Definition: “Oral antimicrobial therapy is the use of chemicals to kill or slowdown the growth of bacteria that cause periodontal disease.”
The most common forms of this therapy are antiseptics and antibiotics.
Antiseptics are found in mouthwash, they are used to help prevent periodontal disease.
Bacteria can grow form clusters or colonies on the tongue, tonsils and in the saliva. Mouth rinses can control the excess growth of bacteria.
The rinses contain

1. Alcohol
2. Chlorhixidine
3. povodine iodine
4. 0.1% sodium hypochloride

The aim is to prevent them from causing disease.

Antibiotics are used to kill specific bacteria. They are placed under the gums or given as pills to treat gum disease. Mostly acute infection control by antibiotics pills.
Periodontal disease and gingival disease is caused by specific type of bacteria. Antibiotics use for that disease for killing the bacteria help to prevent and treat the disease.
The type of antibiotics use depends upon the exact type of the bacteria. The most common antibiotics have been used to treat periodontal disease and gingival disease.

They include:

1. Pencillins
2. Tetracyclines
3. Doxycycline
4. Metronidazole
5. Ciprofloxacin
6. Clindamycin
7. Oflaxacin
8. Ornidazole

Generally first treatment for periodontal disease is scaling and root planning. This combined approach can successfully treat many forms of periodontal disease.
Antibiotics in oral form you will take them for 7 to 10 days.
Antibiotics also used in form of gel and powder, chips.
Now days one of the newest ways to kill bacteria is laser therapy. Lasers kill bacteria in the gum pockets around teeth and to stimulate healing.

1. Maintain good oral hygiene daily.
2. Regularly brushing after each meal
3. Local antibiotics therapy is also important after oral antimicrobial therapy. Periodontal pack in gum area is placed with local antibiotics.
4. Examination of periodontal tissue.
5. If allergic reaction to certain antibiotics, stop taking drug and need to switch to another antibiotics.
6. If in appropriate use of antibiotics can lead to the bacteria becoming resistant to antibiotics effects then take antibiotics properly with proper dose.

Defination:“Removal of bacterially or toxically contaminated root cementum or dentin and leveling irregularities of the surface.”
Most commonly rootplaning is done in following disease and symptoms

1. Bleeding gum
2. Gingival recession
3. Periodontitis
4. Periodontal pocket

Removal of bacterially or toxically contaminated root cementum or dentin with scalers and ultrasonic curettes also known as root planing procedure



First is local anaesthetic used to numb the portion of mouth where rootplaning is necessary.
Root planning involves smoothening the root surface of teeth with thin curettes so gingival tissue more firmly reattach to roots.
This procedure makes it more difficult for plaque to accumulate
Along root surface.
This procedure is done with ultrasonic scaler and curettes in one or two visit.
Oral Care after Root Planing
Do not bite or chew lip, cheek or tongue until numbness has worn off   or avoid chewing for 2 hours after this procedure.

1. For pain take analgesic
2. Take antiseptic mouthwash for prevent oral infection
3. Do not eat spicy foods and drink hot liquids
4. Avoid tobacco and smoking
5. Oral antibiotic for prevention of further oral infection
6. Softly brushing and flossing where root planning is done

INDICATION :
a) After scaling and rootplaning for following purpose.

DEFINATION: Gum biopsy is a surgery in which a small part of gingival tissue is removed for histopathological examination
Procedure:
1.abnormal result of biopsy
      • Amyloid
      • Oral cancer :-
         e. g. 1. Basal cell carcinoma
                2. squamous cell carcinoma
      • Non cancerous mouth  sores
      • Thrombotic thrombocytopenic purpures   (TTP)

COMPLICATION:

1. infection of gum
2. soreness 
3. bleeding gum

ORAL CARE AFTER GINGIVAL BIOPSY:

1. soft diet
2. antiseptic mouth wash use for weak to ten days.
3. avoid or softly brushing the biopsy area for one week 
4. avoid tobacco and smoking.
5. antibiotic for prevention of post operative infection

IMAGES

CAUSES OF GINGIVAL HYPERPLESIA:

1. chronic gingivitis
2. drug induced
3. anticonvulsants (such a phenytoin, Phenobarbital, primidone)
4. calcium, channel blockers, such as nifedipine and verapamil)
5. immunosuppressant- cyclosporine 
6. condition may develop oral manifestation of gingival hyperplasia
7. pregnancy
8. puberty
9. vitamin C deficiency
10. pyogenic gronuloma

systemic disease may develop oralmanifestations of gingival hyperplasia

• leukemia
• granulomatous disease
• neoplasm

benign neoplasm such as: - fibromas
- papillomas
- giant cell granuloma
malignant neoplasm such as
   -carcinoma
   -malignant melanoma

IMAGES

SYMPTOM OF GINGIVAL HYPERPLESIA:

1. gums are  enlarged firm & swollen
2. some patient may also bleeding tenderness in the gums
3. gums cover the teeth portion
4. histological examination gums have increase in number of cells 

TREATMENT:

1. scaling 
2. proper oral hygiene is maintained
3. antibiotics & antiseptic mouth wash 
4. discontinuation of drug which induced hyperplasia
5. gingivectomy with carbon dioxide or YAG laser
6. surgical excision of gingival tissue

Definition:
“A gingivectomy is a surgical excision which includes removal of infected and diseased gingival tissue to achieve more aesthetic appearance and functional contour.
INDICATION
  1. Elimination of suprabony pockets if pocket wall is fibrous and firm.
  2. Elimination of gingival enlargements.
  3. Eliminations of suprabony periodontal abscess

When gingival tissue extends too far on the surface of teeth, length of teeth and height of gum is lost and one or more teeth appear short with gingivectomy return gum position more healthy and aesthetic condition.

Contraindication:
1. Need for bone surgery for examination of bone shape and morphological features
2. Bottom of the pocket located apical to mucogingival junction

Gingivectomy:
Gingivectomy is done for common cause of gingival hyperplasia and periodontal pocket.
Pockets have formed between the teeth and gum. Pocket only involving soft tissue it can be removed by gingivectomy.

Preparation:
Scaling is done for removing plaque and calculus from teeth,gaps and gingival line.
The Procedure:

DEFINITION:  it is a surgical reshaping & recontouring of the gum tissue for more aesthetic, physiological or functional form.

INDICATION:
 1.Regionally limited thickening of  gingival without presence of pathologically deepened pockets
 2.Persistent interdental craters  after necrotizing ulcerative gingivitis/periodontitis
 3.Preprosthectic surgery- reshapes gingiva in area of laterpontic.

CONTRAINDICATION:
 1. Periodontal pocket
 2. Generalised thickened fibrous gingival