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Lecture 4

Scaling and Post-Op Instructions

The purpose of treatment is to create an environment in which the gingival tissue can heal and be maintained in health by the patient.
Incidental curettage Incidentally or accidentally remove diseased tissue from the pocket wall
Intentional curettage Purposely remove diseased tissue from the pocket wall with instruments. This is not done by hygienists.
Periodontal debridement Scaling above and below the gum line to remove plaque and calculus. End point = biologically acceptable root surface to promote healing
Root planing Removing cementum or surface dentin that is rough. End point= smooth root. This is an old technique.
Channeling Using a systematic, overlapping approach. Scale in sections.
Subgingival scaling Rely on tactile sensitivity. Watch the terminal shank.
Rationale/Benefits of Scaling 1. Stop progress of disease 2. Induce changes in microorganisms; 3 month recall 3. Create healthy environment 4. Easier for patient to maintain tissues when healthy 5.Initial prep for perio surgery 6. Prevent recurrence
Use this to see under the tissues Radiographs
Areas to avoid caries, margins of restorations, enamel defects-CEJ & dentin
Approach to scaling Use treatment plan, based on individual needs, determined by your assessment
Single appointment Minimal calculus and you can complete the whole mouth in one appointment
Multiple appointments Excessive calculus and cannot complete the whole mouth in one appointment
Healing time before reassessment in a dental office where you are employed 4-6 weeks
Healing time before reassessment in dental school clinic 2-3 weeks
Immediate evaluation After scaling and before dismissing the patient for the day
Follow-up "on-going" evaluation Evaluating over a series of appointments. Re-explore and re-scale previously scaled quadrants. Evaluate after 2-3 weeks in dental school clinic or 4-6 weeks in dental office
Recall maintenance interval RDH determines how often the patient needs to be seen based on the perio assessment and diagnosis. It could be 3 months, 4 months, 6 months, 12 months.
Tissue response is the most important measure of success in periodontal debridement
hypertonic salt solution 1 teaspoon in 8 ounces of water
Primary reason for a 3 month recall It takes approx. 42 days without daily biofilm control for the subgingival plaque to recolonize to a pathogenic potential. The RDH uses curettes to debride the root surfaces where toothbrushes and floss cannot reach.
How often should a patient be seen typically? As needed
Key points for instrument selection amount and tenacity of calculus; location; depth of pocket; consistency of tissue;
Created by: schubring