1. restore
2. educate
3. motivate
4. strategize

1. patient acceptance, respect & referrals
2. patients may decide to accept more complex & financially productive restorative procedures
3. does not require DDS to preform data collection
4. more production time for DDS for other procedures
5. product sales

4 things that you can charge insurance for related to CAMBRA

(ways to convince your office to start using CAMBRA program)

1. caries susceptibility testing
2. bacteriology studies
3. oral evaluation patient under 3 years old and counseling primary caregiver
4. topical fluoride application for therapeutic measures for moderate to high caries risk patients

Successes in practice for CAMBRA

(ways to convince yoru office to start using CAMBRA program)

• team participation
• order supplies
• incorporate CAMBRA into all new patient exams
• initiate risk assessment & prevention along with treatment protocols
• use of involvement calendars, diagnostic casts and disclosing tablets
• rewards for compliance

• a closed procedure used to remove the ulcerated epithelial lining and the subjacent inflammatory tissue from the gingival pocket

1. to eliminate granulomatous tissue
2. to remove ulcerated epithelium
3. to remove diseased epithelial lining
4. to stimulate new epithelial tissue
5. to shrink shallow pockets
6. to improve tissue tone

• post completed debridement (SCRP)
• shallow pockets depths (4-6mm)
• edematous (swollen) tissue 
• failure to respond to debridement therapy
• tissue tags from the epithelial lining

• fibrotic tissue
• pockets deeper than 6mm
• infrabony pockets
• ANUG
• thin, fragile tissue or mucosa
• lack of attached gingiva
• frenum pulling on gingival margin
• incomplete tooth debridement
• systemic problems or medications which cause gingival enlargement

• 11/12 gracey curette for DISTAL surfaces
• 13/14 gracey curette for MESIAL surfaces
  • facial and lingual surfaces as well

• long and horizontal

• complete debridement
• evaluate tissue (look for edematous tissue)
• probe entire tooth (no more than 6mm pockets)
• insure that anesthesia is profound
• explain procedure to patient, receive informed consent
• sharpen instruments

• administer additional anesthesia if needed
• stabilized tissue with cotton-tipped applicator
• use cutting edge of instrument against tissue
• blade-to-tissue angle is comparable to the blade-to-tooth angle 45-90 degree angle
• strokes are long & horizontal
• instrument pocket until no necrotic tissue or tissue tags are present
• give post operative instructions
• re-evaluate in 3 weeks
  

• start oral hygiene immediately (patient will not hurt the wound)
• light oral hygiene for the first couple days
• normal diet
• pain (use NSAIDS and warm salt water)

• blood clots begin to form

• edematous
• swollen
• bluish-red in color
• BOP

*epithelial cells begin to migrate within 12-24 hours

• less edema
• more normal color
• BOP

*tissue is forming & epithelial cells are progressing but not complete

• edema is almost gone
• color more normal
• little or no BOP

*epithelialization almost complete

*connective tissue organizing, collagen being produced

• normal & firm gingiva
• no BOP

*connective tissue maturation - 21 to 28 days

*keratinization increases

• connective tissue maturation

• necrotic tissue

• surgical wound

• long junctional epithelium re-attachment

• Category A
  • asymptomatic
• Category B
  • symptomatic
• Category C
  • AIDS - indicator conditions

• 500+ CD4+ count
  • may have lymphadenopathy
  • may have dermatologic lesions
  • oral lesions - apthous ulcers, herpes simplex and hair leukoplakia

• 200-500 CD4+ count
  • skin and oral lesions are more common
  • recurrent herpes simplex, varicella-zoster, fever and weight loss
  • candida is a predictor for pneumonia

• 50-200 CD4+ count
  • opportunistic infections
  • wasting syndrome
  • mental disorders
  • neoplasms

• 1st priority - pain
• 2nd priority - restore function
• 3rd priority - preventive measures
• 4th priority - esthetic considerations

• necrotizing periodontitis

• bone marrow suppression
• increased incidence of mouth ulcers and erythema multiforme

• higher incidence of erythema multiforme
• taste alterations
• oral parathesias
• benzodiazapines - elevated blood levels (increased sedation & respiratory depression)
• ecstasy, heroine, cocaine may be life-threatening with some medications
• alcohol reduces effects of medications and causes increased chance of liver toxicity

• increased frequency and recurrence of oral candidosis
• diabetes
• lipodystrophy
• liver toxicity

• methadone

• grapefruit juice
• heighten the effects

• erythematous candidosis

• pseudomembranous candidosis

• hairy leukoplakia

• kaposi's sarcoma

• non-hodgkin's lymphoma

• linear gingival erythema

• thrombocytopenic purpura

• herpes simplex virus

[image]  [image]  [image]

• human papilloma virus

• syphilis

• salivary gland enlargement