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Uncontrolled Diabetes & NSPT (Impaired PMNs/chemotaxis (Inflammation,…
Uncontrolled Diabetes & NSPT
Medication-Induced Hyperplasia + Gingivoplasty & Poor Homecare
Calcium channel blockers- Create gingival overgrowth
Increased blood pressure limits nutrient flow to mouth- decreased chemotaxis/healing process
Sign of healing: Shift from gram - anaerobic bacteria to gram + aerobic bacteria
JE is always part of healing
Control of biofilm- patient education on how it can determine their healing
Control of diet- nutrition can determine the success/failure of healing
HEMOSTASIS
INFLAMMATION
Proliferation
Maturation
increased plaque can increase the inflammation
cytokines are impaired due to poor homecare
bandage for 7-10 days (keep maintained) -& stay on soft, bland diet
expect tissue healing in 2-3 months post gingivoplasty
Use a antiseptic mouthwash like CHX- due to patient's homecare & limited brushing abilities- good for the tissues as well
Impaired PMNs/chemotaxis
layered zone of neutrophils help protect w/ clotting
Clot formation
damages wall from bacteria, trauma, immune response is impaired by diabetes
Prothrombin activattor is initiated
thrombin activates fibrinogen to fibrin fibers
creates a meshwork
Healing time frames:
JE: 5 days
SE: 7-10 days
OE: 10-14 days
CT: 21-28 days
Bone: 4-6 weeks
Regeneration-
may occur if patient has good homecare, comes in for re-care, and takes care of their health- lowers A1C
May need NSPT again because of increased risk of attachment loss
Layers:
Clot
Neutrophils
Granulation tissue
Connective tissue
Inflammation
Pain- pressure from edema
Swelling- from accumulation of fluid
Redness- increased blood flow
Heat- increased blood
Loss of function
Always at a higher risk of attachment loss
NEED to control biofilm in order to heal
Have them back in 4-6 weeks (optimal healing)
affects walling-off bacteria during healing process- delaying healing
Calcium is important in this activation