Periodontics | Diagnosis & Periodontal Exam | INBDE, ADAT

00:15:25
https://www.youtube.com/watch?v=Pm8s9aqs7Ug

Ringkasan

TLDRO vídeo é uma introdução à periodontia, uma especialidade da odontologia voltada para os tecidos que circundam e suportam os dentes, como o osso alveolar, ligamento periodontal, cemento e gengiva. Discute a anatomia da região periodontal, diferencias entre gengiva livre e aderida, e a importância de estruturas como a junção mucogengival. Destaca a distinção entre tecidos saudáveis e doenças periodontais, ressaltando o papel da placa microbiana (biofilme) como fator causador principal. Diferenciações como erosão, abrasão, atrição e abfração são apresentadas em relação ao exame dentário, e também define conceitos como profundidade de bolsa periodontal e perda de inserção clínica. O vídeo é parte de uma série focada na preparação para exame, mas também útil para aplicações clínicas gerais.

Takeaways

  • 🦷 Periodontia envolve estruturas de suporte dos dentes, como osso e gengiva.
  • 📚 Vídeo foca em tópicos relevantes para exames e prática clínica.
  • 🩺 Gengivite é inflamação sem destruição, periodontite inclui destruição tecidual.
  • 🦠 Placa bacteriana é o fator inicial nas doenças periodontais.
  • 📏 Profundidade de bolsa e perda de inserção são medidas críticas no exame periodontal.
  • 🔬 Patogênese da doença periodontal envolve interação bactéria-hospedeiro.
  • 🩸 Sangramento à sondagem é um importante indicativo de inflamação.
  • 🗺️ Saúde periodontal é medida por níveis de inflamação e destruição tecidual.
  • 📉 Diferenciação entre erosão, abrasão, atrição e abfração no contexto dentário.
  • 🦠 Importância do biofilme no desenvolvimento e progressão das doenças periodontais.

Garis waktu

  • 00:00:00 - 00:05:00

    Ryan dá as boas-vindas à série sobre periodontia, destacando a importância do tema no Exame de Conselho, especificamente no Parte C, e sua relevância para a prática clínica e conhecimento geral. Ele oferece uma introdução à periodontia, descrevendo-a como a área da odontologia dedicada ao estudo dos tecidos que sustentam o dente, incluindo osso alveolar, ligamento periodontal, cemento e gengiva. Ele explica a diferença entre sulco gengival saudável e bolsa periodontal, descreve as estruturas gengivais e suas características, como a livre e a gengiva inserida e a mucosa alveolar, destacando sua importância em patologia oral.

  • 00:05:00 - 00:10:00

    Ryan continua discutindo a doença periodontal, explicando que a placa microbiana é o fator inicial fundamental, levando à gengivite e periodontite. Ele detalha a patogênese, que começa com o desafio microbiano da placa subgengival, levando a uma resposta inflamatória do hospedeiro. Se não tratada, pode evoluir para destruição tecidual, caracterizando a periodontite. Ryan também fala sobre termos importantes para o exame, como erosão, abrasão, atrição, abfração e hipersensibilidade, necessários para o entendimento do exame do dente em periodontia.

  • 00:10:00 - 00:15:25

    Ryan discute as medições periodontais objetivas essenciais: profundidade de bolsa à sondagem, perda de inserção clínica e sangramento à sondagem. Ele explica com exemplos detalhados como medir cada um. As medições adicionais incluem recessão gengival e perda óssea alveolar. Ele sublinha a importância de um exame oral completo que avalie os cuidados domiciliares do paciente e outros fatores como a presença de placa, cálculo, inflamação e destruição dos tecidos periodontais. Ele conclui o vídeo incentivando a continuidade na exploração do mundo da periodontia.

Peta Pikiran

Video Tanya Jawab

  • O que é periodontia?

    A periodontia é uma especialidade da odontologia que lida com os tecidos que circundam e suportam os dentes, como osso alveolar, ligamento periodontal, cemento e gengiva.

  • O que é uma bolsa periodontal?

    Uma bolsa periodontal é um espaço patologicamente profundo entre o dente e a gengiva, resultante da progressão de doenças periodontais.

  • Qual é o fator inicial na doença periodontal?

    Placa microbiana, uma camada de bactérias que se acumula na superfície dos dentes, é considerada o fator inicial na doença periodontal.

  • Qual é a diferença entre gengivite e periodontite?

    Gengivite é a inflamação da gengiva sem destruição dos tecidos de suporte, enquanto a periodontite envolve inflamação com destruição dos tecidos.

  • O que significa perda de inserção clínica (CÁL)?

    CÁL é a perda de inserção clínica medida a partir da junção cemento-esmalte até a base da bolsa periodontal.

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Teks
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Gulir Otomatis:
  • 00:00:00
    hey everyone this is Ryan here and
  • 00:00:03
    welcome to the next series on
  • 00:00:05
    periodontics and we're gonna cover a lot
  • 00:00:08
    of great topics in this series it's by
  • 00:00:10
    far one of the most requested from my
  • 00:00:13
    viewers and it has a quite a lot of
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    questions on the Part C Board Exam with
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    48 out of the total 500 and will cover
  • 00:00:22
    each one of these seven categories in
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    order focusing mostly on treatment and
  • 00:00:28
    therapy which is as you can see most
  • 00:00:31
    frequently tested so that being said
  • 00:00:33
    like all of my videos I'm gonna focus
  • 00:00:35
    only on the highest feel things you need
  • 00:00:37
    to know for the exam and while I'm
  • 00:00:39
    gearing these videos for exam
  • 00:00:41
    preparation they can also give you a
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    nice overview for clinical application
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    and general knowledge so what is
  • 00:00:49
    periodontics well periodontics is the
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    branch of Dentistry concerned with the
  • 00:00:55
    periodontium which refers to the hard
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    and soft tissues that surround and
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    support the tooth including the alveolar
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    bone the PDL or the periodontal ligament
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    the cementum and the gingiva so before
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    we can talk about disease let's talk
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    about healthy normal tissue and this is
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    an excellent excellent diagram that we
  • 00:01:20
    can study from and you can notice right
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    off the bat we have our four components
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    of the periodontium those being the
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    alveolar bone the cementum the
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    periodontal ligament which is between
  • 00:01:33
    the cementum and the alveolar bone and
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    the gingiva so let's start by talking
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    about the gingival sulcus sometimes also
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    called the gingival crevice and it's the
  • 00:01:45
    natural space between the tooth and the
  • 00:01:49
    gingiva that surrounds the tooth now
  • 00:01:52
    everybody has a sulcus everyone has
  • 00:01:55
    sulcus between their teeth and their
  • 00:01:59
    gums but when it's pathologically
  • 00:02:02
    deepened then it's called a periodontal
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    pocket and we'll talk a lot about
  • 00:02:07
    pockets throughout this series next
  • 00:02:11
    let's talk about the free-gingival more
  • 00:02:14
    sometimes also called the gingival crest
  • 00:02:16
    this is the peak of the gingiva and it's
  • 00:02:20
    a really important landmark from which
  • 00:02:22
    you'd base most of your periodontal
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    measurements next we have the free
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    gingival groove also sometimes called
  • 00:02:31
    the marginal groove and it's a shallow
  • 00:02:33
    linear depression on the gingival
  • 00:02:36
    surface that demarcates the free gingiva
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    from the attached gingiva now it's more
  • 00:02:44
    evident this shallow linear depression
  • 00:02:48
    is more evident in some patients than
  • 00:02:50
    others but it's an important landmark
  • 00:02:52
    nonetheless if we go a little bit
  • 00:02:55
    further down we'll get to the Mew coach
  • 00:02:57
    in Deauville junction which is exactly
  • 00:02:59
    what the name suggests it's a junction
  • 00:03:02
    between the attached gingiva and the
  • 00:03:06
    alveolar mucosa
  • 00:03:08
    hence mu Cao gingival Junction and if we
  • 00:03:13
    were to go a little bit further down
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    beyond what this diagram shows and we
  • 00:03:19
    said we have this here and then the lip
  • 00:03:23
    would be somewhere over here if we added
  • 00:03:28
    in a couple more components to really
  • 00:03:30
    flesh out this diagram we'd have what's
  • 00:03:33
    called the vestibular fold at the bottom
  • 00:03:36
    which would be the transition between
  • 00:03:37
    the alveolar mucosa and the labial or
  • 00:03:41
    buccal mucosa depending on if you're
  • 00:03:44
    near the lip or the cheek so the free
  • 00:03:49
    gingiva is called free because it's not
  • 00:03:52
    bound down while the attached gingiva is
  • 00:03:55
    firmly attached and bound down to the
  • 00:03:58
    underlying bone and the mucosa is once
  • 00:04:03
    again not bound down and these were
  • 00:04:06
    important considerations particularly
  • 00:04:08
    for oral pathology where some lesions
  • 00:04:10
    appear on bound tissue while others do
  • 00:04:13
    not and also note that the free gingiva
  • 00:04:16
    and the attached gingiva all throughout
  • 00:04:20
    here are Carentan eyes while the
  • 00:04:24
    alveolar mucosa is not correct
  • 00:04:27
    so the fridge in Java is cratan eyes but
  • 00:04:32
    not bound down the attached gingiva is
  • 00:04:35
    both cratan eyes and bound down and the
  • 00:04:38
    alveolar mucosa is neither bound down
  • 00:04:41
    nor keratinized so I think this gives a
  • 00:04:44
    really really nice overview of the
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    normal periodontium all the different
  • 00:04:48
    components and how they're characterized
  • 00:04:50
    so now let's talk about periodontal
  • 00:04:53
    disease when there's some problem with
  • 00:04:56
    the periodontal apparatus so periodontal
  • 00:05:00
    disease is again where there's some
  • 00:05:03
    issue going on with the periodontium and
  • 00:05:06
    microbial plaque is generally considered
  • 00:05:09
    the initiating factor this is super
  • 00:05:11
    important microbial plaque also known as
  • 00:05:14
    biofilm is the accumulation of bacteria
  • 00:05:17
    in a film layer on the tooth surface and
  • 00:05:20
    this could absolutely be an exam
  • 00:05:23
    question where this is generally
  • 00:05:26
    considered the initiating factor and
  • 00:05:28
    periodontal disease so three states we
  • 00:05:32
    have periodontal health there's no
  • 00:05:35
    inflammation no PDL or bone destruction
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    gingivitis is where we have inflammation
  • 00:05:41
    but we don't have any tissue destruction
  • 00:05:44
    and periodontitis or something
  • 00:05:48
    synonymous with periodontal disease
  • 00:05:49
    where we have inflammation and we have
  • 00:05:52
    PDL and bone destruction which is known
  • 00:05:56
    as Cal and we'll talk more about this in
  • 00:05:59
    a later slide so let's talk a little bit
  • 00:06:03
    about pathogenesis
  • 00:06:04
    and I'll say this over and over again
  • 00:06:06
    but periodontal disease is all about an
  • 00:06:10
    interplay between bacteria and the host
  • 00:06:14
    so we have step number one microbial
  • 00:06:18
    challenge presented by sub gingival
  • 00:06:21
    plaque bacteria and again notice how
  • 00:06:25
    plaque is the initiating factor so
  • 00:06:28
    plaque bacteria challenge the host by
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    presenting things like
  • 00:06:32
    lipopolysaccharide antigens and other
  • 00:06:35
    byproducts
  • 00:06:38
    as a response the we have an up
  • 00:06:41
    regulated host immune inflammatory
  • 00:06:44
    response so in other words the host
  • 00:06:46
    responds to this microbial challenge by
  • 00:06:50
    up regulating and sending all of these
  • 00:06:53
    disease fighting white blood cells to
  • 00:06:55
    the site of infection which causes
  • 00:06:58
    inflammation redness swelling things
  • 00:07:02
    like that so this alone was our
  • 00:07:04
    definition of gingivitis inflammation
  • 00:07:06
    without PDL and bone destruction but if
  • 00:07:10
    this challenge stays for an extended
  • 00:07:12
    period of time if it's chronic or if
  • 00:07:15
    it's particularly potent if it's
  • 00:07:17
    aggressive then we get tissue
  • 00:07:19
    destruction which is our definition of
  • 00:07:21
    periodontitis inflammation with PDL and
  • 00:07:25
    bone destruction in effect and this is
  • 00:07:28
    how I think of it the body is retreating
  • 00:07:32
    the bone away from the plaque in order
  • 00:07:35
    to protect itself the great paradox is
  • 00:07:38
    that the body is destroying itself in
  • 00:07:40
    order to protect itself and that's
  • 00:07:43
    periodontal disease in a very simplified
  • 00:07:45
    nutshell and we'll cover a lot more of
  • 00:07:48
    the specifics later in a video just on
  • 00:07:51
    pathogenesis
  • 00:07:54
    all right so tooth exam this is not just
  • 00:07:58
    important in periodontics but all of
  • 00:08:00
    Dentistry but I want to throw in these
  • 00:08:02
    terms because they're very important and
  • 00:08:04
    absolutely will appear on the board exam
  • 00:08:07
    so erosion is caused by acidic foods or
  • 00:08:11
    beverages or a gastric acid so erosion
  • 00:08:14
    is all about acid abrasion is where you
  • 00:08:18
    have loss of tooth structure by
  • 00:08:20
    mechanical where this would be like if
  • 00:08:22
    you're using a hard bristled toothbrush
  • 00:08:25
    and you were doing so very aggressively
  • 00:08:27
    and abrading to structure away overtime
  • 00:08:31
    attrition is where you have a clue so
  • 00:08:34
    where from functional contacts with
  • 00:08:37
    opposing teeth this is particularly
  • 00:08:39
    evident with patients with bruxism
  • 00:08:41
    clenching habits they'll get occlusal
  • 00:08:44
    wear and incisal wear over time a
  • 00:08:47
    fraction is a loss of two structure in
  • 00:08:50
    cervical areas due to tooth
  • 00:08:52
    flexure this can also be a byproduct of
  • 00:08:56
    something like attrition or bruxism or
  • 00:08:58
    clenching where the teeth are being
  • 00:09:00
    flexed and lost and lose some to
  • 00:09:03
    structure in their cervical areas over
  • 00:09:05
    time and hypersensitivity can be the
  • 00:09:08
    result of exposure of dentinal tubules
  • 00:09:11
    and the root surfaces this is something
  • 00:09:14
    that a lot of patients have concerns
  • 00:09:16
    about and things like Sensodyne or
  • 00:09:18
    fluoride products can be used to help
  • 00:09:22
    treat hypersensitivity in some cases all
  • 00:09:27
    right so after we do a tooth exam we're
  • 00:09:31
    doing a periodontal exam which is
  • 00:09:32
    particularly important of course for
  • 00:09:34
    periodontics now these are the three
  • 00:09:37
    most objective periodontal measurements
  • 00:09:39
    and they all have handy three-letter
  • 00:09:42
    acronyms so we'll start talking about
  • 00:09:45
    the probing pocket depth and I mentioned
  • 00:09:48
    pockets before this is what they are
  • 00:09:50
    they're measured from the gingival
  • 00:09:53
    margin to the base of the pocket here
  • 00:09:56
    you see a periodontal probe this one is
  • 00:09:59
    measuring in increments of three
  • 00:10:01
    millimeters so if we measure from the
  • 00:10:05
    gingival margin or the gingival crest to
  • 00:10:08
    the base of the pocket you can see that
  • 00:10:10
    this is three millimeters six
  • 00:10:13
    millimeters total for the pocket depth
  • 00:10:15
    so our probing pocket depth would be six
  • 00:10:18
    millimeters next we have clinical
  • 00:10:21
    attachment loss or Cao which I also
  • 00:10:23
    mentioned previously in this video this
  • 00:10:26
    is measured from the cej the
  • 00:10:29
    cementoenamel junction which is a fixed
  • 00:10:31
    point on the tooth to the base of the
  • 00:10:34
    pocket now in this image and this is not
  • 00:10:37
    always the case
  • 00:10:38
    the cej is at the same part as the
  • 00:10:42
    gingival margin so if we measure from
  • 00:10:44
    the CJ to the base of the pocket we're
  • 00:10:46
    once again going to get a six millimeter
  • 00:10:48
    measurement so our Cal is six
  • 00:10:50
    millimeters and bleeding on probing or
  • 00:10:54
    Bo P is actually the best measure of
  • 00:10:56
    inflammation and periodontal tissues and
  • 00:10:59
    this is when you go you probe a site
  • 00:11:01
    you're going to make a measurement for
  • 00:11:03
    your PPD and your Cal
  • 00:11:05
    it's bleeding a little bit or maybe a
  • 00:11:07
    lot however much if it is bleeding then
  • 00:11:10
    we have a positive recording of Bo P so
  • 00:11:14
    we would say if the patient had been
  • 00:11:16
    bleeding from this site after we probed
  • 00:11:18
    then we would say there's a positive Bo
  • 00:11:21
    P at the site alright so let's do a
  • 00:11:26
    couple more examples we've already
  • 00:11:28
    talked about the middle example that was
  • 00:11:30
    in the last slide we had our PPD of
  • 00:11:32
    6-hour Cal of six let's talk about this
  • 00:11:35
    one next so if we were to measure again
  • 00:11:38
    let's start with the pocket depth from
  • 00:11:40
    gingival margin to the base of the
  • 00:11:42
    pocket now let's say that would be about
  • 00:11:45
    four millimeters now how about the
  • 00:11:49
    clinical attachment loss though the cej
  • 00:11:52
    is a fixed landmark and it's actually in
  • 00:11:55
    the same place as it was in the middle
  • 00:11:57
    example and the base of the pocket is in
  • 00:12:00
    the same place as it was in the middle
  • 00:12:02
    example so if we were to measure from
  • 00:12:04
    cej to the base of the pocket
  • 00:12:07
    we'll get that same six millimeter
  • 00:12:09
    measurement now another equation that
  • 00:12:13
    can sometimes help with some of these
  • 00:12:15
    examples is clinical attachment losses
  • 00:12:18
    equal to the probing pocket depth plus
  • 00:12:21
    the amount of gingival recession so like
  • 00:12:25
    in this example we had our pocket depth
  • 00:12:27
    of four millimeters and you notice there
  • 00:12:29
    was two millimeters of gingival
  • 00:12:31
    recession where we had exposed root
  • 00:12:34
    surface so if we add four plus two we
  • 00:12:37
    get six millimeters of clinical
  • 00:12:38
    attachment loss now for the example on
  • 00:12:43
    the right this one's very different and
  • 00:12:45
    we actually have some swelling of the
  • 00:12:48
    gingiva and there is this almost
  • 00:12:52
    negative
  • 00:12:53
    recession so let's do our probing pocket
  • 00:12:56
    depth first if we went from gingival
  • 00:12:58
    margin to the base of the pocket that
  • 00:13:01
    would be about nine millimeters but now
  • 00:13:04
    how about clinical attachment loss well
  • 00:13:07
    you might have noticed the CJS in the
  • 00:13:09
    same exact spot as it is in these two
  • 00:13:11
    examples as is the base of the pocket so
  • 00:13:14
    the clinical attachment loss is going to
  • 00:13:17
    be the same
  • 00:13:18
    we have a probing pocket depth of nine
  • 00:13:21
    clinical attachment loss of six now you
  • 00:13:24
    could also this equation works for all
  • 00:13:26
    three of these examples you could use it
  • 00:13:28
    on the right example and you'd say the
  • 00:13:31
    pocket depth is nine millimeters there's
  • 00:13:33
    negative recession it would be negative
  • 00:13:36
    three and you get your six millimeters
  • 00:13:38
    so it's a bit more roundabout in that
  • 00:13:39
    example but it can be handy to keep in
  • 00:13:42
    your back pocket now these are some
  • 00:13:46
    additional periodontal measurements we
  • 00:13:48
    have gingival recession which we've
  • 00:13:50
    talked about this is measured from the
  • 00:13:52
    cej to the gingival margin and you have
  • 00:13:55
    exposure of root surface due to apical
  • 00:13:58
    shift of the gingival margin alveolar
  • 00:14:01
    bone loss is a radiographic measurement
  • 00:14:03
    which we'll cover in the next video but
  • 00:14:06
    it's not quite reliable as we'll soon
  • 00:14:08
    see
  • 00:14:09
    separation indicates large number of
  • 00:14:11
    neutrophils in the pocket this is the
  • 00:14:14
    expression of pus from a pocket on
  • 00:14:17
    measurements mobility could be due to
  • 00:14:20
    the loss of periodontal support a
  • 00:14:23
    traumatic occlusion or the combination
  • 00:14:25
    of both and for occasion involvement
  • 00:14:28
    would be bone loss at the branching
  • 00:14:30
    point of a tooth root and we'll talk a
  • 00:14:32
    lot about vacation in our next video on
  • 00:14:35
    classifications and finally oral exam is
  • 00:14:40
    important to talking to the patient
  • 00:14:43
    about their home care how much they're
  • 00:14:45
    brushing how much they're flossing and
  • 00:14:47
    if they're doing it properly and you can
  • 00:14:49
    measure this by local factors like the
  • 00:14:51
    presence of plaque and calculus
  • 00:14:53
    inflammation is something we're looking
  • 00:14:55
    at based on redness swelling and
  • 00:14:57
    bleeding on probing and destruction of
  • 00:15:00
    periodontal tissues we measure by the
  • 00:15:03
    probing pocket depths the clinical
  • 00:15:05
    attachment loss alveolar bone loss
  • 00:15:07
    tooth mobility and firk asian
  • 00:15:09
    involvement so that's it for this first
  • 00:15:13
    video I hope you found it very helpful
  • 00:15:15
    in starting our journey into the world
  • 00:15:18
    of periodontics thank you so much for
  • 00:15:20
    watching everyone we'll see you all in
  • 00:15:22
    the next video
Tags
  • periodontia
  • saúde periodontal
  • doença periodontal
  • biofilme
  • gengivite
  • periodontite
  • placa bacteriana
  • anatomia periodontal
  • exame periodontal
  • inflamação