Periodontologiya - Periodontology

Periodontist
Kasb
Kasb turi
Mutaxassisligi
Faoliyat sohalari
Stomatologiya
Tavsif
Ta'lim talab qilinadi
Tish darajasi
Maydonlari
ish bilan ta'minlash
Kasalxonalar, xususiy amaliyotlar

Periodontologiya yoki periodontika (dan.) Qadimgi yunoncha ίrί, perí - "atrofida"; va choύς, odous - "tish", genetik ςoς, odontos) bo'ladi ixtisosligi ning stomatologiya ning qo'llab-quvvatlovchi tuzilmalarini o'rganadi tish, shuningdek, ularga ta'sir qiladigan kasalliklar va sharoitlar. Qo'llab-quvvatlovchi to'qimalar periodontium o'z ichiga oladi tish go'shti (tish go'shti), alveolyar suyak, tsement, va periodontal ligament. Periodontist - bu periodontal kasallikning oldini olish, diagnostikasi va davolashga va stomatologik implantlarni joylashtirishga ixtisoslashgan tish shifokori.[1]

Periodontium

Periodontiumning diagrammasi. A. Emaye B. Dentin C. Alveolyar suyak D. Og'iz epiteliyasi E. Qo'shilgan gingiva F. Gingival chekka G. Gingival sulkus H. Junctional epiteliya I. Periodontal ligamentning alveolyar tepalik tolalari [PDL] J. PDLning gorizontal tolalari K. Oblique PDL tolalari

Periodontium atamasi tishlarni bevosita o'rab turgan, qo'llab-quvvatlaydigan va himoya qiladigan tuzilmalar guruhini tavsiflash uchun ishlatiladi. Periodontium asosan tish go'shti to'qimalari va suyak suyagidan iborat.[2]

Gingivae

Oddiy tish go'shti ochiq mercan pushti rangidan tortib to og'ir pigmentatsiyaga qadar o'zgarishi mumkin. Asosiy tsement, periodontal ligament va alveolyar suyakni qoplaydigan va himoya qiladigan yumshoq to'qimalar va biriktiruvchi tolalar tish go'shti deb nomlanadi. Tish go'shti uchta anatomik guruhga bo'linadi; bepul, biriktirilgan va tishlararo tish go'shti. Gingival guruhlarning har biri biologik jihatdan boshqacha hisoblanadi; ammo ularning barchasi mexanik va bakterial qirg'inlardan himoya qilishga yordam berish uchun maxsus ishlab chiqilgan.[3]

Bepul tish go'shti

Alveolyar suyak tepasi ustida o'tirgan to'qimalar erkin gingiva hisoblanadi. Sog'lom periodontiumda gingival chekka - bu tsemento-emal birikmasini o'z ichiga olgan tolali to'qima, bu tish atrofi bo'ylab tojning emal yuzasi ildizning tashqi tsement qatlamiga to'g'ri keladi. Gingival sulcus deb nomlangan tabiiy bo'shliq tish va erkin gingiva o'rtasida tish go'shti chegarasida apikal yotadi. Kasal bo'lmagan, sog'lom gingival sulkus odatda 0,5-3 mm chuqurlikda bo'ladi, ammo bu o'lchov periodontal kasallik mavjud bo'lganda ko'payishi mumkin. Gingival sulkus keratinlashtirilmagan qatlam bilan o'ralgan sulkulyar epiteliya deb ataladi; u gingival chekkadan boshlanadi va birikma epiteliyasi va biriktirilgan gingiva boshlanadigan sulkus tagida tugaydi.[4]

Gingiva biriktirilgan

The birikma epiteliyasi bu gingival sulkaning tagida yotadigan va tishni o'rab turgan yoqa o'xshash tasma; u bo'sh va biriktirilgan gingiva orasidagi ajratish joylarini belgilaydi. Birlashma epiteliyasi gingival sulkus atrofida yashovchi mikroorganizmlar uchun maxsus himoya to'sig'ini beradi.[4] Kollagen tolalari biriktirilgan gingivani tsement va alveolyar suyak, shu jumladan asosiy periodontium bilan mahkam bog'laydi va uzunligi va kengligi bilan farq qiladi,[4] og'iz bo'shlig'idagi joylashuvga va shaxsga qarab.,[5][6] Yopilgan gingiva bo'sh gingival chiziq yoki truba va mukogingival birikma o'rtasida yotadi. Yopilgan gingiva mastitatsiya, tishlarni yuvish va gapirish kabi keng tarqalgan mashqlar paytida gingival to'qimalarga qo'yilgan funktsional va chaynash stresslarini tarqatadi.[7] Sog'lik holatida u odatda och pushti yoki marjon pushti rangga ega va sirtni qoqish yoki irqiy pigmentatsiyaga olib kelishi mumkin.[7]

Tish tishlari

Tish oralig'idagi tish go'shti tishning aloqa nuqtasi ostidagi, ikkita qo'shni tish orasidagi bo'shliqni egallaydi. Odatda uchburchak yoki piramidal shaklga ega va ikkita tish oralig'ida (til va yuz) hosil bo'ladi.[4][5] Tish oralig'idagi papillaning o'rta yoki o'rta qismi biriktirilgan gingivadan, chegaralari va uchi esa erkin gingiva tomonidan hosil bo'ladi. Tishsimon papillalar orasidagi markaziy nuqta kol deb ataladi. Bu to'g'ridan-to'g'ri aloqa nuqtasi ostida, yuz va til papillasi o'rtasida joylashgan vodiyga o'xshash yoki konkav depressiyasidir.[6] Ammo tish go'shti turg'unligi bo'lsa yoki tishlar aloqa qilmasa, yo'g'on ichak bo'lmasligi mumkin. Tishdagi tish go'shtining asosiy maqsadi odatiy mastatsiya paytida oziq-ovqat ta'sirini oldini olishdir.[7]


Alveolyar mukoza

Ushbu to'qimalar maydoni keratinlashtirilmagan va mukogingival birikmaning tashqarisida joylashgan. U kamroq mahkamlangan va biriktirilgan gingivadan qizilroq. Bu yonoq va lablarning harakatlanishini ta'minlaydi.[8]

Periodontal ligament

Periodontal ligament - bu tish ildizining tashqi qatlamini, tsementumni, atrofdagi alveolyar suyakka qo'shiladigan biriktiruvchi to'qima. U turli yo'nalishlarda harakatlanadigan va "Sharpining tolalari" orqali tsement va suyak ichiga kiritadigan bir nechta murakkab tola guruhlaridan iborat.[4] Periodontal ligament asosan kollagen tolalaridan iborat, shu bilan birga bo'shashgan to'qima to'qimalarida qon tomirlari va nervlarni joylashtiradi.[6] Mastikatsiya paytida tishlarga qo'yiladigan mexanik yuklarni va boshqa tashqi kuchlarni periodontal ligament yutadi, shu sababli tishlarni o'zlarining uyasi ichida himoya qiladi.[7]

Alveolyar suyak

Periodontal sog'liqda alveolyar suyak tishlarni o'rab oladi va har bir tishni qo'llab-quvvatlaydigan suyak uyasini hosil qiladi. Bukkal va lingual plitalar va rozetkalarning qoplamasi ingichka, ammo zich ixcham yoki kortikal suyakdan iborat.[3] Kortikal plitalar va tish rozetkalari ichida ixcham suyakka nisbatan zichroq bo'lmagan gubkali yoki trabekulyar tipdagi suyak bor.[6]

Tsement

Tsement - bu tish ildizining tashqi qatlami; u tishning dentin qatlamini qoplaydi va periodontal ligamentning kollagen tolalari uchun biriktirilishini ta'minlaydi. Shuningdek, u dentinni himoya qiladi va dentinal tubulalarning aks holda ochiq uchlari uchun muhr beradi. Bu emal yoki dentin kabi qattiq emas va odatda ochiq sariq rangga ega.[7]

Gingival kasalliklar

Gingivit - bu tishlarni o'rab turgan gingiva yoki shilliq qavat to'qimalariga ta'sir qiladigan keng tarqalgan holat. Vaziyat periodontal kasallikning bir shakli; ammo, bu paradontga qaytarilmas zarar yoki o'zgarishlarni (gingiva, periodontal ligament, tsement yoki alveolyar suyak) o'z ichiga olmaydi, chunki bu eng dahshatli. Odatda gingival qon ketishi cho'tka yoki ovqat paytida o'z-o'zidan paydo bo'lganda bemorlar tomonidan aniqlanadi. Shuningdek, u shilliq qavat to'qimalarining umumiy yallig'lanishi, shishishi va qizarishi bilan tavsiflanadi. Gingivit odatda og'riqsizdir va odatda og'iz gigienasining pasayishi yoki yomonligi bilan birgalikda blyashka biofilmining to'planishi natijasidir. Boshqa omillar odamning gingivit xavfini oshirishi mumkin, shu jumladan tizimli holatlar, masalan, nazoratsiz diabet mellitus va ba'zi dorilar. Gingivitning belgilari va alomatlarini og'iz gigienasini yaxshilash va blyashka buzilishini kuchaytirish orqali bartaraf etish mumkin. Agar gingivit davolanmasa, periodontal va umumiy sog'liqqa ko'proq zarar etkazadigan periodontit va unga bog'liq boshqa kasalliklarga o'tish ehtimoli bor.[9]

Periodontal kasalliklar

Periodontal kasallik periodontal to'qimalarning bir qator kasalliklarini o'z ichiga oladi, natijada birikish yo'qoladi va alveolyar suyak yo'q qilinadi.[10]

Periodontal kasalliklar turli xil shakllarni oladi, lekin odatda birlashish natijasidir bakterial blyashka biofilm birikmasi qizil kompleks bakteriyalar (masalan, P. gingivalis, T. forsythia va T. dentikola ) ning tish go'shti va tishlar, xost bilan birlashtirilgan immuno-yallig'lanish tabiiy tishlar atrofidagi suyakni yo'q qilishga olib keladigan mexanizmlar va boshqa xavf omillari. Davolash qilinmasa, ushbu kasalliklar sabab bo'lishi mumkin alveolyar suyak yo'qotish va tishlarning yo'qolishi. 2013 yildan boshlab, Periodontal kasallik, bu kasallikka chalingan bemorlarda yo'qolgan tishlarning 70,8% ni tashkil etdi Janubiy Koreya.[11] Periodontal kasallik tishlarning yo'qolishida ikkinchi o'rinda turadi (tish kariesidan keyin) Shotlandiya.[12] Kundalik ikki marta tozalash va tish ipi parodontal kasalliklarning oldini olishga yordam beradi.[13]

Sog'lom tish go'shti kavkaz odamlarida qoqilgan, och yoki mercan pushti, boshqa irqlarda turli darajadagi pigmentatsiya bilan ta'riflanishi mumkin. Gingival chekka patologiya mavjud bo'lmasdan tsement-emal birikmasida joylashgan. Tish bilan tish go'shti orasidagi tish go'shti cho'ntagi sog'lom deb hisoblash uchun 1-3 mm dan chuqurroq bo'lmasligi kerak. Yumshoq tekshiruvda qon ketishining yo'qligi ham mavjud.[10]

Sog'lom tish go'shti

Periodontal kasalliklarga turli xil omillar sabab bo'lishi mumkin, ularning eng ko'zga ko'ringan qismi tish blyashkasi. Tish blyashka tish yuzasida bakterial biofilm hosil qiladi, agar tish yuzidan gingiva yaqinida etarli darajada olib tashlanmasa, mezbon-mikroblarning o'zaro ta'siri boshlanadi. Bu xost va bakterial omillar o'rtasidagi muvozanatni keltirib chiqaradi, natijada sog'liqdan kasallikka o'zgarishi mumkin. Boshqa mahalliy va / yoki tizimli omillar periodontal kasallikning namoyon bo'lishiga olib kelishi yoki rivojlanishi mumkin. Boshqa omillarga yosh, ijtimoiy-iqtisodiy holat, og'iz gigienasi bo'yicha ta'lim va ovqatlanish kiradi. Tizimli omillar nazoratsiz diabet yoki tamaki chekishni o'z ichiga olishi mumkin.[14]

Periodontal kasallikning alomatlari va belgilari: tish go'shti qon ketishi, gingival retsessiya, halitoz (yomon nafas), harakatlanuvchi tish, yaroqsiz protezlar va blyashka va toshning ko'payishi[15]

Shaxsiy xavf omillariga quyidagilar kiradi: Jins, chekish va spirtli ichimliklarni iste'mol qilish, diabet, semirish va metabolik sindrom, osteoporoz va D vitamini holatlari, stress va genetik omillar.[16]

1999 yilda Amerika Periodontologiya Akademiyasi (AAP) mavjud zaif tomonlarni o'zgartirish uchun 1989 yildan beri mavjud bo'lgan periodontal kasalliklar tasnifini qayta ishlab chiqdi. Eski tasniflashda kasallikning boshlanish yoshiga va rivojlanish tezligiga juda katta ahamiyat berildi, ularni aniqlash qiyin. 1999 yil tasnifi Annals Periodontology-da nashr etilgan. Quyida 1999 yil periodontal kasalliklar va holatlar tasnifining qisqartirilgan versiyasi keltirilgan.[16]

I. Gingival kasalliklar
A. Dental blyashka sababli gingival kasalliklar
B. Blyashka bilan bog'liq bo'lmagan gingival lezyonlar

Gingivit

II. Surunkali Periodontit
(engil: 1-2 mm CAL; o'rtacha: 3-4 mm CAL; og'ir:> 5 mm CAL) A. Mahalliylashtirilgan
B. Umumlashtirilgan (> saytlarning 30% ishtirok etadi)

III. Agressiv Periodontit
(engil: 1-2 mm CAL; o'rtacha: 3-4 mm CAL; og'ir:> 5 mm CAL) A. Mahalliylashtirilgan
B. Umumlashtirilgan (> saytlarning 30% ishtirok etadi)

Retsessiya parodontale

IV. Periodontit tizimli kasalliklarning namoyon bo'lishi sifatida
A. Gematologik kasalliklar bilan bog'liq
B. Genetik kasalliklar bilan bog'liq
C. Boshqacha ko'rsatilmagan

Periyapik xrayda suyak yo'qotilishi

V. Periodontal kasalliklarni nekrotizan qilish
A. Nekrotizan ülseratif gingivit
B. Nekrozlashtiruvchi ülseratif periodontit

VI. Periodontiumning xo'ppozlari
A. Gingival xo'ppoz
B. Periodontal xo'ppoz
C. Perikoronal xo'ppoz

VII. Endodontik lezyonlar bilan bog'liq periodontit
A. Kombinatsiyalangan periodontik-endodontik shikastlanishlar

Abstsesslangan tish periapikal rentgenogrammasi

VIII. Rivojlanish yoki orttirilgan deformatsiyalar va sharoitlar
A. Tish bilan bog'liq lokalizatsiya qilingan omillar, blyashka keltirib chiqaradigan tish go'shti kasalliklarini / periodontitni o'zgartiradi yoki predisposeto qiladi.
B. Tishlar atrofidagi mukogingival deformatsiyalar va sharoit
C. Mucogingival deformatsiyalar va tishsiz tirgaklardagi holatlar
D. Okklyuziv travma

2018 yilda periodontal kasallikning yangi tasnifi e'lon qilindi. Oldingi AAP 1999 tasnifi implant atrofidagi kasalliklar va sharoitlarga ega bemorlarning ehtiyojlarini qondira olmasligi aniqlandi. Periodontal va peri-implantat kasalliklari va holatlarining yangi tasnifi quyidagicha.

Periodontal sog'liq, tish go'shti kasalliklari va holatlari:
Periodontal sog'liq va tish go'shti sog'lig'i
Gingivitis: Dental-Biofilm ishlab chiqarilgan
Gingival kasalliklar: Dental bo'lmagan biofilm
Periodontit:
Periodontal kasalliklarni nekrotizan qilish
Periodontit
Periodontit tizimli kasallikning namoyon bo'lishi sifatida
Periodontiumga ta'sir qiluvchi boshqa holatlar:
Periodontal qo'llab-quvvatlovchi to'qimalarga ta'sir qiluvchi tizimli kasalliklar yoki holatlar
Periodontal xo'ppozlar va endodontik-periodontal lezyonlar
Mucogingival deformatsiyalari va shartlari
Shikastlangan okklyuziv kuchlar
Tish va protez bilan bog'liq omillar
Peri-Implantat kasalliklari va holatlari:
Peri-Implant salomatligi
Peri-Implantatsiya qilingan mukozit
Peri-implantit
Peri-Implant yumshoq va qattiq to'qimalarning etishmovchiligi
[17]

Oldini olish:
Eng samarali profilaktika usuli - bu bemor tomonidan uyda erishilishi mumkin bo'lgan narsa, masalan, to'g'ri tishlarni tozalash texnikasi, tishlarni tozalash uchun vositalar, masalan, tish cho'tkalari yoki iplari va ftorlangan tish pastasi. Shuningdek, bemorlarga har yili stomatologik davolanuvchidan to'liq tozalash bilan birga ikki marta tekshiruvlar o'tkazilishi tavsiya etiladi.
[15]
Davolash:
Periodontistlarni davolash bilan bir qatorda umumiy stomatolog yoki og'iz sog'liqni saqlash terapevti / stomatolog gigienist qo'l asboblari yoki ultratovush skaleri (yoki ikkalasining ham kombinatsiyasi) yordamida odatdagi o'lchovni bajarishi va tozalashi mumkin. Amaliyotchi shuningdek, blyashka tozalashning ixtisoslashtirilgan usullarini (tishlarni tozalash, tishlarni tozalash) buyurishi mumkin. Amaliyotchi shuningdek, bemorga blyashka joylarini o'zlari olib tashlamayotganligini ko'rsatish uchun blyashka indeksini bajarishi mumkin. Buni tish profilaktikasi yordamida olib tashlash mumkin.[15]

Peri-implantit

Periodontologiya shuningdek, tish implantlarini joylashtirish va ularga xizmat ko'rsatishni, shu jumladan davolashni o'z ichiga oladi peri-implantit (tish implantlari atrofida yallig'lanishli suyak yo'qotilishi). Peri-implantit etiologiyasi periodontal kasallikka juda o'xshash deb o'ylashadi.

Etiologiya

Periodontal kasallik uchun asosiy etiologik omil bu tish biofilmining blyashka biofilmidir. Tish biofilmi - bu qattiq, to'kilmasdan yuzaga yopishtirilgan mikroorganizmlar birlashmasi. Og'iz bo'shlig'ida qattiq to'kilmaydigan yuzalarga tishlar, stomatologik tiklovchi materiallar va shunday protezlar o'rnatilgan yoki olinadigan stomatologik asbob kiradi.[18] Dökülmeyen sirtga rioya qilish, tish biofilmindeki bakteriyalarga klinik ahamiyatga ega bo'lgan noyob xususiyatlarga ega bo'lishiga imkon beradi. Biofilmni shakllantirish bosqichlari:

  1. Qabul qilingan pellikulaning shakllanishi: tuprikni va uning selektiv singishini o'z ichiga oladi GCF gidroksiapatit bilan elektrostatik yaqinlik orqali molekulalar.[19]
  2. Bakteriyalarni tashish: Bakteriyalar birdan ikki soatgacha adezinlar, oqsillar va fermentlar orqali olingan pellikulaga yopishib oladilar.[19]
  3. Qayta tiklanadigan o'zaro ta'sir: Mikroorganizmlar va tish yuzasi o'rtasida elektrostatik tortishish yoki gidrofob ta'sir o'tkazish mavjud[19]
  4. Qaytarib bo'lmaydigan ta'sir o'tkazish: Bakterial adezinlar pili va tashqi membrana oqsillari kabi o'ziga xos xost retseptorlarini taniydi. Bakteriyalarning har xil turlari bir-biriga bog'lanib, maxsus retseptorlarni pellicle bilan ta'sir o'tkazishini talab qiladi.[20]
  5. Birgalikda adezyon: Og'iz orqali mikroorganizmlarning bir-biriga yopishishi tabiiy yaqinlik mavjud bo'lib, ular "yopishqoq yopishish" deb nomlanadi. Birgalikda yopishish planktonik yoki bitta madaniy hujayralarning sirt ustida birikkan organizmlarga yopishishini o'z ichiga oladi. Sirt bilan birinchi marta aloqa qiladigan va keyinchalik bakteriyalarning bir-biriga yopishishi uchun platforma yaratadigan organizmlar "erta kolonizatorlar" deb nomlanadi, ular murakkab ko'p qirrali tish biofilmlarining shakllanishiga yordam beradi.[19]
  6. Ko'paytirish: Mavjud blyashka mikroorganizmlarining davomli o'sishi va etilishi va keyinchalik kolonizatorlarni yollash orqali.[19]
  7. Klimaks jamiyati (gomeostaz): uzoq davom etgan barqarorlikdan so'ng bakteriyalar hamjamiyati omon qolish uchun etarli miqdorda oziq moddalarga va himoya vositalariga ega. Ushbu murakkab biofilmlar odatda tozalash qiyin bo'lgan joylarda uchraydi. Ovqatlanish gingival biofilmli organizmlar uchun xostni parhez iste'mol qilishdan va gingival biofilmli organizmlar uchun qon va GKFdan beriladi.[19]
  8. Ajratish: Bir sirtdan ikkinchisiga yoki biofilm ichida uzoqdagi joyda mustamlaka qilishga imkon beradi[21]

Biyofilm tarkibidagi bakteriyalar shilimshiq hujayradan tashqari polisakkarid matritsasi bilan himoyalangan, bu ularni tashqi muhit va kimyoviy terapevtik vositalardan himoya qilishga yordam beradi. Xlorheksidinli og'izni yuvish vositasi yoki antibiotiklar kabi antiseptikni kimyoviy terapevtik agentga misol qilib keltirish mumkin. Shunday qilib, antibiotiklar, odatda, atrofdagi boshqa bakterial infektsiyalardan farqli o'laroq, periodontal kasalliklarni davolashda ishlatilmaydi. Blyashka biyofilmini nazorat qilishning eng samarali usuli bu tishlarni tozalash, tishlarni tozalash yoki tish shifokori tomonidan amalga oshiriladigan periodontal tozalash kabi mexanik olib tashlashdir.[21]

Patogenez

Jismoniy shaxs xost javobi da muhim rol o'ynaydi patogenez periodontal kasallik. Tish go'shti sog'lom ko'rinadigan og'izda ham blyashka mikroorganizmlarining doimiy bakterial yukini boshqarish uchun uy egasi tomonidan doimiy ravishda past darajadagi yallig'lanish reaktsiyasi mavjud. Leykotsitlar va neytrofillar bu asosiy hujayralardir fagotsitoza tish go'shti yorig'ida yoki cho'ntagida joylashgan bakteriyalar. Ular to'qimalardan migratsiya qilishadi, ular gingival yoriqlar suyuqligi deb ataladigan maxsus ekssudatda GCF. Neytrofillar gingival yoriqlar maydoniga jalb qilinadi, chunki ular blyashka mikroorganizmlari tomonidan chiqarilgan molekulalar tomonidan signallanadi. Epiteliya hujayralarining zararlanishi natijasida yallig'lanish reaktsiyasiga yordam berish uchun leykotsitlarni jalb qiladigan sitokinlar ajralib chiqadi. Hujayraning normal reaktsiyalari bilan gingival kasallikning boshlanishi o'rtasidagi muvozanat neytrofillar uchun fagotsitoz uchun juda ko'p miqdorda blyashka bakteriyalari mavjud bo'lganda va ular to'qimalarga zarar etkazadigan toksik fermentlarni ajratib chiqaradi. Bu og'izda qizil, shishgan va yallig'langan tish go'shti ko'rinishida paydo bo'lib, klinik tekshiruv paytida yoki tishlarni tozalash paytida qon ketishi mumkin. Ushbu o'zgarishlar kapillyar o'tkazuvchanlikning oshishi va gingival to'qimalarga yallig'lanish hujayralarining kirib borishi bilan bog'liq. Tish go'shti kasalligi aniqlanib, etiologiya olib tashlanmasa, immunitetga javob berishni boshlaydigan bakteriyalar va limfotsitlarning fagotsitik hazm bo'lishiga yordam beradigan makrofaglar kabi hujayralarni qo'shimcha ravishda qo'shib olinadi.[22] Yallig'lanishga qarshi sitokinlar gingival to'qimalarda ishlab chiqariladi va yallig'lanishni yanada kuchaytiradi, bu surunkali tizimli yallig'lanish va kasallikning rivojlanishiga ta'sir qiladi. Natijada kollagen parchalanishi, infiltrat to'planishi, shuningdek periodontal ligamentdagi kollagen parchalanishi va alveolyar suyak rezorbsiyasi. Ushbu bosqichda kasallik gingivitdan periodontitga o'tdi va qo'llab-quvvatlovchi periodontium tuzilishini yo'qotish qaytarilmas.[21]

Xavf omillari

Xavf omili - bu sog'liqni saqlashda "keyinchalik yuzaga keladigan kasallikning ko'payishi bilan bog'liq xususiyat" deb ta'riflanadigan o'zgaruvchidir.[23]Xavf omillari kasallikni keltirib chiqaradigan omil bo'lishdan ko'ra, kasallikka yordam beradigan o'zgaruvchidir. Xavf omillari o'zgartirilishi mumkin va o'zgartirilmasligi mumkin. O'zgartirilishi mumkin bo'lgan xavf omillari odatda xulq-atvorga ega bo'lib, ular individual yoki atrof-muhit sharoitlari bilan o'zgarishi mumkin, ammo o'zgartirilmaydiganlar odatda genetika uchun xosdir va ularni o'zgartirish mumkin emas. Kasallik uchun xavf omillarini aniqlash uchun dalillarga asoslangan tadqiqotlar va tadqiqotlar zarur, uzunlamasına tadqiqotlar eng statistik ahamiyatga ega natijalarni va xavf omillarini aniqlash uchun eng yaxshi ishonchni beradi. Xavf omillari ko'pincha boshqa o'zgaruvchilar bilan birga keladi, kamdan-kam hollarda kasallikka yordam berish uchun yolg'iz harakat qiladi. Xavf omillari genetik, ekologik, xulq-atvor, psixologik va demografik xarakterga ega bo'lishi mumkin.[24]

Gingival va periodontal kasalliklarni rivojlanish xavfi yuqori bo'lgan odamni qo'yishga yordam beradigan ko'plab xavf omillari mavjud. Biroq, periodontal kasallik uchun yagona etiologik omil hisoblanadi bakterial blyashka yoki biofilm. Periodontal kasalliklarni tashxislash, davolash va davolashda xavf omillarini aniqlash muhim rol o'ynaydi. Ilgari har bir insonda periodontal kasalliklarning paydo bo'lish xavfi bir xil ekanligiga ishonishgan, ammo xavf omillarini aniqlash va tasniflash orqali har bir inson sezuvchanlikni keltirib chiqaradigan va zo'ravonlikka sabab bo'ladigan turli xil xavf omillariga ega bo'lishi yaxshi tushunilgan. periodontal kasallik.

Shaxsiy, o'zgartirilishi mumkin bo'lgan xavf omillariga quyidagilar kiradi.

  • Tamaki chekish - Tamaki chekish periodontal kasallikning asosiy xavf omili sifatida qat'iy belgilangan bo'lib, chekish ta'sir qilish va periodontal to'qimalarni yo'q qilish o'rtasidagi munosabatlar turli xil ilmiy maqolalar tomonidan quvvatlanadi.[25] Chekish og'iz to'qimalarining davolanish qobiliyatini pasaytiradi, qon tomirlarini yo'q qiladi va etkazib berish va immunitetga qarshi muhim organizmlarning to'qimalarga kirib borishini oldini oladi. Shuning uchun patogen bakteriyalar periodontal to'qimalarni tezroq yo'q qilishga va kasallikning og'irligini oshirishga qodir.[26] Yallig'lanishning klinik belgilari unchalik sezilmasa ham, chekuvchilar chekmaydiganlar bilan solishtirganda chuqur cho'ntaklari chuqurligi va klinik bog'lanishlari yo'qolgan joylarning katta qismiga ega.[27] Chekishni to'xtatish va maslahat berish tish shifokorlarining periodontal kasalliklarga chalingan bemorlar bilan ishlashining ajralmas qismidir. Chekishni to'xtatish periodontal kasallikning rivojlanishini oldini olish va og'iz mikroflorasini kamroq patogen mikrob holatiga qaytarish uchun isbotlangan.[28]
  • Spirtli ichimliklarni iste'mol qilish - Alkogolning periodontal to'qimalarga ta'sirini uzunlamasına tadqiq qilish shaklida ko'proq tadqiqotlar o'tkazish kerak. Biroq, hozirgi tadqiqotlar shuni ko'rsatadiki, spirtli ichimliklarni iste'mol qilish periodontal kasallikning rivojlanish xavfini o'rtacha darajada oshiradi.[29]
  • Qandli diabet - Qandli diabet modifikatsiyalanadigan xavf omillari toifasiga kiradi, chunki uni davolash mumkin bo'lmasa ham, uni nazorat qilish mumkin, bu periodontal kasallik bilan kurashishda katta yordam beradi. Periodontal kasallikning zo'ravonligi va rivojlanishini to'g'ridan-to'g'ri ta'sir qiladigan qonda glyukoza nazorati bilan va aksincha, aniq ikki tomonlama munosabatlar o'rnatildi. Qandli diabet bilan og'rigan periodontal kasallikdagi bemorlarda davolanish qobiliyati qandli diabetga ega bo'lmaganlarga qaraganda yomonroq bo'ladi va shuning uchun qonda glyukoza nazorati yomon bo'lsa va davolanish qobiliyatlari tizimli kasallikka chalingan bo'lsa, yanada og'ir kasalliklar xavfi ortadi.[23]
  • Semirib ketish va D vitamini etishmasligi ikkalasi ham yonma-yon yuradigan periodontal kasallik uchun xavf omilidir. Semirib ketish odatda meva va sabzavotlar iste'molining kamayishi, yog ', tuz va shakarga boy oziq-ovqat mahsulotlarining ko'payishi bilan bog'liq. Noto'g'ri dieta nafaqat semirishga yordam beradi, balki muhim immunitet tizimini va og'iz to'qimalari va suyaklarini ta'minlashda muhim rol o'ynaydigan muhim oziq moddalar, jumladan S, D vitamini va kaltsiy etishmasligiga olib keladi.[30]
  • Yomon og'iz gigienasi - Blyashka periodontal kasallik uchun yagona etiologik omil bo'lgani uchun,[31] yomon og'iz gigienasi kasallikning boshlanishi, rivojlanishi va og'irligini aniqlashda eng muhim xavf omilidir. Tishlarni tozalash va tishlarni tozalashni amalga oshirish, ehtimol, tish plakasi biofilmini olib tashlash va periodontal kasalliklarning oldini olishning eng samarali usullaridan biridir.
  • Yurak-qon tomir kasalliklari - Og'iz bo'shlig'i gigienasi nafaqat yurak-qon tomir kasalliklarini rivojlanish xavfi bilan aniq aloqada, balki yuqori darajadagi xolesterin va ateroskleroz jarayonida og'iz bakteriyalarining mexanizmlari surunkali periodontit bilan kasallangan odamlarda ko'payishi mumkin.[32]
  • Stress - Turli tadqiqotlar shuni ko'rsatdiki, psixologik, doimiy surunkali stress ostida bo'lgan odamlarda periodontal halokat tufayli klinik bog'lanish yo'qoladi va alveolyar suyak darajasi pasayadi.[33] Bu patogen bakteriyalarga qarshi himoya mexanizmlarini pasaytiradigan ba'zi immunitet hujayralari va interleykinlarning ko'payishi bilan bog'liq, shuning uchun periodontal kasallik rivojlanish ehtimoli ortadi.

O'zgartirilmaydigan xavf omillariga quyidagilar kiradi.

  • Genetika va Xost javobi bir xil egizaklar va izolyatsiya qilingan mahalliy populyatsiyalar bo'yicha o'tkazilgan tadqiqotlarda periodontal kasallik rivojlanishida muhim rol o'ynaganligi ko'rsatilgan.[34] Periodontal kasallik, shuningdek, bakterial patogenlarning agressiv xususiyatlariga emas, balki anormal yoki immunitetning pasayishiga bog'liq bo'lishi mumkin.[35]
  • Osteoporoz - Osteoporoz bilan kasallangan odamlarda tadqiqotlar shuni ko'rsatdiki, alveolyar suyak sog'lom kattalarga qaraganda kamroq zichroq. Biroq, bu periodontal patogenlar yoki klinik birikmaning yo'qolishi bilan aloqani ko'rsatmaydi, shuning uchun osteoporoz periodontal kasallik uchun haqiqiy xavf omili ekanligini tekshirish uchun ko'proq tadqiqotlar o'tkazish kerak.[23]
  • Giyohvand moddalar bilan bog'liq kasalliklar - Ko'pgina dorilar va dorilar periodontal to'qimalarga salbiy ta'sir ko'rsatishi mumkin, bu og'izning quruqligi va gingival giperplaziya kabi turli xil og'iz sharoitlariga yordam beradi.[36] Tish mutaxassislari har bir tashrif paytida poli-dorixona bemorlarining kasallik tarixini qayta ko'rib chiqishlari, bemorlarning xavfini to'g'ri baholashlari va stomatologik davolanish uchun tegishli harakatlarni belgilashlari juda muhimdir.
  • Gematologik kasalliklar Periodontal to'qimalarga qon orqali olib boriladigan muhim hujayralar va oziq moddalar to'qimalarni himoya qilish mexanizmlari va toksinlar va patogenlarga ta'sir qilish, gaz almashinuvi va samarali gemostaz uchun juda muhimdir. Shuning uchun eritrotsitlar periodontiumning sog'lig'ini saqlashda muhim rol o'ynaydi, ya'ni gematologik kasalliklar periodontal to'qimalarga va kasallikning boshlanishiga katta zarar etkazishi mumkin.[37]
  • Homiladorlik - Tadqiqotlar shuni ko'rsatdiki, homiladorlik paytida og'iz to'qimalari ta'sirlanib, o'zgarib turadi, immunitetning pasayishi va qon tomirlari bilan qon ta'minoti va hajmining ko'payishi. homiladorlik gingival va periodontal kasalliklarga olib kelmasligini, ammo ilgari mavjud bo'lgan kasallikning yallig'lanish reaktsiyasini kuchaytirishi mumkinligini ta'kidlash muhimdir. Shuni ham ta'kidlash kerakki, homiladorlik ilgari o'ylanganidek va og'zaki to'qimalarda yoki tishlarda mineral moddalarni kamaytirmaydi va eski xotinlar ertaklarida eshitilishi mumkin. Mavjud kasallik ko'pincha homiladorlik paytida nafaqat og'zaki kasallik sabab bo'lganligi sababli, balki og'iz atrof-muhitining o'zgarishi tufayli yuzaga keladi. Tishlarni tozalash va tishlarni tozalash orqali og'izning yaxshi gigienasi bilan ushbu ta'sirlarning oldini olish mumkin.[38]

Xavfning xususiyatlari, xavf omillari bilan birgalikda, periodontal kasallikning rivojlanish ehtimolini oshirish yoki kamaytirishga yordam beradigan o'zgaruvchilar sifatida ko'rib chiqilishi kerak. Ko'pgina tadqiqotlar shuni ko'rsatadiki, Yosh, Jins, Musobaqa, Ijtimoiy-iqtisodiy holat, Ta'lim va Genetika shuningdek, periodontal kasalliklarga ta'sir o'tkazish bo'yicha kuchli aloqalarga ega.

Periodontal kasallik multifaktorial bo'lib, tish va og'iz sog'lig'i mutaxassislaridan kasallik amaliyotini samarali boshqarish uchun xavf omillari va ularning mexanizmlarini aniq va puxta tushunishni talab qiladi.[24]

Tashxis

Periodontit va ular bilan bog'liq bo'lgan holatlar noyob alomatlar va turli xil oqibatlarga olib keladigan yallig'lanish kasalliklarining keng doirasi sifatida tan olinadi. Kasallikni aniqlash uchun periodontal va gingival kasalliklarni zo'ravonligiga qarab tasniflash uchun tasniflash tizimlaridan foydalanilgan, etiologiya va davolash usullari.[39] Stomatologiya mutaxassislari bemorning ahvoliga yorliq berishlari va a qilishlari uchun tasniflash tizimiga ega bo'lish zarur periodontal diagnostika. Bemorning tibbiy, stomatologik va ijtimoiy tarixini sinchkovlik bilan tekshirib, har qanday moyil xavf omillarini (yuqoriga qarang) yoki uning asosidagi tizimli kasalliklarni hisobga olgan holda tashxis qo'yiladi. Keyinchalik, bu to'liq ichki va qo'shimcha og'zaki tekshiruv natijalari bilan birlashtirilgan. Periodontal skrining yozuvi (PSR) va davolanish ehtiyojlarining jamoat davri periodontal indeksi (CPITN) kabi ko'rsatkichlar ham tashxis qo'yish va kasallikning og'irligini buyurish yoki tasniflashda ishlatiladi.[40]

Agar ushbu jarayon orqali kasallik aniqlansa, unda ko'pincha tish gigienistlari, og'iz terapevtlari yoki mutaxassis tomonidan periodontal to'liq tahlil o'tkaziladi. periodontologlar. Bunga og'izning to'liq periodontal tekshiruvi va cho'ntak chuqurliklari, klinik birikmaning yo'qolishi va turg'unlik o'lchovlari kiradi. Shu bilan birga kasallik darajasi to'g'risida umumiy tushunchaga ega bo'lish uchun blyashka, qon ketish, furkatsiya ishtiroki va harakatchanlik kabi boshqa tegishli parametrlar o'lchanadi. Radiografiyalar alveolyar suyak darajasini va yo'q qilish darajasini baholash uchun ham amalga oshirilishi mumkin.[41]

Davolash

Periodontal terapiya bosqichlari

Zamonaviy periodontal davolash "Trimeric Model" asosida ishlab chiqilgan va 4 bosqichda amalga oshiriladi. Ushbu bosqichlar periodontal terapiyani mantiqiy ketma-ketlikda olib borilishini ta'minlash uchun tuzilgan va natijada prognoz Belgilanmagan davolash rejasi bilan taqqoslaganda, bemor aniq maqsadsiz.

I bosqich terapiyasi (boshlang'ich terapiya - kasalliklarni nazorat qilish bosqichi)

Jarrohlikdan tashqari bosqich

Jarrohlik bo'lmagan bosqich - bu periodontal davolanish uchun zarur bo'lgan protseduralar ketma-ketligining dastlabki bosqichidir.[42] Ushbu bosqich gingival yallig'lanishni olib tashlash orqali kamaytirish va yo'q qilishga qaratilgan tish blyashka, hisob (tish), tiklash tish chirishi va nuqsonli tiklanishni to'g'irlash, chunki bularning barchasi tish go'shti yallig'lanishiga yordam beradi gingivit.[42] I bosqich favqulodda vaziyatlarni davolash, mikroblarga qarshi terapiya, parhezni nazorat qilish, bemorlarni o'qitish va rag'batlantirish, yatrogen omillarni tuzatish, chuqurlikdan iborat karies, umidsiz tishlar, dastlabki miqyosi, vaqtincha splinting, okklyuzion sozlash, kichik ortodontik tish harakati va tozalash (tish).[42]

Qayta baholash bosqichi

Ushbu bosqichda bemorlar dastlabki terapiyadan 3-6 xafta o'tgach; I bosqich terapiyasidan so'ng amalga oshirilgan bosqichlarni qayta baholash talab etiladi.[42] Odatda periodontal kasallikning og'ir holatlarida 3-6 xaftani qayta baholash juda muhimdir. Qayta baholashni talab qiladigan elementlar dastlabki terapiya natijalari (I bosqich terapiyasi), og'iz gigienasi va holati, qon ketishi va blyashka ballari va qayta ko'rib chiqilishi tashxis va prognoz va agar kerak bo'lsa, butun davolash rejasini o'zgartirish.[43]

II bosqich terapiyasi (jarrohlik bosqichi)

I bosqichdan keyin talabni baholash kerak periodontium jarrohlik uchun.[43] Jarrohlik bosqichini belgilaydigan omillar quyidagilar: periodontal cho'ntak muayyan vaziyatlarda boshqarish, tartibsiz suyak konturlari yoki chuqur kraterlar, mahalliy konlarni to'liq va to'liq olib tashlanmaganligi gumon qilinayotgan joylar, II va III darajalar furkatsiya ishtirok etish, distal kutilayotgan molarlarning so'nggi tishlari mukogingival birikma muammolar, doimiy yallig'lanish, ildizni qoplash va olib tashlash tish go'shtining kattalashishi.

III bosqich terapiyasi (tiklovchi faza)

Ushbu bosqichda har qanday nuqsonlarni olib tashlanishi yoki bartaraf etish yo'li bilan tiklash kerak tish protezi, prostodontiya yoki boshqa tiklash jarayoni.[42]

IV bosqich terapiyasi (parvarishlash bosqichi)

Periodontal terapiyaning so'nggi bosqichi periodontal sog'liqni saqlashni talab qiladi. Ushbu bosqichda bemorlar kasallikning takrorlanishini oldini olish uchun parvarishlash bo'yicha rejalashtirilgan reja asosida qayta tashrif buyurishlari shart.[43] Ta'minot bosqichi periodontal davolanish uchun uzoq muddatli muvaffaqiyatni tashkil etadi va shu bilan ular o'rtasidagi uzoq munosabatlarga yordam beradi og'iz orqali terapevt /tish shifokori /periodontist va sabrli.[43]

Periodontal va restorativ interfeys

The prognoz Qayta tiklovchi davolanish davri sog'lig'i bilan belgilanadi. Qayta tiklovchi davolanishdan oldin periodontal sog'liqni saqlash maqsadlari quyidagilardan iborat:

  1. Periodontal davolanishni firma tashkil etilishini ta'minlash uchun boshqarish kerak tish go'shti chegarasi tiklash uchun tishni tayyorlashdan oldin. Qayta tiklovchi manipulyatsiya paytida qon ketadigan to'qimalarning yo'qligi, kirish va estetik natijalarni ta'minlaydi.[43]
  2. Tishlarni ushlab turish uchun etarli tish uzunligini oshirish uchun ma'lum bir periodontal davolash shakllantiriladi. Oldindan tiklangan ushbu usullarni bajarmaganlik taassurot qoldirish, tish tayyorlash va tiklash kabi muolajalarning murakkabligi yoki muvaffaqiyatsiz bo'lish xavfiga olib kelishi mumkin.
  3. Periodontal terapiya rezolyutsiya sifatida restorativ usulga amal qilishi kerak gingival yallig'lanish tishlarning qayta joylashishiga yoki yumshoq to'qimalar va shilliq qavatdagi o'zgarishlarga olib kelishi mumkin.[43]

Periodontal davolash standarti

Jarrohlik bo'lmagan terapiya bu periodontal terapiyaning oltin standartidir tozalash (tish) birikmasi bilan og'iz gigienasi ko'rsatmalar va bemorni turtki. Bu asosan taxminiylikni yo'q qilish va kamaytirishga qaratilgan patogenlar va periodontal kasallikni barqarorlashtirish uchun mikrobial florani qulay muhitga o'tkazish.[44] Debridment (stomatologik) is thorough mechanical removal of calculus and dental biofilm from the root surfaces of the tooth.[45] Debridment (stomatologik) is the basis of treatment for inflammatory periodontal diseases and remains the golden standard for surgical and non-surgical treatment in the initial therapy. It is conducted by hand instrumentation such as curettes or scalers and ultrasonic instrumentation.[46] It requires a few appointments, depending on time and clinician skills for effective removal of supragingival and subgingival hisob (tish), qachon periodontal pocket ishtirok etadi. It can assist in periodontal healing and reduce periodontal pocketing by changing the subgingival ecological environment.[46] Prevention of periodontal disease and maintenance of the periodontal tissues following initial treatment requires on the patient's ability to perform and maintain effective tish blyashka olib tashlash.[46] This requires patient to be motivated in improving their og'iz gigienasi and requires behaviour change in terms of tishlarni tozalash, interdental cleaning, and other oral hygiene techniques.[47] Personal oral hygiene is often the considered an essential aspect of controlling surunkali periodontit Research has shown that it is important to appreciate the motivation of the patient behaviour changes that has originated from the patient.[47] Patients must want to improve their oral hygiene and feel confident that they have the skills to do this. It is crucial for the clinician to encourage patient changes and to educate the patient appropriately. Motivatsion intervyu is a good technique to ask open-ended questions and express empathy towards the patient.

Role of the Oral Health Therapist

An Og'iz orqali davolash bo'yicha terapevt is a member of the dental team who is dual qualified as a Dental Hygienist va Tish terapevti. They work closely with Dentists and a number of Dental Specialists including Periodontists. It is common for the Oral Health Therapist to be involved in the treatment of gingival and periodontal diseases for patients. Their scope of practice in this area includes oral health assessment, diagnosis, treatment and maintenance and referral where necessary. They also have expertise in providing oral health education and promotion to support the patient to maintain their at home oral care.[48] Oral Health Therapists are employed into the dental team to share the responsibilities of care. They are an important asset as they have been uniquely and specifically trained in preventative dentistry and risk minimisation. This allows the dental team to work more competently and effectively as Dentists can manage more complex treatments or significantly medically compromised patients.[49]

Periodontist

A periodontist is a specialist dentist who treats patients for periodontal related diseases and conditions. They are involved in the prevention, diagnosis and treatment of periodontal disease. Periodontists receive further specialist training in Periodontics after completing a dental degree. Periodontists provide treatments for patients with severe gingival diseases and/or complex medical histories. Periodontists offer a wide range of treatments including root scaling and planing, periodontal surgery, implant surgery and other complex periodontal procedures.[50]

Dental-implant

List of procedures performed by a periodontist:[50]

  • Non-Surgical Treatments
  • Gum Graft Surgery
  • Laser Treatment
  • Regenerative Procedures
  • Dental Crown Lengthening
  • Dental Implants
  • Pocket Reduction Procedures
  • Plastic Surgery Procedures

Patient's are able to access treatment from a specialist periodontist with an appropriate referral from a dental practitioner. The Dental Hygienist, Oral Health Therapist or Dentist will decide upon whether or not the patient requires further treatment from a Periodontist. The practitioner will then fill out a referral form outlining both patient and practitioner concerns, needs and wants.[iqtibos kerak ]

O'qitish

Before applying to any postgraduate training program in periodontology, one must first complete a tish darajasi.

Evropa

Although each European country has its own independent system, an umbrella organisation—the European Federation of Periodontology (EFP)—has the ability to accredit post-graduate programs according to specific guidelines. The EFP awards a certificate of specialized training in periodontology, periodontics and implant dentistry to every successful European candidates after 3 years of full-time training in an accredited post-graduate program. The EFP organizes bi-annual meetings around Europe under the title EuroPerio where many thousands of dentists attend the sessions featuring over 100 of the world's top perio speakers.[51][52] The graduate programs that have been approved are the following: Academic Centre for Dentistry Amsterdam [nl ], Bern universiteti, Sahlgrenska universiteti kasalxonasi, Institute for Postgraduate Dental Education Jönköping, UCL Eastman stomatologiya instituti, Luvayn universiteti (UCLouvain), University Complutense Madridda, Dublin universiteti, Trinity kolleji, Strasburg universiteti yilda Frantsiya, Parij Didro universiteti at Rothschild hospital.[iqtibos kerak ]

Avstraliya

Australian programs are accredited by the Australian Dental Council (ADC) and are 3 years in length and culminate with either a Magistrlik darajasi (MDS) or a Doctor of Clinical Dentistry degree (DClinDent). Fellowship can then be obtained with the Avstraliyalik qirollik stomatologiya jarrohlari kolleji, FRACDS (Perio).[iqtibos kerak ]

Kanada

Canadian programs are accredited by the CDAC[53] and are a minimum of three years in length and usually culminate with a master (MSc or MDent) degree. Graduates are then eligible to sit for the Fellowship exams with the Kanadaning Qirollik stomatologiya kolleji (FRCD(C)). Dentistry is a regulated profession. To become a licensed dentist in Canada you must have a BDS/DDS/DMD degree and be certified by the NDEB.[54] To further specialise into periodontics, accredited dentists are required to undertake a specialty core knowledge examination and complete a postgraduate degree.[iqtibos kerak ]

Hindiston

Periodontics is offered as a specialization field of dentistry in Hindiston. Periodontists attend a Tish jarrohligi magistri (M.D.S.) program affiliated with dental schools in India. The minimum qualification required for the M.D.S. daraja a Tish jarrohligi bakalavri. A majority of dental schools in India offer M.D.S. degrees specializing in Periodontology. The course is three years and students are trained for implantologiya as well as diagnosis and treatment of peri implant diseases along with Periodontology.[iqtibos kerak ]

Birlashgan Qirollik

The Britaniya Periodontologiya Jamiyati exists to promote the art and science of periodontology. Their membership includes specialist practitioners, periodontists, general dentists, consultants and trainees in restorative dentistry, clinical academics, dental hygienists and therapists, specialist trainees in periodontology and many others.[iqtibos kerak ]

Specialist training in periodontics in the UK is either a three-year full-time or four years at three days per week. At the end of the training, candidates are awarded a Master of Clinical Dentistry (MClinDent) before being entered on the specialist list held by the Bosh stomatologiya kengashi.[iqtibos kerak ]

Qo'shma Shtatlar

UCLA stomatologiya maktabi periodontics graduate clinic

The Amerika stomatologiya assotsiatsiyasi (ADA) accredited programs are a minimum of three years in length. Ga ko'ra Amerika Periodontologiya Akademiyasi, U.S.-trained periodontists are specialists in the prevention, diagnosis and treatment of periodontal diseases and oral inflammation, and in the placement and maintenance of dental implants.[55] Many periodontists also diagnose and treat oral pathology. Historically, periodontics served as the basis for the specialty of og'iz orqali davolash. Following successful completion of post-graduate training a periodontist becomes Board eligible for the American Board of Periodontology imtihon. Successful completion of board certification results in Diplomate status in the American Board of Periodontology.[iqtibos kerak ]

Texnik xizmat

After periodontal treatment, whether it be surgical or non-surgical, maintenance periodontal therapy is essential for a long term result and stabilization of periodontal disease. There is also a difference in the maintenance of different types of periodontal disease, as there are different types, such as:[56]

Gingivit

The reversible inflammation of the gums, is easily maintained and easily done by patients alone. After the removal of the inflammatory product, usually plaque or calculus, this allows the gums room to heal. This is done by patients thoroughly cleaning teeth every day with a soft bristle toothbrush and an interdental aid. This can be floss, flosset, pikster or what is preferred by patient. Without patient compliance and constant removal of plaque and calculus, gingivitis cannot be treated completely and can progress in to periodontitis that is irreversible.[57]

Necrotising ulcerative gingivitis (NUG)

Also Acute necrotising ulcerative gingivitis and necrotising ulcerative periodontitis, a type of periodontal disease, different than many other periodontal diseases, clinical characteristics of, gingival necrosis (break down of the gums), gingival pain, bleeding, and halitosis (bad breath), also has a grey colour to the gingiva and a punched out appearance. It is treated through debridement usually under local aesthetic due to immense pain. To maintain and treat the condition completely, a Chlorhexidine mouth wash should be recommended to the patient to use twice daily, oral health instruction should be provided, using a soft bristle toothbrush twice a day or an electric toothbrush and an interdental cleaning aid, such as floss or piksters which cleans the areas that the toothbrush cannot reach. Patient should also be educated on proper nutrition and diet, and also healthy fluid intake, also to complete cease disease smoking cessation should be done not just to completely eradicate disease but also for health od patient. Pain control can be done through ibuprofen or Panadol. In the case of an immunocompromised patient antibiotics should be prescribed. Assessment of treatment should be done after 24 hours of treatment and continued to do so every 3–6 months until signs and symptoms are resolved and gingival health and function restored.[58]

Surunkali periodontit

The inflammation of the gums and irreversible destruction of the alveolar bone and surrounding structures of the teeth, usually slow progressing but can have bursts. Local factors explain presence of disease, such as, diet, lack of oral hygiene, plaque accumulation, smoking etc. Characterised by pocket formation and recession (shrinkage of the gums) of the gingiva. Treatment and maintenance are important in stopping disease progression and to resolve the inflammation, treatment usually consist of scaling and root planning, surgical therapy, regenerative surgical therapy. After treatment, patient care and regular maintenance check ups are important to completely eradicate disease and present reappearance of the disease. This is done through patient effective plaque control and removal, done through daily toothbrushing of twice a day and interdental cleaning once a day, chlorhexidine mouthwash can also be effective. Patient should also present to dentist for maintenance check ups at least every three-months for in office check-up and if necessary, plaque control.[59]

Agressiv periodontit

Involves inflammation of the gingiva and rapid and severe destruction of the periodontal ligament, alveolar bone and surrounding structures, different to chronic periodontitis often happens in patients with good oral health and plaque control and can be genetic. Patients generally appear clinically healthy. It can be localised, which generally has a circumpubertal onset, and generalised which usually occurs in individuals above the age of 35. Treatment is determined on the severity of the disease and the age of the patient. Usually supra gingival (above gums) and sub gingival (under gums) debridement and antibiotics are sometimes necessary. To maintain the treatment and prevent reoccurrence of disease patient care is necessary, such as oral hygiene, like all other forms of periodontitis and gingivitis, brushing twice a day and interdental cleaning is a necessity in maintaining a healthy periodontium and preventing the continuation of periodontal destruction. Regular periodontal check ups are also necessary, every 3–6 months.[iqtibos kerak ]

Periodontit tizimli kasallikning namoyon bo'lishi sifatida

Periodontitis that is caused by systemic disease, there are currently at least 16 systemic diseases that have been linked with periodontal disease, such as, diabetes mellitus, haematological disorders such as acquired neutropenia and leukemia, down syndrome etc. Treatment and preventions are a very important concept in the management and maintenance of periodontitis as a manifestation of systemic disease. Treatment can consist of either surgical or non surgical treatment depending on severity. After treatment patient compliance is important which includes oral hygiene which is tooth brushing twice a day, interdental brushing at least once a day and chlorohexidine mouth wash may also be helpful.[iqtibos kerak ]

Shuningdek qarang

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