1999 classification.

Aggressive periodontitis describes a type of periodontal disease and includes two of the seven classifications of periodontitis as defined by the 1999 classification system:

  1. Localized aggressive periodontitis (LAP)
  2. Generalized aggressive periodontitis (GAP)
<span class="mw-page-title-main">Peri-implantitis</span> Inflammatory disease

Peri-implantitis is a destructive inflammatory process affecting the soft and hard tissues surrounding dental implants. The soft tissues become inflamed whereas the alveolar bone, which surrounds the implant for the purposes of retention, is lost over time.

Peri-implant mucositis is defined as an inflammatory lesion of the peri-implant mucosa in the absence of continuing marginal bone loss.

Periodontal surgery is a form of dental surgery that prevents or corrects anatomical, traumatic, developmental, or plaque-induced defects in the bone, gingiva, or alveolar mucosa. The objectives of this surgery include accessibility of instruments to the root surface, elimination of inflammation, creation of an oral environment for plaque control, periodontal disease control, oral hygiene maintenance, maintaining proper embrasure space, addressing gingiva–alveolar mucosa problems, and esthetic improvement. Surgical procedures include crown lengthening, frenectomy, and mucogingival flap surgery.

References

  1. 1 2 Page, R. C.; Schroeder, H. E. (1976). "Pathogenesis of inflammatory periodontal disease. A summary of current work". Laboratory Investigation. 34 (3): 235–249. PMID   765622.
  2. 1 2 3 4 5 6 Newman, Michael G. (2012). Carranza's Clinical Periodontology. St. Louis, Missouri: Saunders/Elsevier.
  3. 1 2 Boyd, Linda D.; Giblin, Lori; Chadbourne, Dianne (2012). Bidirectional relationship between diabetes mellitus and periodontal disease: State of the evidence". Vol. 46. Canadian Journal of Dental Hygiene. pp. 93–102.
  4. ↑ Nield-Gehrig, Jill S.; Willmann, Donald E (2011). Foundations of Periodontics for the Dental Hygienist. Philadelphia: Lippincott Williams & Wilkins.
  5. 1 2 Newman, Michael; Takei, Henry; Klokkevold, Perry; Carranza, Fermin (2015). Carranza's Clinical Periodontology. St. Louis: Saunders/Elsevier.
  6. ↑ Arabaci, Taner; Cicek, Yasin; Canakci, Cenk F. (2007). Sonic and ultrasonic scalers in periodontal treatment: a review. Vol. 5. International Journal of Dental Hygiene. pp. 2–12.
  7. 1 2 3 4 5 Nield-Gehrig, Jill (2012). Fundamentals of Periodontal Instrumentation & Advanced Root Instrumentation. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins.
  8. ↑ Darby, Michele; Walsh, Margaret (2015). Dental Hygiene: Theory and Practice. St. Louis, Missouri: W. B. Saunders Company.
  9. ↑ Drisko, C. L.; Cochran, D. L.; Blieden, T.; Bouwsma, O. J.; Chen, R. E.; Damoulis, P.; Fine, J. B.; Greenstein, G.; Hinrichs, J.; Somerman, M. J.; Lacono, V.; Genco, R. J. (2000). "Position paper: sonic and ultrasonic scalers in periodontics". Journal of Periodontal. 71: 1792–1801.
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