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Periodontology > Aggressive periodontitis > Flashcards

Aggressive periodontitis Flashcards

1
Q

What is periodontitis?

A

Inflammatory condition affecting the supporting structures of the teeth

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2
Q

What % of tissue loss is caused by bacteria?

A

20%

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3
Q

What does the host response cause to happen?

A

inflammation, bone loss and recession

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4
Q

What factors prime the immune system to periodontitis?

A

Environmental and genetic

Stress, diabetes, obesity, medications

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5
Q

What is meant by symbiosis of bacteria?

A

host response getting on with bacteria

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6
Q

What is meant by dysbiosis?

A

Bad bacteria and primed immune system releasing cytokines

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7
Q

How can the patient prevent the bacteria causing periodontitis?

A

Reduce plaque levels to level that the immune system can cope with

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8
Q

How can stress be a risk factor for periodontitis?

A

Poor coping strategy - don’t want to eat/drink good things and take care of themselves
Cortisol - stops chemotaxis, promoting more cytokines

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9
Q

What are the common features of aggressive periodontits?

A 
Patient's otherwise clinically healthy
Rapid detachment loss and bone destruction -significant differences 6-12 months
Familial aggregation 
Vertical bone bone loss on radiographs
Affects 6's and lateral incisors/canines
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10
Q

What are the secondary features of aggressive periodontitis?

A

Microbial deposits not consistent with destruction
Aggregatibacter actinomycemcomitans and P. gingivalis - these can climb inside epithelial cells
Phagocyte abnormalities - some too responsive to bacteria
Hyper-responsive immune response
Attachment and bone loss may be self-arresting

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11
Q

What result in severe periodontal disease?

A

Polymorphonuclear neutrophil defects

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12
Q

Localised aggressive periodontitis is associated with PMN defect, what does this in turn affect?

A

Chemotaxis
Phagocytosis
Bacterial killing

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13
Q

How is chronic periodontitis different to aggressive?

A

Chronic:
Prevalent in adults (may occur in children)
Commensurate with OH and plaque levels, local predisposing factors, smoking and stress
Host factors determine the pathogenesis and progression of the disease
Rate of progression slow - moderate
Further periodontal breakdown will occur in sites that are left untreated

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14
Q

How is aggressive periodontitis different to chronic?

A

Aggressive:
Non-contributory medical history
Rapid attachment loss and bone destruction
Familial aggregation of cases

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15
Q

What takes place during the clinical examination of the diagnosis of the periodontitis?

A 
Probing pocket depth
Bleeding index
Plaque index
Recession
Attachment loss
Mobility 
Furcation involvement 
Additional tests: radiographs, vitality test
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16
Q

How can having Papillion lefevre syndrom lead to having the same signs/symptoms of aggressiveP

A

As the teeth erupt, get hyperimflammatory respnse

Root shape is generic: tapered, narrow roots - dont need a lot of bone loss to get mobility

17
Q

Why is diagnosis important?

A

Medico-legally
Early management priority
Treatment modality
Early referral

18
Q

How can antibiotics be used to treat A.a

A

Amoxicillin 500mg plus metronidazole 400mg TDS 7 days

19
Q

what other antibiotic can be used for treatment?

A

Azithromycin 500mg once daily for 3 days

used to kill P.gingivalis

20
Q

What must be done before prescribing antibiotics

A

<25% plaque control before prescribing - antibiotic resistance
Counterproductive unless thorough debridement and homecare
ideally given during first cycle of non-surgical treatment

21
Q

What is the 2 steps of the treatment strategy?

A

Cause related therapy

Corrective therapy

22
Q

What are the factors that influence complete calculus removal?

A

Extent of the disease
Anatomic factors
Skills of the operator
instruments used

23
Q

How long does it take for bacteria to move in pockets >4mm?

A

Have stagnation zone, takes 12 weeks

24
Q

What are the different approaches to subgingival infection control?

A

Quadrant RSD (gold standard)
single stage full mouth RSD
Same day full mouth RSD

25
Q

How can the patient cause non-surgical treatment failure?

A

Poor motivation/co-operation
patient circumstances
Patient medical history

26
Q

How can the operator cause non-surgical treatment failure?

A

Incorrect diagnosis

Inadequate non-surgical treatment

27
Q

How can the anatomy cause non-surgical treatment failure?

A 
Multiple intra-bony defects
Furcation involvement
Very deep sites
Difficult anatomy of tooth borne or roots
Difficult access
Gingival biotype
28
Q

What are the different aims of periodontal surgery

A

Pocket reduction
Pocket elimination
Regeneration

29
Q

How can you surgically treat intrabony and furcation defects?

A

Filled with granulation tissue and bacteria - need to remove
Grafting particulate or create blood clot

30
Q

What is an example of what is done at intrabony surgery?

A

Curette everything

Chippings packed in, when healed this turns into stroma of natural bone - acts as scaffolding

31
Q

What is done for maintenance?

A

3 monthly hygiene visits
Supportive periodontal therapy including OHI
Review annually: including risk factors, hygiene methods and motivation

32
Q

What can you refer patients for?

A

Diagnostic, treatment planning and advice service for patients with perio diseases

33
Q

What must all referrals be expected to contain?

A

BPE scores
Summary of treatment already provided/ treatment response
Details of known risk factors including smoking and quit attempts
Evidence of longitudnal monitoring of patients from whom there appears to be periodontal deterioration

34
Q

What treatment should already have been done before referring a periodontal patient?

A

OHI, with particular emphasis on interdental cleaning
S+P
sub-ging scale

35
Q

what is the GDP still responsible for?

A

The routine elements of shared care

36
Q

What is sent to the GDP on completion of the treatment?

A

pre and post treatment charts sent for info in future monitoring and maintenance
A recall interval programme of perio in the primary care practice will be suggested

37
Q

Who gets considered for secondary care treatment?

A

BPE’s 3 and 4
Advanced chronic perio - after initial treatment
Aggressive perio
Medical conditions, medical histories or syndromes that directly affect perio status
Perio-endo lesions

38
Q

What are the different medical conditions that would lead to referral?

A

Mucogingival problems
gingival recession
Other perio defects for which surgery indicated
Following initial therapy

39
Q

Which patients SHOULDN’T be referred for specialist advice and treatment planning?

A

Only gingivitis
Poor OH or non-responsive to or non-compliant with initial phase therapy from primary care
with BPE of 2 or less
Economic referrals

Periodontology (7 decks)

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