3. Periodontal Disease Prevention Flashcards
Healthy Periodontium
____
____ Bone
____
____
gingiva
alveolar
periodontal ligament
cementum
Periodontal Disease Model
____ burden > ____ host > epithelium, connective tissue & bone ____ > bleeding, pockets, loss of attachment & bone loss
infectious
susceptible
metabolism
Risk Factors for Periodontal Diseases
____ & ____ Host Factors
____ & ____
innate
acquired
environment
biofilm
Periodontal Disease Risk Assessment
- Innate factors:
- ____
- gender
- ____
- congenital conditions
- Acquired Risk Factors:
- ____
- medications
- ____
- income, SES
- Environmental Factors:
- poor ____
- tobacco use
- infrequent ____
- occlusion
age race diabetes/systemic conditions stress/nutrition oral hygiene dental care
Risk factors for perio disease
Non-modifiable: ____, ____, race, congenital coniditons
Modifiable: ____, poorly controlled diabetes, ____, osteoporosis, low diet ____, stress/inadequate coping
age gender smoking obesity calcium/vitamin D
Monitor Health Status
- ____ routine
- ____ testing readily available
- collaborate with ____
- educate patient about ____ to identify & reduce complex interaction of ____
health history laboratory primary care providers risks risk factors
Oral Complications in Diabetics
Increased ____ and Periodontitis
____, Xerostomia Enlarged ____ Gland
Caries, Tooth Loss
____ Dysfunction, Burning Mouth
gingivitis
thrush
parotid
taste
Change Local Environmental Factors
- identify & eliminate ____ restorations
- eliminate ____ depth
- complete ____ therapy
- evaluate & adjust occlusion
iatrogenic
pocket
orthodontic
Quitting Tobacco Essential in Periodontal Care
- More than 50% of adult periodontal cases are attributable to ____
- In current smokers ____ of cases may be caused by smoking
cigarette smoking
75%
Gram Negative Anaerobes
- Reside ____ in pocket
- Very difficult to access & control daily by patient
- ____
- Tannerella Forsythia
- ____
- AA: Aggregatibacter Actinomycetemcomitans
subgingivally
p. gingivalis
t. denticola
Controlling Microbial Plaque Biofilm
____ Removal
Ø Toothbrush, Interdental Cleaners
Ø Water Pic (Oral Irrigator)
Antimicrobial Rinses & Toothpastes
Ø Rinses: 0.12% Chlorhexidine, ____ or Cetylpyridium Chloride
Ø Toothpaste: ____ or .0454 Stannous Fluoride
mechanical
essential oils
3% triclosan
Target Bacteria
Mechanical \_\_\_\_ Removal \_\_\_\_ Rinses & Toothpastes \_\_\_\_ placed antiseptics or antibiotics (gels or threads) \_\_\_\_ Antibiotics \_\_\_\_ Therapy
plaque antimicrobial locally systemic pocket reduction
Identify and Increase Patient’s ____ Level
educational
Use Disclosing Solution To Visualize ____
plaque biofilm
____ Index
Gingival Bleeding on Probing or Instrumentation
Practice Teaching ____ Skills
Bleeding
Oral Hygiene
Brush Your Teeth And Gums
- Brush ____ a day???
- Use a ____ toothbrush
- Bass & Modified Bass Method (Sulcular Brushing)
- Angle the bristles into the ____, gently wiggle brush against tooth, roll remaining surface
- ____ stroke
- Fones: ____ brushing
- Stillmans, Charter
- Don’t forget your ____
twice soft gum line rolling circular tongue
Powered Brushing
3 Basic Types
- ____ Battery Powered
- ____ brush, ____
- Rechargeable Battery
- Braun Oral B
- Sonice Rechargeable Battery
- Sonicare, Braun Sonic
AA
spin
actibrush
Power Toothbrushes
- removes ____, stain and reduces gingivitis greater than manual brushing
- reduce physical & ____ skill needed for brushing
- easier to use for ____
- easier to brush someone else’s ____
plaque
cognitive
children
teeth
Power Brushes Remove More Plaque in Same Time
Percentage Reduction of Plaque Over ____
time
Cochrane Collaboratio, 2003
- comparisons difficult to differing research designs
- ____ (oral B braun) most effective in reducing plaque, gingivitis and bleeding
rotation oscillation
Floss Between Your Teeth
- use floss daily
- stretch floss between fingers
- glide floss between teeth, slide floss under gums
- scrape floss against side of tooth
- no difference ____ floss
waxed/unwaxed
Research base for flossing
- cochrane systematic review shows evidence that ____ plus toothbrushing reduced gingivitis, with weak evidence of plaque reduction
- ____ flossing reduced interproximal caries risk
- ____ brushes remove more plaque & reduce gingivitis as well as flossing
flossing
professional
interproximal
Antiseptic Agents Mouth Rinse, Toothpaste
0.12% \_\_\_\_ Rinse • \_\_\_\_ Mouth Rinse • 0.454% \_\_\_\_ Fluoride Toothpaste • .3% \_\_\_\_ Toothpaste, 2% \_\_\_\_ Copolymer, 0.2% \_\_\_\_
chlorhexidine gluconate essential oil stannous triclosan gantrez sodium fluoride
0.12% Chlorhexidine - Anti-plaque, anti-gingivitis
- complete ____ kill in 30s with a 15ml rinse 2x a day
- controls gingivitis & ____
- disrupts ____
- substantive for ____ hours
- available in ____ free versions, check label
microbial candida cell wall 12 alcohol
0.12% Chlorhexidine -anti-plaque, anti-gingivitis
- ____ stain
- strong ____
- reduces ____
- interacts with ____ in toothpaste
- DO NOT USE in ____, CHX will be rendered inactive
brown flavor taste SLS (sodium lauryl sulfate) combination
Essential Oil Mouth Rinse - anti-plaque, anti-gingivitis
- listerine mouthrinse, & other generic products
- thymol, menthol, eucalypotl, methyl salicylate disrupt ____ & function
- ____ spectrum antiseptic, also targets ____ from gram negative
- ____ alcohol concentration, LISTERINE Zero
- Use a 20ml rinse full strength for 30 seconds ____ daily
- check label for therapeutic versions
cell wall broad endotoxins 21/28% twice
Ethanol Mouthrinses & Risk for Oral Cancer: Conflicting Evidence, Consensus: Safe with Caution
- Meta analysis revealed no statistically significant association bt EtOH containing mouthrinses & ____
- 10 reviews/6 case control studies against an ____, with 1 review/9 case control studies supporting ____
- conclusion: mouthrinses considered safe
- recommendation: use with caution, continue to develop ____ versions
cancer
association
association
non-alcoholic
0.07% CPC - crest pro health rinse, colgate total rinse
- Alcohol Free Rinse Makes Anti-Plaque & Anti- Gingivitis Claims, No ____ Seal
- “____” Essential Oils in Reducing, Plaque, Gingivitis & Bleeding Garcia, J Evid Based Dent Practice, 2008
- feres, JADA, 2010
- variations in products (crest complete + fluoride)
ADA
at least as good as
Research Base for Rinsing
- ____ and ____ effective in reducing plaque and gingivitis (Boyle, 2013)
- ____ plus brushing reduces more plaque and gingivitis than brushing & flossing (Sharma, 2004)
- ____ equivocal
- ____ rinse reduces caries in both children and adults
CHX essential oil essential oil CPC sodium fluoride
0.3% Triclosan Toothpaste, 2% Gantrez Copolymer, 0.243% Sodium Fluoride - anti-plaque, anti-gingivitis, anti-caries
- formulated in toothpaste (colgate total) that is accepted for antiplaque, antigingivitis, anticaries and tartar control claims
- anti-bacterial effects - 24% less ____, 57% less ____, 14% ____
- anti-inflam effects - reduces markers of inflammation: ____, IL1b, ____, CRP
plaque biofilm
gingivitis
caries reduction
PGE2
TNFa
0.3% Triclosan Colgate Total
- ____ Copolymer Ensures Stability & Twelve Hour Substantivity
- Triclosan provides anti____ and anti-____ ____ spectrum action
- ____ reduces dentin hypersensitivity and also reduces calculus
- reduces decay due to ____
PVM/MA septic inflammatory broad zinc chloride sodium fluoride
0.454% SnF2 - crest pro health - anti-plaque, anti-gingi, anti-caries
- Stannous ion in fluoride stabilized with ____
- ____ reductions vary from -2 to 22.7%
- ____ reductions range from 18-22%
- ____ reductions 24%
sodium hexametaphosphate
plaque
gingivitis
dentin hypersensitivity
Oral Irrigation: Water Flosser? As compared to floss - 50% \_\_\_\_ reduction - Twice as effective reducing \_\_\_\_ - 29% better at \_\_\_\_ reduction
gingivitis
bleeding
plaque
Oral Irrigation Research
Best at plaque reduction: irrigation w/ ____
Best as gingivitis reduction: irrigation w/ ____
CHX
essential oils
Role of Antibiotic Agents in Treatment of Periodontal Disease
- Topical gels placed ____
- Minocycline microspheres (arestin)
- doxycycline gel (atridox)
- tetracycline threads (actisite)
- metronidazole (elyzol)
- ____ full strength anti’s
- tetracyclines, metronidazole, quinolone & macrolid
- Systemic low dose antibiotics as ____
- doxycycline 20mg (periostat)
subgingivally
systemic
host modulation
Tartar control products
- ____ scavengers - reduce new calculus ____
- cosmetic, not ____
- ____
- ____
calcium formation therapeutic pyrophosphates zinc chloride
Frequent Professional Care Controls Risks For Periodontal Diseases
- Periodontal Debridement Reduces ____ & ____ Biofilm and Other Deposits
- Scaling and Root Planing
Remove all ____ and ____ calculus - Interval Based on Patient’s ____ and Extent of ____
supra subgingival supragingival subgingival risks disease
