Ch 24

Question 1

what is present in periodontal disease

Answer 1

• increased number of pathogens
• decreased number of beneficial bacteria
• conducive environment
• susceptible host

Question 2

2 main attackers for perio/aggressive perio

Answer 2

1. aa

2. pg

Question 3

what are gram + facultative bacteria

Answer 3

• can survive with or without oxygen

- ex: sterptococcus sp, actinomyces sp

Question 4

what are gram + obligate anaerobic bacteria

Answer 4

• cant use oxygen for growth can even be destroy by o2

- ex: peptostreptococcus micros, eubacterium

Question 5

what are gram - anaerobic

Answer 5

• aa

- pg

Question 6

what are gram - obligate anaerobic

Answer 6

• pg
• prevotella intermedia
• bacteriodes forsythus (new name is tannerella forsythensis)
• fusobacterium nucleatum
• spirochetes (treponema denticola)

Question 7

what do active sites of chronic perio usually have present

Answer 7

• pg
• b. forsynthis or tanerella f
• p. intermedia
• eikenella corrodens
• f nucleatum
• campylobacter recta; selenomonas sp.
• spirochetes
• peptostreptococcus micros

Question 8

what else may be present in aggressive perio

Answer 8

• capnocytophaga

Question 9

what is the goal of periodontal therapy

Answer 9

• aims to eliminate the potentially pathogenic microorganisms, allowing the residual pockets to be colonized by species of bacteria that are not associated with disease activity (beneficial species)

Question 10

what is periodontal therapy

Answer 10

• adjunct to scaling and root planing
• all adjunctive therapies (eg rinses, irrigation, systemic antibiotics) may be performed in conjunction with mechanical debridement

Question 11

what is a systemic drug

Answer 11

• into circulation – pill form

Question 12

what is a locally applied antibiotic

Answer 12

• topical: oral rinses, oral irrigation

- controlled-release/sustained-release: powder, gel, chip

Question 13

what is biofilm

Answer 13

• gel matrix
• varying thickness
• need a lot to penetrate biofilm (removal necessary first)
• require substantivity of drug
• matrix must be professionally removed subg
• drugs applied if required: not effective alone, always an adjunct to periodontal debridement and/or surgery

Question 14

what are the 2 types of systemic therapy

Answer 14

1. systemic antibiotic therapy

2. host modulated (enzyme suppression) therapy

Question 15

what is the rationale for systemic antibiotics

Answer 15

• can attack specific bacteria
• limitations in mechanical removal
• concentrates in GCF
• well-controlled clinical studies show positive results

Question 16

what are the advantages for systemic delivery

Answer 16

• delivery of drug to base of pocket
• bacterial reservoirs are treated
• delivery into tissue (pg, aa, spirochetes)
• different antibiotics can be used based on need

Question 17

what are the disadvantages to systemic drugs

Answer 17

• adverse side effects
• dilution of drug till reches GCF
• patient noncompliance
• biofilm effect
• reinfection and/or bacterial resistance

Question 18

what conditions should we use systemic antibiotics for

Answer 18

• refractory perio
• aggressive perio
• medically compromised patients
• NUP
• regenerative procedures
• implants

Question 19

how can we select the proper antibiotics

Answer 19

• microbiology testing: not always possible, expensive, evidence based
• specific bacteria: with particular cases
• mechanical debridement: need good OHI (only short term fix if all aspects of hygiene maintenance is not performed)

Question 20

what are the 2 types of antibiotics

Answer 20

• bacteriostatic (suppress multiplication)

- bactericidal (kill bacteria)

Question 21

what families are there for systemic antibiotics

Answer 21

• tetracycline (doxycycline, minocycline)
• clindamycin
• penicillins (amoxicillin, amoxicillin + clavulanic acid)
• metronidazole
• erythromycins (azalides)
• fluoroquinolones (ciprofloxacin)

Question 22

what are properties of tetracycline

Answer 22

• broad spectrum
• antibacterial: bacteriostatic, inhibit protein synthesis
• non antibacterial effects (periostat): anticollagenase, inhibit secretion of collagenase from neutrophils, inhibit bone resorption
• spectrum of activity: localized aggressive, refractory, treatment for AA