Debridement (dental)

Debridement (dental)
Teeth before (top) and after (bottom) a thorough mechanical debridement
ICD-9-CM	96.54
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In dentistry, debridement refers to the removal by dental cleaning of accumulations of plaque and calculus (tartar) in order to maintain dental health.

Dental debridement is a procedure by which plaque and calculus (tartar) that have accumulated on the teeth is removed. Debridement may be performed in the process of personal or professional teeth cleaning. Professional debridement techniques include the use of ultrasonic instruments (which fracture the calculus, thereby facilitating its removal), as well as the use of hand tools, including periodontal scaler and curettes. Debridement may also be performed using saline solution..

Periodontal Pockets

A periodontal pocket is formed from a disease process; it is defined as the apical extension of the gingiva, resulting in detachment of the periodontal ligament (PDL). The PDL is a ligament that attaches the root of the tooth to the supporting alveolar bone. This ligament allows for occlusal force absorption. Plaque accumulates within the pocket initiating an inflammatory response due to an increased number of spirochetes. There are different types of bacteria that make up dental plaque. In cases of aggressive periodontitis three major species of bacteria have been identified within the periodontal pocket. These bacteria include Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans. Healthy gingiva consists of few microorganisms, mostly coccoid cells and straight rods. Diseased gingiva consists of increased numbers of spirochetes and mobile rods.Interactions between plaque and host inflammatory response determine the alterations in pocket depths. Bacterial plaque initiates a nonspecific host inflammatory response with the intention of eliminating necrotic cells and harmful bacteria. During this process cytokines, proteinases, and prostaglandins are produced which can cause damage, or kill healthy tissues such as macrophages, fibroblasts, neutrophiles, and epithelial cells. The exposure to connective tissue and blood capillaries, allows microorganisms to gain an entryway to the circulation. This suppresses host protection mechanisms, leading to further destruction of bone.