Application of Periodontal Dressing

By: Dr. Liberty D. Rosales

Purpose of Periodontal Dressing
Provide mechanical protection for surgical wound to facilitate healing
Prevents post operative bleeding by maintaining the initial clot in place
Supports mobile teeth during healing
Helps in shaping or molding the newly formed tissue
Provide patient comfort by isolating area from external irritations or injuries

Characteristics of Acceptable Dressing Material

Should be nontoxic or nonirritating to the tissues
Conveniently prepared, place and removed with minimal discomfort to
patient
Should maintain adhesion to itself and to the teeth and tissues
Should not damage or stain any restorative materials
Types of Dressings:
A. Zinc Oxide Eugenol Packs (hard pack)
B. Non Eugenol Packs (soft pack)
C. Light cure packs

Zinc Oxide Eugenol Packs

Basic Ingredient: a. powder
b. liquid
Brand names:

PPC
Wards

Characteristics:

a. hard, brittle: hard to mix and breaks easily

b. Can be prepared in quantity and stored in work size pieces
c. Max powder must be incorporated to achieve a thick mix
Non Eugenol Packs
Basic Ingredients: a. base
b. accelerator
Brand name: Coe-Pak
Characteristic:
a. Pliable and smoother
b. Must be prepared at the time of use
c. Does not contain asbestos and eugenol
d. Most widely use
Light Cure Packs
Basic Ingredient:

syringe

Brand Name:

Barricaid

Characteristics:
a. Non brittle and very elastic
b. No mixing required
Application of Non Eugenol Packs
Materials Needed
non eugenol pack (Coe-Pak)
petroleum jelly
spatula (wooden tongue depressor)
mixing pad
Preparing the Periodontal Dressing

 With the use of wooden tongue depressor, mix equal lengths of paste from
the tubes containing accelerator and base until the paste is uniform in color
Paste is placed in a paper cup of water at room temp.
In 2-3 minutes, the paste loses its tackiness
In 3-5 minutes it can be handled and roll it into two strips approximately the
length of the treated area
Remains workable 15-20 minutes
Inserting the Periodontal Dressing
The end of one strip is hooked around the distal surface of the last molar
remainder of the strip is brought forward along the facial surface to the
midline and gently pressed into place
The second strip is applied into the lingual surfaces by joining the pack at the
distal surface of the last molar tooth and then brought forward along the
gingival margin to the midline
Strips are joined interproximally by applying gentle pressure on the facial and
lingual surfaces of the pack
Pack shld extend from tooth to tooth covering the edentelous areas
Dressing shld not interfere with muscle and cheek, overextension causes
irritation.
Excess pack irritated mucobuccal fold and floor of mouth and interferes w/
tongue
Dressing shld extend only to the height of contour of the teeth
Shld not be in occlusal contact during clossure
Frenums shld move freely
Characteristic of a Well Placed Dressing
Shld be secured and rigid
Little bulk as possible
Is locked interdentally so it cannot be displaced

 Covers all surgical wound and interdental areas w/out unecessary

overextension
Shld have a smooth surface to prevent irritation and discourage plaque
retention
Dressing Removal and Replacement
Dressing may be left in place from 7-10 days
If dressing breaks or falls off before appointed time, healing tissue needs to
be evaluated by the dentist
After 5 days, dressing replacement may not be needed
If replacement is indicated, the whole dressing shld be replaced because
remainder is usually loose
Treatment of Emergencies
By: Dr. Liberty D. Rosales
Treatment of Acute Gingival Disease
ANUG
First Visit

Isolate acutely involved area w/ cotton rolls and dried

Apply topical anesthesia and swabbed the area w/ cotton pellet to remove the
pseudomembrane and non attached surface debris
After the area is cleansed w/ warm water, the superficial calculus is removed
Subgingival scaling and curettage are contraindicated at this time bec of the
possibility of extending the infection into deeper tissue, may cause
bacteremia
Unless for emergency, extractions or periodontal surgery are postponed until
patient is symptom free for al least a period of 4 wks

The patient is also told to rinse the mouth every 2 hrs w/ a glassful of an
equal mixture of warm water and 3% hydrogen peroxide

 Twice daily rinses w/ 0.12% chlorhexidine are also very effective

Patient w/ moderate to severe ANUG and local lymphadenopathy or other
symptom are placed on antibiotic regimen of penicillin, 250-500mg every 6
hrs, metronidazole, 250-500mg 3x a day for 7 days is also effective
Instruction to patient:
avoid tobacco, alcohol, condiments
pursue usual activities but avoid excessive physical exertion
confine tooth brushing to removal of surface debris w/ a bland
dentrifices
Second Visit
1 to 2 days after the first visit
Patient condition usually improved and the pain diminished or no longer
present
Gingival margins of the involved areas are erythemaatous, but w/out
pseudomembrane
Scaling is performed if sensitivity permits
Instruction to the patient are the same as those previously
Third Visit
1 to 2 days after the second visit
The patient shld be essentially symptom free
There may still be some erythema in the involved area and the gingiva may
be slightly painful on tactile stimulation
Scaling and root planing are repeates
Patient is instructed on plaque control procedures
Hydrogen peroxide rinses are discontinued, but chlorhexidine rinses can be
maintained
Subsequent Visits
Tooth surfaces of the involved areas are scaled and smoothed

 Plaque control performed by the patient is checked and corrected if

necessary
Parient w/out gingival disease other than the treated acute involvement are
dismissed for 1 wk
If the condition is satisfactorily at that time, the patient is dismissed for 1
month, at w/c time the schedule for subsequent recall visit is determine dacc
to the patients need
Acute Pericoronitis
Gently flushing the area w/ warm water to remove debris and exudate
Swabbing w/ antiseptic after elevating the flap gently from the tooth w/ a
scaler, the underlying debris is removed
Area is flushed w/ warm water
Antibiotics can be prescribed in severe cases
If the gingival flap is swollen and fluctuant, an anteropost incision to
establish drainage is made
Acute Herpetic Gingivostomatitis
Treatment consist of palliative measures to make the patient comfortable
until the disease runs its course
Plaque, food debris and superficial calculus are removed to reduce gingival
inflammation
Relief of pain to enable the patient to eat comfortably is obtained w/ topical
anesthetic mouthwashes, such as lidocaine hydrochloride viscous solution
Before each meal the patient swish w/ one tablespoon of this soln and spit
out
Supportive Treatment:
1. Copious fluid intake
2. Systemic antibiotic therapy for the management of toxic systemic
complications
3. Relief of pain
Periodontal Abscess

Purposes:
1. Alleviate pain
2. Control spread of infection
3. Establish drainage
Drainage Through the Pocket
Apply topical anesthesia
A flat instrument or a probe is carefully introduced into the pocket in an
attempt to distend the pocket wall
A small currette or a Morse scaler can then be gently used to penetrate the
tissue and establish drainage
When drainage cannot be easily established via the pocket or when the
abscess can be seen pointing through the gingiva, an external incision is
indicated
Drainage Through an External Incision
Abscess is isolated , dried and swabbed w/ antiseptic soln followed by a
topical anesthetic
W/ a Bard Parker no. 12 blade, a vertical incision thhrough the most fluctuant
area of the lesion, extending from the mucogingival fold to the gingival
margin
After the initial extravasation of blood and pus, irrigate the area w/ warm
water and gently spread the incision to facilitate drainage
After the drainage stops, the area is dried and painted w/ antiseptic
Patient w/out systemic complications are instructed to rinse hourly w/ a soln
of a teaspoon of salt in a glass of warm water and return the next day
Penicillin or other antibiotics are prescribed for patients w/ fever
Patient also instructed to avoid exertion and is put on a copious diet
Gingival Abscess
After topical anethesia is applied, the fluctuant area of the lesion is incised w/
no 12 blade
Incision is gently widened to permit drainage

 The area is cleansed w/ warm water and covered w/ a gauze pad

After bleeding stops, the patient is dismissed for 24 hrs and instructed to
rinse every 2 hrs w/ a glassful of warm water
When patient returns, the lesion is generally reduced in size and symptom
free
A topical anesthetic is applied and the area is scaled
If the residual size of the lesion is too great, the lesion is removed surgically