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247 Periodontics > Chapter 27 & 31 > Flashcards

Chapter 27 & 31 Flashcards

1
Q

What is systemic delivery of chemical agents?

A

Tablet or capsule dissolves, the agent enters the circulation, then enters the periodontal tissue and is incorporated into the GCF

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2
Q

What is topical delivery of chemical agents?

A
  • Intraoral placement of a chemical agent
  • Local delivery of control-release devices into the pocket where it contacts the biofilm on the teeth or pocket
  • Some agents will enter the systemic circulation through the mucous membranes
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3
Q

Why is resistance of biofilm to delivery of agents a consideration to make?

A

The surface of biofilm is covered by ECM which acts as a barrier to some chemical agents

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4
Q

Why are microbial resevoirs for periodontal pathogens a consideration to make?

A

Niches in the oral cavity allow periodontal pathogens to live undisturbed by routine theray leading to repopulation of the pockets

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5
Q

What are some examples of microbial resevoirs for periodontal pathogens?

A
  • Protected sites like furcation areas
  • Bacteria in residual calculus deposits
  • Within layers of CT adjactent to the periodontal pocket
  • Dentinal tubules
  • Irregularities in the tooth surface
  • Poorly defined restoration margins
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6
Q

What is the criteria for effectiveness of chemical agents?

A

IT MUST:
- Reach the sites of disease activity, base of pocket
- Be delivered at a bacteriostatic or bactericidal concentration
- Remain in place long enough to be effective

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7
Q

What systemic antibiotics have been studied for use in periodontal disease?

A
  • Penicillin/amoxicillin
  • Tetracyclines
  • Erythromycin
  • Metronidazole
  • Clindamycin
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8
Q

When do we choose to use antibiotics to treat periodontal disease?

A
  • When there has been continued periodontal breakdown after thorough mechanical therapy
    *
  • Educate petients about why antibiotics are not routinely used in treatment (resistance plus effectiveness of mechanical therapy)
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9
Q

How are tetracyclines used in periodontal patients?

A
  • Effective against most strains of A. actinomycetemcomitans
  • Inhibit the action of collagenase
  • Effective in subantimicrobial doses w/o the development of resistance
  • Concentrate in GCF
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10
Q

How do controlled-release topical chemical agents used?

A
  • An antimicrobial is embedded in a carrier material placed directly in the pocket
  • Chlorhexadine and tetracycline in current use
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11
Q

What is the rationale for using controlled-release chemical agents?

A

Sustained delivery of therapeutic levels of antimicrobial agent for an extended period

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12
Q

What are the benefits of controlled-release chemical agents?

A
  • Small gains in attachment level
  • Beneficial in pts or sites not amenable to surgery
  • Use in combination w/ periodontal instrumentation
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13
Q

What are the agents and mechanisms of use for minocycline hydrochloride microspheres?

A

Minocycline Hydrochloride Microspheres
- Broad spectrum semisynthetic bacteriostatic tetracycline
- Arestin powdered microspheres
- Applied w/ a cannula subgingivally
- Concentrates subgingivally, high substantivity
- Released over a period of 5-7 days
- Adverse rxns: Oral candidiasis, allergic rxn, development of resistant bacteria

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14
Q

What are the agents and mechanisms of use for Doxycycline Hyclate Gel?

A
  • Atridox
  • Solidifies into a wax-like substance subgingivally, where it degrades over time
  • Gel can cling to applicator and be pulled out without cannula
  • Adverse rxns: oral candidiasis, allergic rxn, development of resistant bacteria
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15
Q

What are the agents and mechanisms of use for chlorhexadine gluconate chip?

A
  • PerioChip- chlorhexadine in a gelatin carrier
  • Inserted in pockets > 5mm
  • Bioabsorbed
  • Adjunct to periodontal instrumentation, reduces AB loss
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16
Q

Describe the desireable qualities of a therapeutic mouth rinse

A
  • Active ingredient should be bacteriostatic or bactericidal for periodontal pathogens
  • Stable at room temp with a reasonable shelf life
  • When retained in the oral cavity, release slowly over time resulting in continual antimicrobial effect
  • No harmful effects locally or systemically
17
Q

Problems with therapeutic mouth rinses

A
  • No chemicals are completely safe for all patients
  • Alcohol: avoid use in dependent pts
  • Sodium: hypertensive pts
  • Essential oils may cause a burning sensation or dry mucous membranes
  • Chlorhexadine gluconate may cause allergic rxns, extrinsic staining, discoloration of tongue, taste alterations, increase in calc formation and transient anesthesia
18
Q

What is oil pulling used for?

A
  • Prevention of gingival bleeding
  • Prolonged time in the mouth draws out all the bacteria and toxins
  • No reliable evidence to support or disprove oil pulling
19
Q

Describe the gingiva or primary dentition

A
  • Red in color due to increased vascularity/thinner epithelium
  • Smooth texture with stippling present
  • Rounded margina
  • Flabby consistency due to less developed collagen detwork
  • Shallow sulcus
  • Rounded and saddle shaped papillae w/ broad facial to lingual dimension and narrow mesial to distal
  • Attached gingiva is narrow at the mandible
20
Q

Describe the radiographic assessment of the PDL and AB in primary dentition

A
  • PDL is wider and less dense fibers
  • AB has less trabeculae and larger marrow spaces
  • Lamna dura is prominent w/ wider PDL space
  • Septa are broader and flatter than seen in adults, w/ bony crests within 1-2mm of the CEJ
21
Q

What is the relationship between biofilm and inflammation in primay dentition?

A
  • The amount of plaque biofilm does not correlate w/ level of inflammation
  • Increase in plaque–> decrease in inflammation
22
Q

What is the cause and treatment of eruption gingivitis?

A
  • Plaque accumulation in areas of exfoliating/erupting teeth and inadequate hygiene
  • Epithelial migration under resorbing teeth causes increased pocket depth
  • Tx: quickly reversible w/ improved hygiene or eruption
23
Q

What is the cause and treatment for pericoronal abscess?

A
  • Localized purulent infection around partially erupted tooth, frequently erupting molar
  • Bad taste, tender to painful–> trismus, spreading infection, Ludwig’s angina
  • Tx: debridement, antibiotics if spreading, excision, extraction
24
Q

What percentage of teenagers exhibit bleeding upon probing?

A

60%

25
Q

Describe chronic pediatric periodontitis

A
  • Rare, similar to that seen in adults
  • Not detectable by visual exam
  • Aggressive forms
  • Necrotizing
26
Q

What happens in more aggressive forms of pediatric periodontitis?

A
  • Rapid destruction of PDL and bone- 3-4x the adult chronic rate
  • No obvious signs/symptoms of systemic disease
  • Impaired phagocytosis
  • Hyper inflammatory response to bacterial endotoxins
  • Small amounts of biofilm
  • More A. actinomycetemcomitans
  • Soft tissue may appear normal
  • Poor response to therapy
  • Episodic
  • 2 patters of disease
27
Q

What are the two patters of aggressive forms of pediatric periodontitis?

A
  • Molar incisor pattern
  • Generalized pattern
28
Q

WHat are the characteristics of molar incisor pattern?

A
  • Vertical bone loss around 1st molars and incisors
  • Neutrophil defect
  • Seen in less than 1% of the population
  • Starts in primary dentition and progresses to permanent dentition
  • Tx: Broad-spectrum antibiotics, tetracycline alone, combined with metronidazole
  • Corrective surgery as needed and frequent recalls
29
Q

What are the characteristics of generalized pattern of pediatric periodontitis?

A
  • At least 3 permanent teeth other than 1st molars and incisors
  • Usually occurs under age 30
  • Tissue may appear normal or may be acutey inflammed, ulcerated and fiery red
  • Do medical evaluation for underlying systemic conditions
  • Does not respond well to conventional nonsurgical therapy or antibiotics
30
Q

What are recurrent apthous ulcers?

A

“Canker Sores”
- Small, recurrent painful round or ovoid ulcers w/ well defined red margins like a halo
- Central yellow or grey floor
- Develops on nonkeratinized tissue: buccal mucosa, mucobuccal fold, floor of mouth, ventral surface of tongue, soft palate
- Not contagious
- Unknown etiology

31
Q

What triggers apthous ulcers?

A
  • Minor trauma: dental works, brushing, cheekbite
  • Toothpaste/rinses: sodium lauryl sulfate
  • Food sensitivities: chocolate, coffee, strawberries, eggs, nuts, cheese and spicy or acidic foods
  • Lack of B12, zinc, folate and/or iron
  • Stress
  • Tx: spontaneous healing 4-14 days

247 Periodontics (19 decks)

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