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The science of photodisinfection has a fascinating treatment alternative as a potential tool, and then history. Literature dates back to 1500 BC decide which of these tools are best suited for a describing therapy involving the placement of certain specific problem. A patient may benefit most from kinds of seeds on the skin which were then exposed to a “conservative” or nonsurgical approach in one sunlight. These seeds contained a psoralen compound, quadrant, and a more “invasive” or surgical approach which has since been shown to be a photosensitizing in another. From a clinical perspective, the critical compound. Since that time, there are numerous determining factor is the treatment (or treatments) conditions which have been shown to benefit from that will ultimately serve the patient best.
the therapeutic effects of lights such as psoriasis and newborn jaundice. In the early 1990’s, it was found that photosensitisers could be used in conjunction with light to kill microorganisms, and indeed bacteria, yeasts and viruses can be inactivated in this way. As evidenced in the periodontal literature, the beneficial Cationic sensitisers have been proven to kill both gram effects of scaling and root planing in the treatment of positive and gram negative bacteria in the presence of chronic periodontitis have been extensively studied and validated. The reduction of clinical inflammation, The following is a case report utilizing microbial shifts to a less pathogenic flora, decreased photodisinfection with FotoSan for treatment of probing depth of periodontal pockets, a gain in the chronic periodontitis in an isolated periodontal defect.
clinical attachment, and a diminished progression of disease, are amongst these benefits.
Clinical options for treating periodontal Generally, clinical soft-tissue conditions improve following nonsurgical treatment. However, some Traditionally, the treatment of periodontal diseases is intraoral sites do not re spond to this initial therapy composed of two distinct phases. The initial therapy, and may benefit from a surgical approach. Surgical or nonsurgical phase, consists of procedures that access can facilitate mechanical instrumentation are specifically designed to eliminate or control the of the roots, reduce probing depths significantly, various risk factors, which may contribute to chronic and even regenerate or reconstruct lost periodontal periodontitis. In this phase, hygienists provide oral tissues. Clinical trials indicate that both surgical hygiene instruction and periodic reinforcement; and nonsurgical therapy approaches can effectively perform sub and supra-gingival debridement to stabilize clinical attachment levels1.
remove microbial plaque and calculus; treat or remove Each of these therapeutic modes has various local irritation factors such as decay, overhangs, advantages and drawbacks. A nonsurgical mechanical ill-contoured crowns, and misaligned teeth; and approach may be deemed more conservative. However, recommend the use of various antimicrobial agents it may have limited efficacy in advanced diseased sites as adjuncts to the above treatments. If the initial since it does not fully eliminate pathogenic bacteria therapy does not significantly improve the periodontal from all infected areas; in particular, bacteria in condition, periodontal surgery is considered in order deeper pockets and furcation areas2. Flap reflection is to help re solve the disease process and/or assist in the considered more invasive, but can be more effective in correction of anatomic defects. A variety of surgical increasing the clinician’s ability to debride the roots in modalities may be appropriate in managing an these difficult areas2. Osseous surgery has been shown to produce an even greater reduction of probing depths, In selecting periodontal treatment modalities, but on the other hand, results in more extensive the dental professional should closely examine each pock ets, increased clinical reattachment, be considered a less invasive approach10. during periodontal surgery to “disinfect” identified as chronic periodontitis are the areas that may be difficult to instrument result of a complex chain of events that (such as furcations), particularly prior to bacteria in the gingival sulcus, and in due course leads to a series of destructive host been used in various medical applications which is elicited by the bacteria in the gingival tissue, is ultimately responsible attachment of the tooth to the underlying process can cause the tooth to loosen, and which causes cell destruction of targeted in a selected periodontal defect within 60 in 1989. Today, there are several hundred peer-reviewed, preclinical studies written photosensitizing solution (Toludine Blue O) which selectively binds to the periodontal periodontal health is generally associated effectiveness of photodynamic disinfection with the reduction in the levels of these against various pathogens associated with cells. The second step is illumination of anaerobic bacteria in the dental plaque6. this site with the light diffusing tip from primarily on reducing the bacterial load photodisinfection is the targeting and the elimination of the bacteria most responsible for the progression of periodontal disease. nonsurgical procedures, with the occasional (without the need for anesthetic) into the anti microbial agents in certain situations. periodontal pocket. The dye binds to the lipopolysaccharides and lipids found on the forsythia, Fusobacterium nucleatum and cell walls of both gram-negative and gram- Actinobacillus actinomycetemcomitans. positive bacteria. Because of a difference procedures. Their use is limited, due to in thick ness of the peptidoglycan layer in negative bacteria are also inactivated.
the emergence of re sistant bacteria, the their cell walls, gram-negative bacteria development of potential hypersensitivity take up the methylene blue stain faster. to administer. However, there are certain maximal efficacy. It is essential to flood frequency matches that of the molecule of the periodontal pocket to be treated with antimicrobial agents directly at the site of hit the dye molecules, they initiate the little solution will adversely affect the infection (in the periodontal pocket) have photodynamic chain of events. The oxygen results. The required irradiation time is been shown to improve treatment efficacy, molecules surrounding the dye are caused one minute and must be valued. Too little to lose an electron, and thus become free radicals. The free oxygen radicals are toxic to the bacterial cell walls and disrupt them, be treated individually. Results are better leading to the destruction of the bacteria. profusely. Excessive bleeding can dilute the photosensitizing solution. If a patient is bleeding extensively after mechanical collagenases, and lipopolysaccharides are it not only kills gram-negative bacteria inactivated, resulting in a re duced host for photodisinfection. Some tissue sites associated with periodontal disease, but respond considerably better when treated are responsible for tissue destruction, thus greatly improving a patient’s chances of healing8. FotoSan is also non-antibiotic, and a result, does not carry any risks of promoting antibiotic resistance9. In clinical in a significant reduction of the clinical trials, those patients receiving FotoSan debridement of the root is essential prior treatment in conjunction with scaling and to the application of the photodisinfection suppuration, bleeding on probing, oedema, root planing (SRP) experienced significant and in the probing depths of pockets. For therapies may result in a decreased need these patients, it was noted that while the SRP only: these benefits included shallower for surgical intervention, and can therefore CALINIC Y
soft-tissue re cession was not significant.
received periodontal therapy (surgical and/ should provide exciting new opportunities or nonsurgical), but were still exhibiting a lesser reduction of probing depths but Disinfection of class II and III furcation a very significant reduction of bleeding Sarah Holslag has worked in the dental industry on probing. Since the lack of bleeding on for many years as a dental assistant and now as a dental hygienist. Sarah’s hygiene career has probing is one the few reliable indicators included private and specialist practice, public health, corporate, continuing education and dental hygiene percentage of bleeding sites is a desirable education. A graduate of Tafe SA in South Australia FotoSan represents a novel and effective outcome even when the changes in probing with an Advanced Diploma in Oral Health (Dental Hygiene), Sarah is currently embarking on the task of conjunction with standard scaling and root a Bachelor of Science in Dental Hygiene at Northern Arizona University, being the first Australian to be accepted into a bachelor program in the USA. Sarah currently practices clinical dental hygiene where she disease. Its nonsurgical profile improves has gained extensive experience in the management of complex periodontal cases, aesthetics, implants the process more attractive to patients. Its and the clinical application of lasers in soft tissue ease of use makes it suitable for hygienists. THE CASEA 49 year-old male with localised chronic periodontitis with an acute localised infection, presented for an emergency appointment to treat an acute periodontal infection with an isolated chronic 10 mm pocket with heavy bleeding on probing (BOP) and exudate on the distal of the maxillary left canine with a draining sinus present on the buccal attached mucosa. He was a non-smoker in poor general health with no known allergies. His medical history included: Chronic Urticaria, bronchial asthma, reflux, eczema, anxiety, hyperlipidaemia, hypertension. He is currently taking lipitor, lopid, losec, micardis, nasonex were performed consisting of power-driven maxillary right canine one week later due to heavy bleeding in the distal and palatal precluding possible surgical intervention from the practice for a period of two years aspect. Five days later, scaling and root where he had previously been referred to a periodontist but had not attended.
with FotoSan was performed on the affected supra gingivally with a blunt FotoSan tip.
erythema, mild cyanosis, rolled gingival margins and a ‘thickened’ soft tissue eliminate residual periodontal pathogens on probing in the treatment site. Clinical in the affected site and so avoid the need evaluation at this time revealed reduced with no evidence of a vertical fracture. healed and no exudate present. Oral hygiene were repeated, again consisting of power- local photodisinfection utilising FotoSan. Surgical treatment options were discussed planing, followed immediately by a second continue with a nonsurgical approach.

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