https://www.spreaker.com/podcast/periodontics--4547644enCoursesCopyright Dr.Mayakha Mariamhttps://d3wo5wojvuv7l.cloudfront.net/t_rss_itunes_square_1400/images.spreaker.com/original/61b433233ce0fdfd7cffff6545a4ea64.jpghttps://www.spreaker.com/podcast/periodontics--4547644Sat, 27 Sep 2025 11:13:25 +0000Dr.Mayakha MariamDr.Mayakha Mariamthegulfiedentist@gmail.comThese are lectures of The Gulfie Dentist Online Coachingfalseepisodichttps://www.spreaker.com/episode/1-perio-intro--40400230https://api.spreaker.com/episode/40400230Wed, 19 Aug 2020 07:03:46 +0000Dr.Mayakha Mariam45falsefullhttps://www.spreaker.com/episode/2-perio-anatomy--404002461 Gingiva
2 Attachment apparatus*
a. Pdl
b. Alveolar bone
c. Cementum (has dead cells) acellular cementum

PARTS OF GINGIVA

 Normal range of gingival sulcus depth is- 2-3mm

 Colour of normal gingiva is an interplay between – keratin layer, melanine, blood vessels, epithelial thickness.**

 FREE GINGIVA – Also known as unattached / marginal gingiva. From the gingival margin till the free gingival groove / base of the sulcus.
(sulcus is in healthy gums, whereas pocket is in unhealthy / diseased
gums) KERATINIZED

 ATTACHED GINGIVA- From free gingival groove (base of the sulcus) to the
mucogingival junction. KERATIINIZED
o Healthy one shows stippling.
o Best views by drying the gingiva.
o Highest width is seen in incisors-
 Maxillary : 3.4-4.5
 Mand - 3.3-3.9**
o Narrowest seen in molars
 Max 1.9mm
 Mand 1.8mm

 ALVEOLAR MUCOSA
o From mucogingival junc to fold
o Non keratinized


 INTERDENTAL GINGIVA
a) Anterior – pyramidal
b) Posterior — col shape
c) Midline diastema — triangular

FREE GINGIVAL GROOVE
MUCOGINGIVAL JUNCTION
BIOLOGICAL WIDTH

 Biological width — junctional epithelium + connective tissue = 2 mm***]]>https://api.spreaker.com/episode/40400246Wed, 19 Aug 2020 07:03:40 +0000Dr.Mayakha MariamPERIODONTIUM 1 Gingiva 2 Attachment apparatus* a. Pdl b. Alveolar bone c. Cementum (has dead cells) acellular cementum PARTS OF GINGIVA  Normal range of gingival sulcus depth is- 2-3mm  Colour of normal gingiva is an interplay between – keratin...1 Gingiva
2 Attachment apparatus*
a. Pdl
b. Alveolar bone
c. Cementum (has dead cells) acellular cementum

PARTS OF GINGIVA

 Normal range of gingival sulcus depth is- 2-3mm

 Colour of normal gingiva is an interplay between – keratin layer, melanine, blood vessels, epithelial thickness.**

 FREE GINGIVA – Also known as unattached / marginal gingiva. From the gingival margin till the free gingival groove / base of the sulcus.
(sulcus is in healthy gums, whereas pocket is in unhealthy / diseased
gums) KERATINIZED

 ATTACHED GINGIVA- From free gingival groove (base of the sulcus) to the
mucogingival junction. KERATIINIZED
o Healthy one shows stippling.
o Best views by drying the gingiva.
o Highest width is seen in incisors-
 Maxillary : 3.4-4.5
 Mand - 3.3-3.9**
o Narrowest seen in molars
 Max 1.9mm
 Mand 1.8mm

 ALVEOLAR MUCOSA
o From mucogingival junc to fold
o Non keratinized


 INTERDENTAL GINGIVA
a) Anterior – pyramidal
b) Posterior — col shape
c) Midline diastema — triangular

FREE GINGIVAL GROOVE
MUCOGINGIVAL JUNCTION
BIOLOGICAL WIDTH

 Biological width — junctional epithelium + connective tissue = 2 mm***]]>396falsefullhttps://www.spreaker.com/episode/3-oral-mucous-membrane--40400240
KERATINIZED MUCOSA
 Hard palate
 Gingiva (70% para & 30% ortho)

NON – KERATINIZED (stratum cornea absent)
 Soft palate
 Floor of mouth
 Alveolar mucosa
 Sulcular epithelium
 Buccal mucosa

SPECIALISED MUCOSA
 Dorsum of tongue

LAYERS OF MUCOSA
EPITHELIUM
LAMINA LUCIDA
BASEMENT MEMBRANE (contains TYPE IV COLLAGEN)
LAMINA DENSA
CONNECTIVE TISSUE
 Basement membrane connections to epithelium
 Via — desmosoms and hemidesmosomes

LAYERS OF EPITHELIUM
Stratum cornea (surface layer)
Stratum granulosum
Stratum spinosum
Stratum basalis (innermost layer)
 Most common epithelium – squamous epithelium
 No blood supply
 How does epithelium get Nutrition? By diffusion from connective tissue
a) Stratum basalis – highly dividing cells
b) Odland bodies (reserve bodies) – stratum spinosum
c) Stratum granulosm – contains granules that get activated from enzymes and produce keratin for the cornea layer of the epithelium
d) Stratum cornea – keratin deposition


KERATINIZATION
a) Para keratinized (with nuclei) — 70% gingiva
b) Ortho keratinized (devoid nuclei) — 30% gingiva

NON KERATINOCYTES:-
 Free nerve cells
 Melanocytes
 Langerhan cells]]>https://api.spreaker.com/episode/40400240Wed, 19 Aug 2020 07:03:34 +0000Dr.Mayakha MariamORAL MUCOUS MEMBRANE:- KERATINIZED MUCOSA  Hard palate  Gingiva (70% para & 30% ortho) NON – KERATINIZED (stratum cornea absent)  Soft palate  Floor of mouth  Alveolar mucosa  Sulcular epithelium  Buccal mucosa SPECIALISED MUCOSA  Dorsum of...
KERATINIZED MUCOSA
 Hard palate
 Gingiva (70% para & 30% ortho)

NON – KERATINIZED (stratum cornea absent)
 Soft palate
 Floor of mouth
 Alveolar mucosa
 Sulcular epithelium
 Buccal mucosa

SPECIALISED MUCOSA
 Dorsum of tongue

LAYERS OF MUCOSA
EPITHELIUM
LAMINA LUCIDA
BASEMENT MEMBRANE (contains TYPE IV COLLAGEN)
LAMINA DENSA
CONNECTIVE TISSUE
 Basement membrane connections to epithelium
 Via — desmosoms and hemidesmosomes

LAYERS OF EPITHELIUM
Stratum cornea (surface layer)
Stratum granulosum
Stratum spinosum
Stratum basalis (innermost layer)
 Most common epithelium – squamous epithelium
 No blood supply
 How does epithelium get Nutrition? By diffusion from connective tissue
a) Stratum basalis – highly dividing cells
b) Odland bodies (reserve bodies) – stratum spinosum
c) Stratum granulosm – contains granules that get activated from enzymes and produce keratin for the cornea layer of the epithelium
d) Stratum cornea – keratin deposition


KERATINIZATION
a) Para keratinized (with nuclei) — 70% gingiva
b) Ortho keratinized (devoid nuclei) — 30% gingiva

NON KERATINOCYTES:-
 Free nerve cells
 Melanocytes
 Langerhan cells]]>283falsefullhttps://www.spreaker.com/episode/4-cementum-bone--40400242 With age cementum on root end become thicker & irregular.
 This increase in the width of cementum is greater in the APICAL & LINGUAL areas.**
 COLOUR
o VITAL – YELLOW
o NON – VITAL — GREY OR GREEN
 Cementum starts formation from cervical area
 Cementum in cervical2/3rd  acellular extrinsic fiber,
 In coronal acellular intrinsic,
 In apical mixed cellular
 Acellular – cervical region A x C
 Cellular – apex region C x A
 Thickness
o Thickest at apex
o Thin at CEJ
 Age changes – content increases with age at apex
 SHARPEY’S FIBRES – connection from cementum to
alveolar bone. Parallel to bone and parallel to
cementum?
 Transseptal fibers are Fibers which completely
embedded in cementation and pass from cementum
of one tooth to the cementum of adjacent tooth.
 HYPERCEMENTOSIS
o Low grade periapical infection
o Excessive occlusal force, bruxism
The end of PDL fibers that are embedded in the alveolar bone and cementum are called - Sharpey's
fiber is the dominant type of fibers found in cementum.

Nb: dental tissue similar to bone – DENTINE (histologically) not cementum]]>https://api.spreaker.com/episode/40400242Wed, 19 Aug 2020 07:03:27 +0000Dr.Mayakha MariamCEMENTUM  With age cementum on root end become thicker & irregular.  This increase in the width of cementum is greater in the APICAL & LINGUAL areas.**  COLOUR o VITAL – YELLOW o NON – VITAL — GREY OR GREEN  Cementum starts formation from cervical... With age cementum on root end become thicker & irregular.
 This increase in the width of cementum is greater in the APICAL & LINGUAL areas.**
 COLOUR
o VITAL – YELLOW
o NON – VITAL — GREY OR GREEN
 Cementum starts formation from cervical area
 Cementum in cervical2/3rd  acellular extrinsic fiber,
 In coronal acellular intrinsic,
 In apical mixed cellular
 Acellular – cervical region A x C
 Cellular – apex region C x A
 Thickness
o Thickest at apex
o Thin at CEJ
 Age changes – content increases with age at apex
 SHARPEY’S FIBRES – connection from cementum to
alveolar bone. Parallel to bone and parallel to
cementum?
 Transseptal fibers are Fibers which completely
embedded in cementation and pass from cementum
of one tooth to the cementum of adjacent tooth.
 HYPERCEMENTOSIS
o Low grade periapical infection
o Excessive occlusal force, bruxism
The end of PDL fibers that are embedded in the alveolar bone and cementum are called - Sharpey's
fiber is the dominant type of fibers found in cementum.

Nb: dental tissue similar to bone – DENTINE (histologically) not cementum]]>222falsefullhttps://www.spreaker.com/episode/5-bone-periodontal-ligament--40400241 PDL attachment is to : alv. Bone proper or called bundle bone
 The crest of INTERDENTAL BONE is said to be parallel to the marginal gingiva
 Or you could also say it id parallel to the line drawn from the CEJ of adjacent teeth.
 Now if the position of CEJ of the neighboring tooth is variable, then the bone will be angulated towards the line.***

PERIODONTAL LIGAMENT
 Cells
o Fibroblast
o Osteoblast
o Cementoblast
o Cell rest of malassez

Lateral periodontal cyst from rest of serres ,while apical periodontal cyst from rest of malassez.
 Fibres
o Collagen
o Elastic fibres
 Cementoblasts present in pdl
 Cell rest of malassez seen commonly at apex

FIBRES OF PDL
 COLLAGEN 1,3,7
 Most dental tissue type I collagen fibres
o Eg: pdl,alveolar bone, cementum, gingiva, dentin
o They are most abundant
 Anchoring fibres are type 7, seen in pdl
 Type 3 also seen in pdl

Ageing OF PDL
 Elastic fibres increase and cells decreases
 Function of pdl
 Formative, nutritive, anchorage, cushioning (type 7)]]>https://api.spreaker.com/episode/40400241Wed, 19 Aug 2020 07:03:20 +0000Dr.Mayakha MariamBONE  PDL attachment is to : alv. Bone proper or called bundle bone  The crest of INTERDENTAL BONE is said to be parallel to the marginal gingiva  Or you could also say it id parallel to the line drawn from the CEJ of adjacent teeth.  Now if the... PDL attachment is to : alv. Bone proper or called bundle bone
 The crest of INTERDENTAL BONE is said to be parallel to the marginal gingiva
 Or you could also say it id parallel to the line drawn from the CEJ of adjacent teeth.
 Now if the position of CEJ of the neighboring tooth is variable, then the bone will be angulated towards the line.***

PERIODONTAL LIGAMENT
 Cells
o Fibroblast
o Osteoblast
o Cementoblast
o Cell rest of malassez

Lateral periodontal cyst from rest of serres ,while apical periodontal cyst from rest of malassez.
 Fibres
o Collagen
o Elastic fibres
 Cementoblasts present in pdl
 Cell rest of malassez seen commonly at apex

FIBRES OF PDL
 COLLAGEN 1,3,7
 Most dental tissue type I collagen fibres
o Eg: pdl,alveolar bone, cementum, gingiva, dentin
o They are most abundant
 Anchoring fibres are type 7, seen in pdl
 Type 3 also seen in pdl

Ageing OF PDL
 Elastic fibres increase and cells decreases
 Function of pdl
 Formative, nutritive, anchorage, cushioning (type 7)]]>264falsefullhttps://www.spreaker.com/episode/6-principle-group-of-fibers--40400256
a) Alveolocrestal fibres – prevents extrusion of teeth
b) Horizontal fibres – prevents lateral movement of teeth
c) Oblique fibres – withstands masticatory forces, most abundant
QN. Periodontal ligament fibers in middle third of root is oblique.
d) Apical fibres – absent in young permanent teeth , because of open apex
e) Intraradicular fibres – absent in single rooted teeth
TRANSEPTAL FIBRES
 Transseptal fibers are Fibers which completely embedded in cementation and pass from cementation of one tooth to the cementation of adjacent tooth.
 the only fibers present in cementum only
 Not a pdl group of fibres
 Responsible for orthodontic relapse
 This fibre is removed in pericision(surgical Rx to prevent ortho relapse)
 Dentogingival fibre — the 1st fibre lost during extraction
 In pulp :- - Cell rich zone inner most pulp layer contain fibroblast
 – Cell free zone rich in capillaries & nerve networks
 - Odontoblastic layer contain odontoblast.]]>https://api.spreaker.com/episode/40400256Wed, 19 Aug 2020 07:03:09 +0000Dr.Mayakha MariamPRINCIPLE GROUP OF PDL FIBRES: a) Alveolocrestal fibres – prevents extrusion of teeth b) Horizontal fibres – prevents lateral movement of teeth c) Oblique fibres – withstands masticatory forces, most abundant QN. Periodontal ligament fibers in middle...
a) Alveolocrestal fibres – prevents extrusion of teeth
b) Horizontal fibres – prevents lateral movement of teeth
c) Oblique fibres – withstands masticatory forces, most abundant
QN. Periodontal ligament fibers in middle third of root is oblique.
d) Apical fibres – absent in young permanent teeth , because of open apex
e) Intraradicular fibres – absent in single rooted teeth
TRANSEPTAL FIBRES
 Transseptal fibers are Fibers which completely embedded in cementation and pass from cementation of one tooth to the cementation of adjacent tooth.
 the only fibers present in cementum only
 Not a pdl group of fibres
 Responsible for orthodontic relapse
 This fibre is removed in pericision(surgical Rx to prevent ortho relapse)
 Dentogingival fibre — the 1st fibre lost during extraction
 In pulp :- - Cell rich zone inner most pulp layer contain fibroblast
 – Cell free zone rich in capillaries & nerve networks
 - Odontoblastic layer contain odontoblast.]]>201falsefullhttps://www.spreaker.com/episode/7-pathogenesis--40400252 Subgingival plaque is the initiating factor her- the microorganism in it release toxins
 Our immune system sends response in the form of white blood cells, cytokines,
prostaglandins, Matrix Metalo Protein (mmp)
 Then cause tissue distruction

BLOOD CELLS
All born / formed in bone marrow

RBC
 No nucleus
 Life span is 120 days

PLATELETS
 No nucleus
 Below 80,000 — no surgery possible
 Below 50,000 — no injury at all
o 50,000 cells/mg — critical count of platelets

WBC
 GRANULOCYTES
o NEUTROPHIL
 Predominant inflammatory cells in pdl pockets
o BASOPHIL
 Allergy
o EOSINOPHIL
 Allergy
 Least abundant WBC
 AGRANULOCYTES
o T
o B – plasm cells

1. NEUTROPHIL
a. POLYMORPHO NEUTROPHIL LEUKOCYTES
b. PMNL cells present in acute infection and suppurative cases-pdl abcess , while
chronic lymphocytes.
c. Most abundant WBC in pdl pockets
d. Acute inflammatory cell
e. It is the cell that will become defective in diabetes mellitus
f. Destroys PDL membrane in periodontitis
g. Diabetes condition, weak activity of PMNL
h. Action – phagocytosis eg: macrophage

OTHER NEUTROPHIL DEFECTIVE CONDITIONS:-
i. Neutropenia
j. Granulocytosis
k. Chediak – Higashi syndrome
l. Papillon – Lefevre syndrome
m. Leukocyte adhesion deficiency
n. DM most importantly!

Phagocytosis is the process of engulfing particles.

Chemotaxis is attraction of neutrophils to site of local injury.
2. CELLS OF SPECIFIC RESPONSE
a. T cells
b. B cell or Plasma cells
i. Produce immunoglobins Ig G A M E
ii. Most dominant in perio pockets.

3. INNATE IMMUNE CELLS
a. Neutrophils
b. Monocytes
c. Macrophages
d. Mast cells
e. Dentrite cells
4. LANGERHANS CELL DISEASE
a. Eosinophil infiltrate to pdl — cause early loss of 1° tooth]]>https://api.spreaker.com/episode/40400252Wed, 19 Aug 2020 07:03:02 +0000Dr.Mayakha MariamPATHOGENESIS  Subgingival plaque is the initiating factor her- the microorganism in it release toxins  Our immune system sends response in the form of white blood cells, cytokines, prostaglandins, Matrix Metalo Protein (mmp)  Then cause tissue... Subgingival plaque is the initiating factor her- the microorganism in it release toxins
 Our immune system sends response in the form of white blood cells, cytokines,
prostaglandins, Matrix Metalo Protein (mmp)
 Then cause tissue distruction

BLOOD CELLS
All born / formed in bone marrow

RBC
 No nucleus
 Life span is 120 days

PLATELETS
 No nucleus
 Below 80,000 — no surgery possible
 Below 50,000 — no injury at all
o 50,000 cells/mg — critical count of platelets

WBC
 GRANULOCYTES
o NEUTROPHIL
 Predominant inflammatory cells in pdl pockets
o BASOPHIL
 Allergy
o EOSINOPHIL
 Allergy
 Least abundant WBC
 AGRANULOCYTES
o T
o B – plasm cells

1. NEUTROPHIL
a. POLYMORPHO NEUTROPHIL LEUKOCYTES
b. PMNL cells present in acute infection and suppurative cases-pdl abcess , while
chronic lymphocytes.
c. Most abundant WBC in pdl pockets
d. Acute inflammatory cell
e. It is the cell that will become defective in diabetes mellitus
f. Destroys PDL membrane in periodontitis
g. Diabetes condition, weak activity of PMNL
h. Action – phagocytosis eg: macrophage

OTHER NEUTROPHIL DEFECTIVE CONDITIONS:-
i. Neutropenia
j. Granulocytosis
k. Chediak – Higashi syndrome
l. Papillon – Lefevre syndrome
m. Leukocyte adhesion deficiency
n. DM most importantly!

Phagocytosis is the process of engulfing particles.

Chemotaxis is attraction of neutrophils to site of local injury.
2. CELLS OF SPECIFIC RESPONSE
a. T cells
b. B cell or Plasma cells
i. Produce immunoglobins Ig G A M E
ii. Most dominant in perio pockets.

3. INNATE IMMUNE CELLS
a. Neutrophils
b. Monocytes
c. Macrophages
d. Mast cells
e. Dentrite cells
4. LANGERHANS CELL DISEASE
a. Eosinophil infiltrate to pdl — cause early loss of 1° tooth]]>384falsefullhttps://www.spreaker.com/episode/8-pathogenesis-2--40400257
 IgG
— most abundant Ig in blood and in GCF
— passive immunity through placenta

 IgA
— all secretion of body contains this eg: saliva (lacrimal)
— passive immunity through milk (colestrum breast milk)

 IgM
— first Ig to reach site of infection

 IgE
— abundant in allergy and anaphylaxis]]>https://api.spreaker.com/episode/40400257Wed, 19 Aug 2020 07:02:56 +0000Dr.Mayakha MariamIMMUNOGLOBINS:- (produced by B lymphocytes) (G-A-M-E)  IgG — most abundant Ig in blood and in GCF — passive immunity through placenta  IgA — all secretion of body contains this eg: saliva (lacrimal) — passive immunity through milk (colestrum...
 IgG
— most abundant Ig in blood and in GCF
— passive immunity through placenta

 IgA
— all secretion of body contains this eg: saliva (lacrimal)
— passive immunity through milk (colestrum breast milk)

 IgM
— first Ig to reach site of infection

 IgE
— abundant in allergy and anaphylaxis]]>129falsefullhttps://www.spreaker.com/episode/9-pathogenesis-3--40400251Most important proteinase involved in destruction of
periodontal tissue
EG: MMP – 8, MMP – 13


GINGIVAL CREVICULAR FLUID

 GCF has most abundance of IgG
 CONTAINS
o Components of CT
o Epithelium
o Inflammatory cells
o Serum
o Microbial flora living there in the sulcus
 More neutrophils to defend the gingiva.
 Most drug concentration
o 1st tetracycline/doxycycline
o 2nd metronidazole
 DOXYCYCLINE – similar to tetracycline

QN Tetracycline cause brownish discoloration in all teeth & appear yellowish with UV light

 Pedo —20mg
 Therapeutic value — 100mg /day (Antibacterial dose)
 Sub antimicrobial dose = 20mg — bacteriostatic at GCF]]>https://api.spreaker.com/episode/40400251Wed, 19 Aug 2020 07:02:45 +0000Dr.Mayakha MariamMMPS — MATRIX METALO PROTEINASES Most important proteinase involved in destruction of periodontal tissue EG: MMP – 8, MMP – 13 GINGIVAL CREVICULAR FLUID  GCF has most abundance of IgG  CONTAINS o Components of CT o Epithelium o Inflammatory cells...Most important proteinase involved in destruction of
periodontal tissue
EG: MMP – 8, MMP – 13


GINGIVAL CREVICULAR FLUID

 GCF has most abundance of IgG
 CONTAINS
o Components of CT
o Epithelium
o Inflammatory cells
o Serum
o Microbial flora living there in the sulcus
 More neutrophils to defend the gingiva.
 Most drug concentration
o 1st tetracycline/doxycycline
o 2nd metronidazole
 DOXYCYCLINE – similar to tetracycline

QN Tetracycline cause brownish discoloration in all teeth & appear yellowish with UV light

 Pedo —20mg
 Therapeutic value — 100mg /day (Antibacterial dose)
 Sub antimicrobial dose = 20mg — bacteriostatic at GCF]]>205falsefullhttps://www.spreaker.com/episode/10-gingival-pathologies-1--40400250
STAGES ----------- FINDINGS ------------- CELLS INVOLVED
---------------------------------------------------------------------------
INITIAL GCF ----- 1ST sign of gingivitis --- PMNL or neutrophils

ACUTE ------------ bleeding on probing, definitive sign of gingivitis ---- T - lymphocytes

CHRONIC / ESTABLISHED ----- edematous or fibrous – smokers plasma / B – lymphocytes (7-
21 days)

ADVANCED -------- onset of PDL destruction plasma/B lymphocytes


CONDITIONAL GINGIVITIS :-
 All these plaque induced gingivitis
 Systemic conditions — pregnancy, DM, Leukemia, puberty
 PREGNANCY GINGIVITIS:-
 P.intermedia – orange complex
 Begins 2nd/3rd
 Disappears in 9th month.

 PREGNANCY TUMOUR
 EPULIS GRAVIDIUM:— kind of Angio-granuloma or pyogenic granuloma (old name) ie bleeding on touch
o Irritation of interdental papilla results in tumor like growth at papilla
 Rx
o Scaling  best time is 2nd trimester (remove irritant)

NB: safest antibiotic in pregnancy – Amoxycillin *]]>https://api.spreaker.com/episode/40400250Wed, 19 Aug 2020 07:02:37 +0000Dr.Mayakha MariamPLAQUE INDUCED GINGIVITIS:- STAGES ----------- FINDINGS ------------- CELLS INVOLVED --------------------------------------------------------------------------- INITIAL GCF ----- 1ST sign of gingivitis --- PMNL or neutrophils ACUTE ------------...
STAGES ----------- FINDINGS ------------- CELLS INVOLVED
---------------------------------------------------------------------------
INITIAL GCF ----- 1ST sign of gingivitis --- PMNL or neutrophils

ACUTE ------------ bleeding on probing, definitive sign of gingivitis ---- T - lymphocytes

CHRONIC / ESTABLISHED ----- edematous or fibrous – smokers plasma / B – lymphocytes (7-
21 days)

ADVANCED -------- onset of PDL destruction plasma/B lymphocytes


CONDITIONAL GINGIVITIS :-
 All these plaque induced gingivitis
 Systemic conditions — pregnancy, DM, Leukemia, puberty
 PREGNANCY GINGIVITIS:-
 P.intermedia – orange complex
 Begins 2nd/3rd
 Disappears in 9th month.

 PREGNANCY TUMOUR
 EPULIS GRAVIDIUM:— kind of Angio-granuloma or pyogenic granuloma (old name) ie bleeding on touch
o Irritation of interdental papilla results in tumor like growth at papilla
 Rx
o Scaling  best time is 2nd trimester (remove irritant)

NB: safest antibiotic in pregnancy – Amoxycillin *]]>304falsefullhttps://www.spreaker.com/episode/11-gingival-pathologies-2--40400249 STD
 Herpes infection
 Candida infection
 Hereditary
 Food/paste/restoration allergy
 Iatrogenic
 Traumatic
 Foreign body in sulcus


DRUG INDUCED GINGIVAL ENLARGEMENT

Dilantin (phynotoin )don't give with metronidazole
 Gingival hyperplasia – drug induced
 Gingival enlargement  by plaque
 Drugs:
o Phenytoin  antiepileptic
 60% chances – most common cause for DIGE
o Nifedipine
 Antihypertensive
 Ca-channel blockers
o Cyclosporins – immunosuppresants
 20% chances – for organ transplants
 Management
o 1st line Rx – scaling and replacement of drugs
o 2nd line Rx – gingivectomy



ANUG /TRENCH MOUTH ULCER/ VINCENT STOMATITIS

o Pseudomembrane
o Acute necrotising ulcer gingivitis
o Organisms causing
 Fusiform
 Treponima denticola (spirochete) }red complex gram -ve
 Borelia Vincenti
o Precipitating factors
 Smoking, pericoronitis(infection)
 DOWN’S SYNDROME, bed ridden patients
o C/F
 Multiple punched out ulcers in Interdental papilla + marginal gingiva**
 Halitosis**
 Dull pain
 Sometimes fever
 Pt. physiological stress, smoker before 1 yr he reported to the clinic, he has necrosis gingival , redness, no attachment loss , treated by mechanical debridement and systemic antimicrobial therapy.**
o If not treated, it will lead to complications
 Necrotising ulcerative periodontitis
 Cancrum oris / NOMA
 Investigations required – dark field microscope
o Rx
 Antibiotic if required – amox 500 mg + metro 400 mg
 Mouth wash – H2O2 + CHX
 1st step in Rx – removal of pseudomembrane
 Then medication + mouth wash
 Surgery
 Extraction of offending tooth done only after 4 weeks ie after ANUG
subsides
 Anterior – gingivoplasty shaping of gingiva done as cosmetic
correction of ANUG]]>https://api.spreaker.com/episode/40400249Wed, 19 Aug 2020 07:02:28 +0000Dr.Mayakha MariamNON – PLAQUE INDUCED CONDITIONS:  STD  Herpes infection  Candida infection  Hereditary  Food/paste/restoration allergy  Iatrogenic  Traumatic  Foreign body in sulcus DRUG INDUCED GINGIVAL ENLARGEMENT Dilantin (phynotoin )don't give with... STD
 Herpes infection
 Candida infection
 Hereditary
 Food/paste/restoration allergy
 Iatrogenic
 Traumatic
 Foreign body in sulcus


DRUG INDUCED GINGIVAL ENLARGEMENT

Dilantin (phynotoin )don't give with metronidazole
 Gingival hyperplasia – drug induced
 Gingival enlargement  by plaque
 Drugs:
o Phenytoin  antiepileptic
 60% chances – most common cause for DIGE
o Nifedipine
 Antihypertensive
 Ca-channel blockers
o Cyclosporins – immunosuppresants
 20% chances – for organ transplants
 Management
o 1st line Rx – scaling and replacement of drugs
o 2nd line Rx – gingivectomy



ANUG /TRENCH MOUTH ULCER/ VINCENT STOMATITIS

o Pseudomembrane
o Acute necrotising ulcer gingivitis
o Organisms causing
 Fusiform
 Treponima denticola (spirochete) }red complex gram -ve
 Borelia Vincenti
o Precipitating factors
 Smoking, pericoronitis(infection)
 DOWN’S SYNDROME, bed ridden patients
o C/F
 Multiple punched out ulcers in Interdental papilla + marginal gingiva**
 Halitosis**
 Dull pain
 Sometimes fever
 Pt. physiological stress, smoker before 1 yr he reported to the clinic, he has necrosis gingival , redness, no attachment loss , treated by mechanical debridement and systemic antimicrobial therapy.**
o If not treated, it will lead to complications
 Necrotising ulcerative periodontitis
 Cancrum oris / NOMA
 Investigations required – dark field microscope
o Rx
 Antibiotic if required – amox 500 mg + metro 400 mg
 Mouth wash – H2O2 + CHX
 1st step in Rx – removal of pseudomembrane
 Then medication + mouth wash
 Surgery
 Extraction of offending tooth done only after 4 weeks ie after ANUG
subsides
 Anterior – gingivoplasty shaping of gingiva done as cosmetic
correction of ANUG]]>418falsefullhttps://www.spreaker.com/episode/12-periodontitis--40400248 If pt c/o pain on chewing, cold test is normal, but sensitivity otherwise and pain on biting !
o Here pulp is normal acc to pulp test
o Pdl is affected –pain on biting
o Sensitivity is due to the cementum tear in th epdl- through which dentine is exposed and hence the sensitivity (its not the pulp that is affected here so no pulpitis here okay )

WIDENING OF PDL SPACE
 Periodontitis
 Osteosarcoma
 TFO
 Scleroderma – bilateral bone loss at angle of mandible also seen

NARROWING OF PDL SPACE
 Ankylosis
 Hypofunction of tooth
 Hypercementosis – seen in Paget’s disease

NB: feature that distinguish periodontits from gingivitis – presence of clinically
detachable attachement loss in periodontits


TRAUMA FROM OCCLUSION
 Trauma from occlusion
 C/F – mobility of tooth (most common)
 No pocket formation – differentiating from periodontitis
 TOP +VE ,erythema gingiva
 R/F – widening of PDL – most important diagnosis
 Type of bone loss seen in 2° TFO is – vertical /angular bone loss
 RX
o 1° TFO  coronoplasty
o 2° TFO  coronoplasty + splinting
 PRIMARY TFO
o Excessive occlusive forces that exceeds the adaptive capacity of normal periodontitis
 SECONDARY TFO
o Normal occlusive forces that excedes the adaptive capacity of diseased
periodontium]]>https://api.spreaker.com/episode/40400248Wed, 19 Aug 2020 07:02:20 +0000Dr.Mayakha MariamPERIODONTITIS  If pt c/o pain on chewing, cold test is normal, but sensitivity otherwise and pain on biting ! o Here pulp is normal acc to pulp test o Pdl is affected –pain on biting o Sensitivity is due to the cementum tear in th epdl- through which... If pt c/o pain on chewing, cold test is normal, but sensitivity otherwise and pain on biting !
o Here pulp is normal acc to pulp test
o Pdl is affected –pain on biting
o Sensitivity is due to the cementum tear in th epdl- through which dentine is exposed and hence the sensitivity (its not the pulp that is affected here so no pulpitis here okay )

WIDENING OF PDL SPACE
 Periodontitis
 Osteosarcoma
 TFO
 Scleroderma – bilateral bone loss at angle of mandible also seen

NARROWING OF PDL SPACE
 Ankylosis
 Hypofunction of tooth
 Hypercementosis – seen in Paget’s disease

NB: feature that distinguish periodontits from gingivitis – presence of clinically
detachable attachement loss in periodontits


TRAUMA FROM OCCLUSION
 Trauma from occlusion
 C/F – mobility of tooth (most common)
 No pocket formation – differentiating from periodontitis
 TOP +VE ,erythema gingiva
 R/F – widening of PDL – most important diagnosis
 Type of bone loss seen in 2° TFO is – vertical /angular bone loss
 RX
o 1° TFO  coronoplasty
o 2° TFO  coronoplasty + splinting
 PRIMARY TFO
o Excessive occlusive forces that exceeds the adaptive capacity of normal periodontitis
 SECONDARY TFO
o Normal occlusive forces that excedes the adaptive capacity of diseased
periodontium]]>158falsefullhttps://www.spreaker.com/episode/13-pdl-pockets-diagnosis--40400247
 Patient with healthy gingiva , upon insertion of perio probe , it should stop at --> Most coronal of junctional epithelium ***
 Best measurement of periodontitis by attachment level**,
 While BLEEDING ON PROBING
o To detect tissue response to oral hygiene measures – will see less bleeding.****
o It is the best to measure the inflammation
 Slightly bleeding increase capillary fragility..... This is due to vit k deficiency****
 PERIODONTAL POCKET DEPTH – FROM GINGIVAL MARGIN TO BASOE OF THE POCKET
 CLINICAL ATTACHMENT LOSS – FROM CEJ TO BASE OF THE POCKET
 Pocket depth measurable by probing at 25g force
 GINGIVAL RECESSION – FROM CEJ TO GINGIVAL MARGIN]]>https://api.spreaker.com/episode/40400247Wed, 19 Aug 2020 07:02:11 +0000Dr.Mayakha MariamPERIODONTAL POCKET & DIAGNOSIS:-  Patient with healthy gingiva , upon insertion of perio probe , it should stop at --> Most coronal of junctional epithelium ***  Best measurement of periodontitis by attachment level**,  While BLEEDING ON PROBING o...
 Patient with healthy gingiva , upon insertion of perio probe , it should stop at --> Most coronal of junctional epithelium ***
 Best measurement of periodontitis by attachment level**,
 While BLEEDING ON PROBING
o To detect tissue response to oral hygiene measures – will see less bleeding.****
o It is the best to measure the inflammation
 Slightly bleeding increase capillary fragility..... This is due to vit k deficiency****
 PERIODONTAL POCKET DEPTH – FROM GINGIVAL MARGIN TO BASOE OF THE POCKET
 CLINICAL ATTACHMENT LOSS – FROM CEJ TO BASE OF THE POCKET
 Pocket depth measurable by probing at 25g force
 GINGIVAL RECESSION – FROM CEJ TO GINGIVAL MARGIN]]>225falsefullhttps://www.spreaker.com/episode/14-types-of-pockets--40400243 Isolated pockets can be seen in :
o Vertical root fracture,
o Palatogingival groove
 Types
o True
o Pseudo
 Pseudo pocket
o Seen in gingivitis QN: gingival tumor
o Rx is scaling fibroma
 True pocket QN: pericoronitis
o Supra
o Infra
o Suprabony
 Rx – gingivectomy
o Infrabony
 Base of pocket is below alveolar bone
 Attachment of the epithelium is below the crest of alveolar bone.
 Divided into 3 types based on the no.of walls present /left

3 walled defect 
 Rx: regenerative osseous surgery\ treated with which autogenous osseous coagulum that contain: Mixed intraoral cancellous & cortical bone mixed with patient blood**
 3 wall defects in adult : mixed cortical and cancellous from his own intraoral mixed with his blood.
 good prognosis

2 walled defect / osseous crater (most common)
 Rx regenerative osseous surgery or resective osseous surgery
 Best graft to treat this is Cancellous freeze dried bone allograft****

1 walled defect  resective osseous surgery
 poor prognosis]]>https://api.spreaker.com/episode/40400243Wed, 19 Aug 2020 07:02:00 +0000Dr.Mayakha MariamTYPES OF POCKETS  Isolated pockets can be seen in : o Vertical root fracture, o Palatogingival groove  Types o True o Pseudo  Pseudo pocket o Seen in gingivitis QN: gingival tumor o Rx is scaling fibroma  True pocket QN: pericoronitis o Supra o... Isolated pockets can be seen in :
o Vertical root fracture,
o Palatogingival groove
 Types
o True
o Pseudo
 Pseudo pocket
o Seen in gingivitis QN: gingival tumor
o Rx is scaling fibroma
 True pocket QN: pericoronitis
o Supra
o Infra
o Suprabony
 Rx – gingivectomy
o Infrabony
 Base of pocket is below alveolar bone
 Attachment of the epithelium is below the crest of alveolar bone.
 Divided into 3 types based on the no.of walls present /left

3 walled defect 
 Rx: regenerative osseous surgery\ treated with which autogenous osseous coagulum that contain: Mixed intraoral cancellous & cortical bone mixed with patient blood**
 3 wall defects in adult : mixed cortical and cancellous from his own intraoral mixed with his blood.
 good prognosis

2 walled defect / osseous crater (most common)
 Rx regenerative osseous surgery or resective osseous surgery
 Best graft to treat this is Cancellous freeze dried bone allograft****

1 walled defect  resective osseous surgery
 poor prognosis]]>313falsefullhttps://www.spreaker.com/episode/15-furcation-involvement--40400232QN Nabers probe is Probe used to detect
furcation

GRADE 1
No inter radicular bone loss
Suprabony pocket
Rx – gingivectomy

GRADE II
Also known as CULL – D – SAC
Bone loss present at furcation
No through and through probing
Rx – regenerative and resective osseous surgery

GRADE III
Through and through probing
Rx – hemisection and bicuspidisation QN
Dividing the M into 2 halves + removing a portion of crown and root(hemisection)
Dividing the M into 2 halves and preserving the both

In case of maxilla Rx- root resection(other indication : long standing radiolucency with one of the root of maxillary molar)
— interdental aids – proxa brushes***

GRADE IV
Through and through probing + furcation visible , poor prognosis]]>https://api.spreaker.com/episode/40400232Wed, 19 Aug 2020 07:01:37 +0000Dr.Mayakha MariamFURCATION INVOLVEMENT :- NABER’S PROBE QN Nabers probe is Probe used to detect furcation GRADE 1 No inter radicular bone loss Suprabony pocket Rx – gingivectomy GRADE II Also known as CULL – D – SAC Bone loss present at furcation No through and...QN Nabers probe is Probe used to detect
furcation

GRADE 1
No inter radicular bone loss
Suprabony pocket
Rx – gingivectomy

GRADE II
Also known as CULL – D – SAC
Bone loss present at furcation
No through and through probing
Rx – regenerative and resective osseous surgery

GRADE III
Through and through probing
Rx – hemisection and bicuspidisation QN
Dividing the M into 2 halves + removing a portion of crown and root(hemisection)
Dividing the M into 2 halves and preserving the both

In case of maxilla Rx- root resection(other indication : long standing radiolucency with one of the root of maxillary molar)
— interdental aids – proxa brushes***

GRADE IV
Through and through probing + furcation visible , poor prognosis]]>157falsefullhttps://www.spreaker.com/episode/16-lap-pericoronitis--40400231
 Organism – A A comitants ( actinomycetem comitants)
 C/F – minimal plaque
o Spacing and proclination of anteriors
o Mobility of 1st molar
 R/F – arc shaped and mirror shaped bone loss
 Pathology – defective neutrophils function
 Syndrome – pappilone Lefevre Syndrome
 C/F –
 LAP
 Calcification of duramater
 Palmar and plantar keratosis

 Drug of choice –
o tetracycline /doxycycline
o Also Ciprofloxacin
o In order to increase the success rate of treating local juvenile periodontitis, we need
to give local antibiotic treatment (pouches n all)**


PERICORONITIS
Pericoronitis by streptococcus gram +ve
SYMPTOMS OF PERICORONITIS
 Pain in mouth
 Halitosis
 Lymph node enlargement]]>https://api.spreaker.com/episode/40400231Wed, 19 Aug 2020 07:01:20 +0000Dr.Mayakha MariamLOCALIZED AGGRESSIVE PERIODONTITIS  Organism – A A comitants ( actinomycetem comitants)  C/F – minimal plaque o Spacing and proclination of anteriors o Mobility of 1st molar  R/F – arc shaped and mirror shaped bone loss  Pathology – defective...
 Organism – A A comitants ( actinomycetem comitants)
 C/F – minimal plaque
o Spacing and proclination of anteriors
o Mobility of 1st molar
 R/F – arc shaped and mirror shaped bone loss
 Pathology – defective neutrophils function
 Syndrome – pappilone Lefevre Syndrome
 C/F –
 LAP
 Calcification of duramater
 Palmar and plantar keratosis

 Drug of choice –
o tetracycline /doxycycline
o Also Ciprofloxacin
o In order to increase the success rate of treating local juvenile periodontitis, we need
to give local antibiotic treatment (pouches n all)**


PERICORONITIS
Pericoronitis by streptococcus gram +ve
SYMPTOMS OF PERICORONITIS
 Pain in mouth
 Halitosis
 Lymph node enlargement]]>195falsefullhttps://www.spreaker.com/episode/17-calculus--40400236Calculus induce further periodontal lesion due to:
o More plaque adhere to it
a) SUPRA GINGIVAL CALCULUS:-
a. Mineralized by saliva
b. Easy to detach
c. Calculus differ in their composition
d. Yellow in colour,
e. Usually seen near major salivary glands
b) SUB GINGIVAL CALCULUS
a. Mineralized by GCF
b. Composition is hydroxy apetite crystals]]>https://api.spreaker.com/episode/40400236Wed, 19 Aug 2020 07:00:35 +0000Dr.Mayakha MariamCALCULUS Calculus induce further periodontal lesion due to: o More plaque adhere to it a) SUPRA GINGIVAL CALCULUS:- a. Mineralized by saliva b. Easy to detach c. Calculus differ in their composition d. Yellow in colour, e. Usually seen near major...Calculus induce further periodontal lesion due to:
o More plaque adhere to it
a) SUPRA GINGIVAL CALCULUS:-
a. Mineralized by saliva
b. Easy to detach
c. Calculus differ in their composition
d. Yellow in colour,
e. Usually seen near major salivary glands
b) SUB GINGIVAL CALCULUS
a. Mineralized by GCF
b. Composition is hydroxy apetite crystals]]>142falsefullhttps://www.spreaker.com/episode/18-plaque--40400235 Main cause in gingivitis + periodontitis

DENTAL PLAQUE COMPOSITION
o SUPRAGINGIVAL-
 Aerobic
 Starts on the tooth surface as gram +ve then stacks G- on outer surfaces
 There are more detached plaques within supragingival plaques than subgingival plaques. *

o SUBGINGIVAL-
 Anaerobic
 Coronal portion is G+ve and apical most is filled of G-ve bacteria
 The detached plaques within subgingival area are the ones that are more toxic to tissue than attached plaques*


CONSTITUENTS :
o Bacteria
o Inorganic material- CALCIUM, SODIUM, PHOSPHORUS & FLUORIDES
o Organic components-polysacharrides, proteins, glycoproteins and lipids, Food-GLUCANS AND FRUCTANS]]>https://api.spreaker.com/episode/40400235Wed, 19 Aug 2020 07:00:25 +0000Dr.Mayakha MariamPLAQUE  Main cause in gingivitis + periodontitis DENTAL PLAQUE COMPOSITION o SUPRAGINGIVAL-  Aerobic  Starts on the tooth surface as gram +ve then stacks G- on outer surfaces  There are more detached plaques within supragingival plaques than... Main cause in gingivitis + periodontitis

DENTAL PLAQUE COMPOSITION
o SUPRAGINGIVAL-
 Aerobic
 Starts on the tooth surface as gram +ve then stacks G- on outer surfaces
 There are more detached plaques within supragingival plaques than subgingival plaques. *

o SUBGINGIVAL-
 Anaerobic
 Coronal portion is G+ve and apical most is filled of G-ve bacteria
 The detached plaques within subgingival area are the ones that are more toxic to tissue than attached plaques*


CONSTITUENTS :
o Bacteria
o Inorganic material- CALCIUM, SODIUM, PHOSPHORUS & FLUORIDES
o Organic components-polysacharrides, proteins, glycoproteins and lipids, Food-GLUCANS AND FRUCTANS]]>164falsefullhttps://www.spreaker.com/episode/19-plaque-formation--404002451. PELLICLE FORMATION –
a. A thin layer of salivary glycoprotiens (ie. Made of saliva, mainly composed of
proteins, not carbohydrates okay!) is formed on the tooth surface within minutes of polishing.
b. They serve as attachment sites for bacteria

2. ADHESION AND ATTACHMENT OF BACTERIA
a. Within minutes
b. Initial adhesion is due to weak reversible VAN DER WAALS forces
c. Firm attachment is due to strong irreversible interactions btwn the molecules on bacteria(adhesion molecules on them) and host pellicle receptors on tooth

3. COLONIZATION AND PLAQUE MATURATION
a. Within 24-48hrs
b. Firmly attached primary people provide new receptors for other bacteri through a process called CO-ADHESION
c. As the bacteria grow in number and the biofilm that is formed in the process matures, there is a shift from G+ve to anaerobic G-ve

 Materia Alba – unorganised structure DIFFERS FROM
 Plaque – organised matrix
 Plaque formation in a cleansed tooth begins – after 1 hour**** - bacteria starts coming back and building colonies.
 24 hours is to compete maturation- the take taken to form plaque**]]>https://api.spreaker.com/episode/40400245Wed, 19 Aug 2020 06:59:41 +0000Dr.Mayakha MariamPLAQUE FORMATION 1. PELLICLE FORMATION – a. A thin layer of salivary glycoprotiens (ie. Made of saliva, mainly composed of proteins, not carbohydrates okay!) is formed on the tooth surface within minutes of polishing. b. They serve as attachment sites...1. PELLICLE FORMATION –
a. A thin layer of salivary glycoprotiens (ie. Made of saliva, mainly composed of
proteins, not carbohydrates okay!) is formed on the tooth surface within minutes of polishing.
b. They serve as attachment sites for bacteria

2. ADHESION AND ATTACHMENT OF BACTERIA
a. Within minutes
b. Initial adhesion is due to weak reversible VAN DER WAALS forces
c. Firm attachment is due to strong irreversible interactions btwn the molecules on bacteria(adhesion molecules on them) and host pellicle receptors on tooth

3. COLONIZATION AND PLAQUE MATURATION
a. Within 24-48hrs
b. Firmly attached primary people provide new receptors for other bacteri through a process called CO-ADHESION
c. As the bacteria grow in number and the biofilm that is formed in the process matures, there is a shift from G+ve to anaerobic G-ve

 Materia Alba – unorganised structure DIFFERS FROM
 Plaque – organised matrix
 Plaque formation in a cleansed tooth begins – after 1 hour**** - bacteria starts coming back and building colonies.
 24 hours is to compete maturation- the take taken to form plaque**]]>290falsefullhttps://www.spreaker.com/episode/20-complexes-microorganisms--40400237
Yellow complex – leads to gingivitis and periodontitis (seen in years old patient)
Or purple complex –
o most abundant
o Color complex of calculus in 18 y yellow or purple.********
o fusobacterium nucleatum – bridging micro- organisms
Secondary colonization :RED,GREEN , ORANGE
o Grame -ve facultative anaerobes
o Rods nd filaments

 Complexes seen:

o Red complex:**
 Bleeding on probing +ve
 P gingivilis – chronic**generalised periodontitis
 Treponima denticola(spirochetes) – ANUG / ANUP**
 T Forsythia

o Green complex
 AA comitans – localized aggressive perio (LAP)**
 Capnocytophagem – puberty gingivitis(18 year old female)

o Orange complex***
 P intermedia – pregnancy gingivitis**
 Fusiform – ANUG
 Campylobacter

o Pregnancy – orange complex
o Smokers = red+orange+tannernella forynthe]]>https://api.spreaker.com/episode/40400237Wed, 19 Aug 2020 06:59:22 +0000Dr.Mayakha MariamMICROORGANISMS & THE COMPLEXES Yellow complex – leads to gingivitis and periodontitis (seen in years old patient) Or purple complex – o most abundant o Color complex of calculus in 18 y yellow or purple.******** o fusobacterium nucleatum – bridging...
Yellow complex – leads to gingivitis and periodontitis (seen in years old patient)
Or purple complex –
o most abundant
o Color complex of calculus in 18 y yellow or purple.********
o fusobacterium nucleatum – bridging micro- organisms
Secondary colonization :RED,GREEN , ORANGE
o Grame -ve facultative anaerobes
o Rods nd filaments

 Complexes seen:

o Red complex:**
 Bleeding on probing +ve
 P gingivilis – chronic**generalised periodontitis
 Treponima denticola(spirochetes) – ANUG / ANUP**
 T Forsythia

o Green complex
 AA comitans – localized aggressive perio (LAP)**
 Capnocytophagem – puberty gingivitis(18 year old female)

o Orange complex***
 P intermedia – pregnancy gingivitis**
 Fusiform – ANUG
 Campylobacter

o Pregnancy – orange complex
o Smokers = red+orange+tannernella forynthe]]>178falsefullhttps://www.spreaker.com/episode/21-plaque-ohi--40400229 Seen in – hard tissue + prosthetic appliance
 Can only be removed by Mechanical means, Eg: brushing, flossing
 Plaque cannot be removed chemically but only be prevented it will not wash off the
plaque!******
 The benefit of rinsing mouth with water is to  prevent plque formation by washing off the
food debris.
 How will you asses oral hygiene / efficiency of oral hygiene methods prescribed to the
patient? Plaque index**** not Calculus index

PLAQUE CONTROL : MECHANICAL
a) Tooth paste
a. Fluoride in toothpaste – 1000pm – above 4 years
b. Anti – tartar agents or anti plaque — Triclosan , Zn compound and pyrophosphate**

b) Tooth brush
a. For pedo  small head and long handle
b. 1st powered toothbrush – 1939 *****

c) Mouthwash
a. Fluoride mouth wash — above 6 years age**

BRUSHING TECHNIQUE
 Best Tq – modified bass technique. Modified Bass tooth brushing is
o the best method because it enter interproximal area &cervical, can be used with
gingival recession, & advice to all types of pt. with or without periodontal
involvement.- UNIVERSAL
o Type of brushing bristles works as active part
 Best Tq for pedo — Fones Tq
 Best Tq in periodontitis — sulcular Tq
 Best Tq in gingival recession — modified stillman’s (side of bristles)  used with edematous, inflamed , loss of contour, & progressive recession .
 Best Tq after periodontal flap surgery — charters Tq

FLOSS
o Main use of floss.: to destroy interdental plaque matrix****
o Acute injury to tissue during improper flossing - Laceration of interdental papilla****

INTERDENTAL AIDS
Type I embrassure — dental floss of ideal length – 18 inch
Type II embrasure — proxa brush**, also for grade III furcation
Type III embrasure — unified brush

STIM U DENT
 Orange coloured stick
 Best interdental aid
 Help in plaque removal + gingival massage

WATER FLOSSER
 Can dilute bacterial toxins only********]]>https://api.spreaker.com/episode/40400229Wed, 19 Aug 2020 06:58:43 +0000Dr.Mayakha MariamPLAQUE AND OHI  Seen in – hard tissue + prosthetic appliance  Can only be removed by Mechanical means, Eg: brushing, flossing  Plaque cannot be removed chemically but only be prevented it will not wash off the plaque!******  The benefit of rinsing... Seen in – hard tissue + prosthetic appliance
 Can only be removed by Mechanical means, Eg: brushing, flossing
 Plaque cannot be removed chemically but only be prevented it will not wash off the
plaque!******
 The benefit of rinsing mouth with water is to  prevent plque formation by washing off the
food debris.
 How will you asses oral hygiene / efficiency of oral hygiene methods prescribed to the
patient? Plaque index**** not Calculus index

PLAQUE CONTROL : MECHANICAL
a) Tooth paste
a. Fluoride in toothpaste – 1000pm – above 4 years
b. Anti – tartar agents or anti plaque — Triclosan , Zn compound and pyrophosphate**

b) Tooth brush
a. For pedo  small head and long handle
b. 1st powered toothbrush – 1939 *****

c) Mouthwash
a. Fluoride mouth wash — above 6 years age**

BRUSHING TECHNIQUE
 Best Tq – modified bass technique. Modified Bass tooth brushing is
o the best method because it enter interproximal area &cervical, can be used with
gingival recession, & advice to all types of pt. with or without periodontal
involvement.- UNIVERSAL
o Type of brushing bristles works as active part
 Best Tq for pedo — Fones Tq
 Best Tq in periodontitis — sulcular Tq
 Best Tq in gingival recession — modified stillman’s (side of bristles)  used with edematous, inflamed , loss of contour, & progressive recession .
 Best Tq after periodontal flap surgery — charters Tq

FLOSS
o Main use of floss.: to destroy interdental plaque matrix****
o Acute injury to tissue during improper flossing - Laceration of interdental papilla****

INTERDENTAL AIDS
Type I embrassure — dental floss of ideal length – 18 inch
Type II embrasure — proxa brush**, also for grade III furcation
Type III embrasure — unified brush

STIM U DENT
 Orange coloured stick
 Best interdental aid
 Help in plaque removal + gingival massage

WATER FLOSSER
 Can dilute bacterial toxins only********]]>272falsefullhttps://www.spreaker.com/episode/22-instruments--40400253QN Schwartz periotriever To remove broken instrument from gingival sulcus

PROBES
 Technique – walking the probe
 Force applied – 0.25 N*
 Most common – Williams probe
 Missing pts on probe – 4 and 6
 WHO probe
o Tip diameter of 0.5mm
o Black marking for 3.5 and 5.5 mm
o Used in CPIT index America
o Light weight
 Most common for furcation – Nabers probe
 Pressure sensitive probe – FOSAT – MILLER PROBE
o RECORDS – CEJ

SCALER
 Supra gingival scaling
 Short, powerful pull motion
 After scaling and root planning, healing happens by long junctional epithelium**
 TYPES
o Piezoelectric,
o Magnetostrictive*******
This scaler is used with elliptical motion ********
o Sonic,
o Ultrasonic

CURETTE
 Subgingival scaling
 Root planning
 Long, light pull motion
UNIVERSAL CURRETTE
 Two cutting edge
 Not area specific
 90°
 Blade of a pdl instrument should be perpendicular to the shank****
 Shank should be parallel to the tooth surface, but blade/cutting edge should be perpendicular ok?

GRACEY CURETTE
 One cutting edge
 Area specific
 70° or offset
 #11 #12 mesial surface of posterior
 #13 #14 distal surface of posterior

 All currettes (gracey/universal) are semi – circular in cross section
 Best angulation of activation of any perio instrument - 70° (45°- 90°)
 Angulation : the relationship b/w the instrument blade and the tooth surface
 The part of instrument that should be parallel during calculus removal is the shank **]]>https://api.spreaker.com/episode/40400253Wed, 19 Aug 2020 06:58:35 +0000Dr.Mayakha MariamINSTRUMENTS QN Schwartz periotriever To remove broken instrument from gingival sulcus PROBES  Technique – walking the probe  Force applied – 0.25 N*  Most common – Williams probe  Missing pts on probe – 4 and 6  WHO probe o Tip diameter of 0.5mm...QN Schwartz periotriever To remove broken instrument from gingival sulcus

PROBES
 Technique – walking the probe
 Force applied – 0.25 N*
 Most common – Williams probe
 Missing pts on probe – 4 and 6
 WHO probe
o Tip diameter of 0.5mm
o Black marking for 3.5 and 5.5 mm
o Used in CPIT index America
o Light weight
 Most common for furcation – Nabers probe
 Pressure sensitive probe – FOSAT – MILLER PROBE
o RECORDS – CEJ

SCALER
 Supra gingival scaling
 Short, powerful pull motion
 After scaling and root planning, healing happens by long junctional epithelium**
 TYPES
o Piezoelectric,
o Magnetostrictive*******
This scaler is used with elliptical motion ********
o Sonic,
o Ultrasonic

CURETTE
 Subgingival scaling
 Root planning
 Long, light pull motion
UNIVERSAL CURRETTE
 Two cutting edge
 Not area specific
 90°
 Blade of a pdl instrument should be perpendicular to the shank****
 Shank should be parallel to the tooth surface, but blade/cutting edge should be perpendicular ok?

GRACEY CURETTE
 One cutting edge
 Area specific
 70° or offset
 #11 #12 mesial surface of posterior
 #13 #14 distal surface of posterior

 All currettes (gracey/universal) are semi – circular in cross section
 Best angulation of activation of any perio instrument - 70° (45°- 90°)
 Angulation : the relationship b/w the instrument blade and the tooth surface
 The part of instrument that should be parallel during calculus removal is the shank **]]>334falsefullhttps://www.spreaker.com/episode/23-flap-surgeries--40400233
GINGIVECTOMY
 After gingivectomy, surface epithelium occurs in 7-14 days
 They heal by secondary intention, because there is no tissue approximating.
 INDICATIONS FOR GINGIVECTOMY:
o DIGE cases
o To eliminate suprabony pocket***
o To remove pseudopocket,**** in fibrous enlargement cases
o To eliminate gingival abscesses
o For suprabony pdl abscess !

 CONTRA INDICATIONS TO GINGIVECTOMY
o Anterior aesthetic zone.
o If there is defect in the alveolar bone!!!********
o Infrabony pockets
o Osseous reconstruction cases.**** (tricky one)

FLAP SURGERY
A portion of marginal periodontal tissue that has been surgically separated coronally from its underlying support and blood supply and attached apically by a pedicle of supporting vascular connective tissue

Perio surgery miscellaneous
 Wait 6 months after perio surgery for maturation of entire periodontium
 Periodontitis prognosis – depends on loss of clinical attachment QN
 Success of perio Rx – depends on good oral hygiene QN
 Best indication for successful perio Rx is --> NO bleeding on probing QN
 Indications : accessibility and visualization
 Best to access a bony defect
 After perio surgery, re-attachment happen as soon as in a week.
 evaluation of improved periodontal health: no bleeding on probing/ decreased plaque score attachment level***

FLAP DESIGN
 Wide base to ensure adequate blood supply.
 Most commonly used flap --> modified Widman flap]]>https://api.spreaker.com/episode/40400233Wed, 19 Aug 2020 06:58:27 +0000Dr.Mayakha MariamPERIO SURGERIES: FLAPS AND GRAFTS GINGIVECTOMY  After gingivectomy, surface epithelium occurs in 7-14 days  They heal by secondary intention, because there is no tissue approximating.  INDICATIONS FOR GINGIVECTOMY: o DIGE cases o To eliminate...
GINGIVECTOMY
 After gingivectomy, surface epithelium occurs in 7-14 days
 They heal by secondary intention, because there is no tissue approximating.
 INDICATIONS FOR GINGIVECTOMY:
o DIGE cases
o To eliminate suprabony pocket***
o To remove pseudopocket,**** in fibrous enlargement cases
o To eliminate gingival abscesses
o For suprabony pdl abscess !

 CONTRA INDICATIONS TO GINGIVECTOMY
o Anterior aesthetic zone.
o If there is defect in the alveolar bone!!!********
o Infrabony pockets
o Osseous reconstruction cases.**** (tricky one)

FLAP SURGERY
A portion of marginal periodontal tissue that has been surgically separated coronally from its underlying support and blood supply and attached apically by a pedicle of supporting vascular connective tissue

Perio surgery miscellaneous
 Wait 6 months after perio surgery for maturation of entire periodontium
 Periodontitis prognosis – depends on loss of clinical attachment QN
 Success of perio Rx – depends on good oral hygiene QN
 Best indication for successful perio Rx is --> NO bleeding on probing QN
 Indications : accessibility and visualization
 Best to access a bony defect
 After perio surgery, re-attachment happen as soon as in a week.
 evaluation of improved periodontal health: no bleeding on probing/ decreased plaque score attachment level***

FLAP DESIGN
 Wide base to ensure adequate blood supply.
 Most commonly used flap --> modified Widman flap]]>220falsefullhttps://www.spreaker.com/episode/24-flaps-classifications--40400244 Conventional technique-splitting the interdental papilla.
 Papilla preservation flap  used in graft placement in aesthetic zones, to preserve the esthetic look of papilla. So that the “black triangle” is not formed after the perio surgery


Classification acc to placement of flap after surgery

 APICALLY DISPLACED FLAP
o It is almost impossible to perform on maxillary lingual area.
o Advantage- it convert unattached gingiva to attached gingiva ******
o Indication —
 increase width of attached gingiva
 No pocket formation
o Disadvantage —
 Cannot be used in anterior aesthetic zone
 Coz root visibillity

 CORONALLY AND LATERALLY DISPLACED FLAP
o Indication – to correct resection
o Disadvantage – pocket formation]]>https://api.spreaker.com/episode/40400244Wed, 19 Aug 2020 06:58:18 +0000Dr.Mayakha MariamClassification if papilla id preserved or not  Conventional technique-splitting the interdental papilla.  Papilla preservation flap  used in graft placement in aesthetic zones, to preserve the esthetic look of papilla. So that the “black triangle”... Conventional technique-splitting the interdental papilla.
 Papilla preservation flap  used in graft placement in aesthetic zones, to preserve the esthetic look of papilla. So that the “black triangle” is not formed after the perio surgery


Classification acc to placement of flap after surgery

 APICALLY DISPLACED FLAP
o It is almost impossible to perform on maxillary lingual area.
o Advantage- it convert unattached gingiva to attached gingiva ******
o Indication —
 increase width of attached gingiva
 No pocket formation
o Disadvantage —
 Cannot be used in anterior aesthetic zone
 Coz root visibillity

 CORONALLY AND LATERALLY DISPLACED FLAP
o Indication – to correct resection
o Disadvantage – pocket formation]]>197falsefullhttps://www.spreaker.com/episode/25-flap-classifications-2--40400254
Full thickness mucoperiosteal flap
 Includes surface mucosa (consisting of epithelium, basement membrane, and
connective tissue lamina propria) and the contiguous periosteum of the underlying alveolar bone.
 Mucoperiosteal flap
 Bone exposure required – osseous surgery, heals by primary intention.
Also used in apically repositioned flaps,
 DIASADVANTAGE OF FULL THICKNESS FLAP
o Interdental papilla integrity can be compromised.

 ADVANTAGES OF FULL THICKNESS FLAP
o Primary intention healing
 Incisions :-

o INTERNAL BEVEL INCISION
 First incision
 To remove pocket lining

o CREVICULAR INCISION
 To use No:12 blade
 Only used in perio

o INTERDENTAL INCISION


Partial thickness flap
 Includes only the mucosa,
 Mucosal flap
 Used for mucogingival surgeries, bone exposure is not required here.]]>https://api.spreaker.com/episode/40400254Wed, 19 Aug 2020 06:58:08 +0000Dr.Mayakha MariamClassification according bone exposure after flap / thickness Full thickness mucoperiosteal flap  Includes surface mucosa (consisting of epithelium, basement membrane, and connective tissue lamina propria) and the contiguous periosteum of the...
Full thickness mucoperiosteal flap
 Includes surface mucosa (consisting of epithelium, basement membrane, and
connective tissue lamina propria) and the contiguous periosteum of the underlying alveolar bone.
 Mucoperiosteal flap
 Bone exposure required – osseous surgery, heals by primary intention.
Also used in apically repositioned flaps,
 DIASADVANTAGE OF FULL THICKNESS FLAP
o Interdental papilla integrity can be compromised.

 ADVANTAGES OF FULL THICKNESS FLAP
o Primary intention healing
 Incisions :-

o INTERNAL BEVEL INCISION
 First incision
 To remove pocket lining

o CREVICULAR INCISION
 To use No:12 blade
 Only used in perio

o INTERDENTAL INCISION


Partial thickness flap
 Includes only the mucosa,
 Mucosal flap
 Used for mucogingival surgeries, bone exposure is not required here.]]>216falsefullhttps://www.spreaker.com/episode/26-gtr--40400239Placing a membrane to increase the growth of periodontium
 Function – to present long junctional epithelium]]>https://api.spreaker.com/episode/40400239Wed, 19 Aug 2020 06:57:58 +0000Dr.Mayakha MariamGUIDED TISSUE REGENERATION Placing a membrane to increase the growth of periodontium  Function – to present long junctional epitheliumPlacing a membrane to increase the growth of periodontium
 Function – to present long junctional epithelium]]>88falsefullhttps://www.spreaker.com/episode/27-bone-swaging--40400234Pushing of bone into contact root surface without fracturing bone at its base
(done if edentulous area present near the wall defect)]]>https://api.spreaker.com/episode/40400234Wed, 19 Aug 2020 06:55:43 +0000Dr.Mayakha MariamBONE SWAGGING Pushing of bone into contact root surface without fracturing bone at its base (done if edentulous area present near the wall defect)Pushing of bone into contact root surface without fracturing bone at its base
(done if edentulous area present near the wall defect)]]>79falsefullhttps://www.spreaker.com/episode/28-bone-grafts--40400238
A. AUTOGENOUS GRAFTS – AUTOGRAFT
a. From same individual – different donor site
b. Best graft For osseous defect– cancellous graft (since they have pores for blood vessels to pass)*******
c. Eg: bone coagulum
d. Best extraoral donor site:
i. Post surface of iliac bone (nerve supply here is iliogastric nerve)
ii. Best graft for condyle of mandible
1. 5th and 6th costocondral graft
2. 6th and 9th rib graft for ridge augmentation

B. ALLOGENOUS GRAFT – HOMOGRAFT
a. From same species – different individual
b. DFDBG – Decalcified Freeze dried Bone Graft
i. For grade 2 furcation involvement
ii. Best for osseous defect is – DECALCIFIED CANCELLOUS FREEZE DRIED BONE GRAFT*****

C. XENOGRAFT GRAFT
a. Graft from different species, POVINE GRAFT FOR EG.

D. ALLOPLASTIC GRAFT
a. From inorganic substance
b. Eg: hydroxyapatite
E. Graft from identical twins – ISO GRAFT
F. Condyle : post chondral graft
G. Child for alveolar process : iliac crest
H. 3 wall defects in adult : mixed cortical and cancellous from his own intraoral mixed with his blood.
I. 2 wall defect in perio --> Cancellous freeze dried bone allograft*]]>https://api.spreaker.com/episode/40400238Wed, 19 Aug 2020 06:53:00 +0000Dr.Mayakha MariamBONE GRAFTS A. AUTOGENOUS GRAFTS – AUTOGRAFT a. From same individual – different donor site b. Best graft For osseous defect– cancellous graft (since they have pores for blood vessels to pass)******* c. Eg: bone coagulum d. Best extraoral donor site:...
A. AUTOGENOUS GRAFTS – AUTOGRAFT
a. From same individual – different donor site
b. Best graft For osseous defect– cancellous graft (since they have pores for blood vessels to pass)*******
c. Eg: bone coagulum
d. Best extraoral donor site:
i. Post surface of iliac bone (nerve supply here is iliogastric nerve)
ii. Best graft for condyle of mandible
1. 5th and 6th costocondral graft
2. 6th and 9th rib graft for ridge augmentation

B. ALLOGENOUS GRAFT – HOMOGRAFT
a. From same species – different individual
b. DFDBG – Decalcified Freeze dried Bone Graft
i. For grade 2 furcation involvement
ii. Best for osseous defect is – DECALCIFIED CANCELLOUS FREEZE DRIED BONE GRAFT*****

C. XENOGRAFT GRAFT
a. Graft from different species, POVINE GRAFT FOR EG.

D. ALLOPLASTIC GRAFT
a. From inorganic substance
b. Eg: hydroxyapatite
E. Graft from identical twins – ISO GRAFT
F. Condyle : post chondral graft
G. Child for alveolar process : iliac crest
H. 3 wall defects in adult : mixed cortical and cancellous from his own intraoral mixed with his blood.
I. 2 wall defect in perio --> Cancellous freeze dried bone allograft*]]>178falsefullhttps://www.spreaker.com/episode/29-gingival-recession-classification--40400255 Caused by tooth brush trauma or plaque deposits
 Stages – MILLER’S CLASSIFICATION

CLASS I
 Marginal gingival recession (MGR), that does not extend up to mucogingival junction (MGJ)
 Rx : coronally / laterally displaced flap or Free gingival graft

CLASS II
 MGR that extends up to mucogingival junction with no loss of interdental soft tissue and bone
 Rx : CONNECTIVE TISSUE FLAP/GRAFT WITH PARTIAL SPLIT****
NB: difference between I & II GR is width of attached gingiva

CLASS III
o MGR extended up to MGJ with mild to moderate interdental soft tissue + bone loss
o Rx : regenerative or resective osseous surgery
NB: difference between II & III GR is interdental bone loss

CLASS IV
o Severe interdental soft tissue + bone loss
o Poor prognosis
o Rx : extraction
o DEPTH OF ATTACHEMENT LOSS = GINGIVAL RECESSION + SULCULS DEPTH]]>https://api.spreaker.com/episode/40400255Wed, 19 Aug 2020 06:52:41 +0000Dr.Mayakha MariamGINGIVAL RECESSION & GRAFTS  Caused by tooth brush trauma or plaque deposits  Stages – MILLER’S CLASSIFICATION CLASS I  Marginal gingival recession (MGR), that does not extend up to mucogingival junction (MGJ)  Rx : coronally / laterally... Caused by tooth brush trauma or plaque deposits
 Stages – MILLER’S CLASSIFICATION

CLASS I
 Marginal gingival recession (MGR), that does not extend up to mucogingival junction (MGJ)
 Rx : coronally / laterally displaced flap or Free gingival graft

CLASS II
 MGR that extends up to mucogingival junction with no loss of interdental soft tissue and bone
 Rx : CONNECTIVE TISSUE FLAP/GRAFT WITH PARTIAL SPLIT****
NB: difference between I & II GR is width of attached gingiva

CLASS III
o MGR extended up to MGJ with mild to moderate interdental soft tissue + bone loss
o Rx : regenerative or resective osseous surgery
NB: difference between II & III GR is interdental bone loss

CLASS IV
o Severe interdental soft tissue + bone loss
o Poor prognosis
o Rx : extraction
o DEPTH OF ATTACHEMENT LOSS = GINGIVAL RECESSION + SULCULS DEPTH]]>235falsefull