Aggressive periodontitis Flashcards
Periodontitis
Inflammatory condition affecting supporting structure of the teeth
Multifactorial aetiology
Variety of presentations
Chronic. Aggressive, Localised and Generalised
forms
Different treatment strategies
Requires pt engagement
What do we need for a perio party?
Over 800 bacterial species!
Host response
Host response
Stress -long term -short term -poor coping strategy Diet Exercise Illness Sleep Smoking
Common features of poor host response
Pts otherwise clinically healthy
Rapid attachment loss and bone destruction
Familial aggregation
Secondary features of host response
Microbial deposits not consistent with destruction. A.a nos and for some P.g??? Phagocyte abnormalities Hyper – responsive inflam/immune response. Attachment and bone loss may be self arresting
Genetic polymorphisms as risk factors for AgP - background
Polymorphonuclear (PMN) defects result in severe perio disease LAgP is associated with a PMN defect • Chemotaxis • Phagocytosis • Bacterial Killing AgP Patients have hyper-responsive PMN
AAP classification of chronic perio
10-15% are susceptible to a more destructive process
Prevalent in adults but may occur in children.
Commensurate with oral hygiene and plaque levels, local
predisposing factors, smoking and stress.
Host factors determine the pathogenesis and progression
of disease
Rate of progression in most cases slow to moderate;
periods of rapid tissue destruction may occur.
Further periodontal tissue breakdown is likely to occur in
diseased sites that are left untreated
AAP classification of aggressive perio
Localised and generalised Primary features (major common features) -non-contributory MH -rapid attachment loss and bone destruction -familial aggregation of cases
Diagnosis of aggressive perio
History -complaint -HPC -DH/ SH/ FH -pt motivation for treatment Clinical examination -probing pocket depth -PI & BI -recession -attachment loss (measured by taking PPD and REC) -mobility -furcation inolvement Additional tests -radiographs -vitality tests
Importance of diagnosis
Medico legal
Early management priority
Treatement modality
Early referral
Antibiotics
Regimen
– Amoxicillin 500mg plus Metronidazole 400mg TDS 7 days
– Azithromycin 500mg once daily three days
Counterproductive unless includes thorough
debridement and homecare
Ideally during first cycle of Non surgical
MUST not be overprescribed
Treatment strategy
Cause related therapy (initial therapy)
Corrective therapy
Non-surgical therapy: hand instruments vs sonic and ultrasonic scalers
No differences in effectiveness
Several studies have reported the use of sonic and/or ultrasonic
instruments can result in a 20-50% savings in time
Deep pockets
Why do we worry? What does it mean for pt? What does it mean for practitioner within Band 2 treatment (3 UDAs)? What does it mean for specialist?
Non-surgical therapy: factors that influence complete calculus removal:
Extent of disease
Anatomical factors
Skills of operator
Instruments used
Non-surgical therapy: approaches to subgingival infection control
Quadrant RSD (gold standard)
Single stage full mouth RSD
Same day full mouth RSD
Why would non-surgical fail?
Pt failure
Operator failure
Anatomical failure
Non-surgical failure: pt failure
- Poor motivation/cooperation
- Patient circumstances
- Patient medical history
Non-surgical failure: operator failure
- Incorrect diagnosis
* Inadequate non surgical
Non-surgical failure: anatomical failure
- Multiple intra-bony defects >3mm
- Furcation involvements
- Very deep sites
- Difficult anatomy of tooth bone or roots
- Difficult access
- Gingival Biotype
Surgery
Aggressive cases higher likelihood of needing
surgery
Anatomical sites require surgical correction
Aims of surgery depend on clinical situation
• Pocket reduction
• Pocket elimination
• Regeneration
Often require more complex rehabilitation
Maintenance
Key for all pts initially 3 monthly
hygienist visits
Supportive Periodontal therapy including OHI
Review annually including risk factors, hygiene
methods and motivation
Referral acceptance into secondary care
Comprehensive diagnostic, treatment planning, and advice
service for patients with periodontal diseases
All referrals will be expected to contain the following
information:
• BPE scores;
• Summary of treatment already provided / the treatment
response;
• Details of known risk factors including smoking history
(pack years) and quit attempts;
• Evidence of longitudinal monitoring of patients for whom
there appears to be periodontal deterioration
In normal circumstances referrals will only be accepted
for treatment when the following treatment has been
undertaken:
•OHI with particular emphasis on
the appropriate form of interdental cleaning;
• Supragingival scaling and polishing;
• Subgingival scaling.
Patients should continue to see their own GDP for
routine dental examinations
GDP - responsible for routine elements of shared care
On completion of periodontal treatment, pre- and posttreatment
charts will be sent to the GDP for their information in
future monitoring and maintenance of the patient.
A recall interval programme of periodontal care in the primary
care practice will be suggested.
Referral acceptance into secondary care - who gets considered for treatment?
• BPE scores of 3 or 4
• Advanced chronic periodontitis (post initial
treatment)
• Aggressive periodontitis
• Medical conditions, medication histories or syndromes that directly affect periodontal status
• Mucogingival problems, gingival recession or
other periodontal defects for which surgery may
be indicated, following initial therapy.
• Periodontal-endodontic lesions
Referral acceptance into secondary care - pts who should not be referred for specialist advice and treatment planning are those
• With only gingivitis
• With poor oral hygiene or who are non responsive to, or non compliant with initial
hygiene phase therapy provided in primary care
• With BPE scores of 2 or less.
• Economic referrals
