Aggressive periodontitis Flashcards
What is periodontitis?
Inflammatory condition affecting the supporting structures of the teeth
What % of tissue loss is caused by bacteria?
20%
What does the host response cause to happen?
inflammation, bone loss and recession
What factors prime the immune system to periodontitis?
Environmental and genetic
Stress, diabetes, obesity, medications
What is meant by symbiosis of bacteria?
host response getting on with bacteria
What is meant by dysbiosis?
Bad bacteria and primed immune system releasing cytokines
How can the patient prevent the bacteria causing periodontitis?
Reduce plaque levels to level that the immune system can cope with
How can stress be a risk factor for periodontitis?
Poor coping strategy - don’t want to eat/drink good things and take care of themselves
Cortisol - stops chemotaxis, promoting more cytokines
What are the common features of aggressive periodontits?
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
What are the secondary features of aggressive periodontitis?
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
What result in severe periodontal disease?
Polymorphonuclear neutrophil defects
Localised aggressive periodontitis is associated with PMN defect, what does this in turn affect?
Chemotaxis
Phagocytosis
Bacterial killing
How is chronic periodontitis different to aggressive?
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
How is aggressive periodontitis different to chronic?
Aggressive:
Non-contributory medical history
Rapid attachment loss and bone destruction
Familial aggregation of cases
What takes place during the clinical examination of the diagnosis of the periodontitis?
Probing pocket depth Bleeding index Plaque index Recession Attachment loss Mobility Furcation involvement Additional tests: radiographs, vitality test
How can having Papillion lefevre syndrom lead to having the same signs/symptoms of aggressiveP
As the teeth erupt, get hyperimflammatory respnse
Root shape is generic: tapered, narrow roots - dont need a lot of bone loss to get mobility
Why is diagnosis important?
Medico-legally
Early management priority
Treatment modality
Early referral
How can antibiotics be used to treat A.a
Amoxicillin 500mg plus metronidazole 400mg TDS 7 days
what other antibiotic can be used for treatment?
Azithromycin 500mg once daily for 3 days
used to kill P.gingivalis
What must be done before prescribing antibiotics
<25% plaque control before prescribing - antibiotic resistance
Counterproductive unless thorough debridement and homecare
ideally given during first cycle of non-surgical treatment
What is the 2 steps of the treatment strategy?
Cause related therapy
Corrective therapy
What are the factors that influence complete calculus removal?
Extent of the disease
Anatomic factors
Skills of the operator
instruments used
How long does it take for bacteria to move in pockets >4mm?
Have stagnation zone, takes 12 weeks
What are the different approaches to subgingival infection control?
Quadrant RSD (gold standard)
single stage full mouth RSD
Same day full mouth RSD
How can the patient cause non-surgical treatment failure?
Poor motivation/co-operation
patient circumstances
Patient medical history
How can the operator cause non-surgical treatment failure?
Incorrect diagnosis
Inadequate non-surgical treatment
How can the anatomy cause non-surgical treatment failure?
Multiple intra-bony defects Furcation involvement Very deep sites Difficult anatomy of tooth borne or roots Difficult access Gingival biotype
What are the different aims of periodontal surgery
Pocket reduction
Pocket elimination
Regeneration
How can you surgically treat intrabony and furcation defects?
Filled with granulation tissue and bacteria - need to remove
Grafting particulate or create blood clot
What is an example of what is done at intrabony surgery?
Curette everything
Chippings packed in, when healed this turns into stroma of natural bone - acts as scaffolding
What is done for maintenance?
3 monthly hygiene visits
Supportive periodontal therapy including OHI
Review annually: including risk factors, hygiene methods and motivation
What can you refer patients for?
Diagnostic, treatment planning and advice service for patients with perio diseases
What must all referrals be expected to contain?
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
What treatment should already have been done before referring a periodontal patient?
OHI, with particular emphasis on interdental cleaning
S+P
sub-ging scale
what is the GDP still responsible for?
The routine elements of shared care
What is sent to the GDP on completion of the treatment?
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
Who gets considered for secondary care treatment?
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
What are the different medical conditions that would lead to referral?
Mucogingival problems
gingival recession
Other perio defects for which surgery indicated
Following initial therapy
Which patients SHOULDN’T be referred for specialist advice and treatment planning?
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
