Chapter 27 & 31 Flashcards
What is systemic delivery of chemical agents?
Tablet or capsule dissolves, the agent enters the circulation, then enters the periodontal tissue and is incorporated into the GCF
What is topical delivery of chemical agents?
- 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
Why is resistance of biofilm to delivery of agents a consideration to make?
The surface of biofilm is covered by ECM which acts as a barrier to some chemical agents
Why are microbial resevoirs for periodontal pathogens a consideration to make?
Niches in the oral cavity allow periodontal pathogens to live undisturbed by routine theray leading to repopulation of the pockets
What are some examples of microbial resevoirs for periodontal pathogens?
- 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
What is the criteria for effectiveness of chemical agents?
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
What systemic antibiotics have been studied for use in periodontal disease?
- Penicillin/amoxicillin
- Tetracyclines
- Erythromycin
- Metronidazole
- Clindamycin
When do we choose to use antibiotics to treat periodontal disease?
- 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)
How are tetracyclines used in periodontal patients?
- 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
How do controlled-release topical chemical agents used?
- An antimicrobial is embedded in a carrier material placed directly in the pocket
- Chlorhexadine and tetracycline in current use
What is the rationale for using controlled-release chemical agents?
Sustained delivery of therapeutic levels of antimicrobial agent for an extended period
What are the benefits of controlled-release chemical agents?
- Small gains in attachment level
- Beneficial in pts or sites not amenable to surgery
- Use in combination w/ periodontal instrumentation
What are the agents and mechanisms of use for minocycline hydrochloride microspheres?
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
What are the agents and mechanisms of use for Doxycycline Hyclate Gel?
- 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
What are the agents and mechanisms of use for chlorhexadine gluconate chip?
- PerioChip- chlorhexadine in a gelatin carrier
- Inserted in pockets > 5mm
- Bioabsorbed
- Adjunct to periodontal instrumentation, reduces AB loss
Describe the desireable qualities of a therapeutic mouth rinse
- 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
Problems with therapeutic mouth rinses
- 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
What is oil pulling used for?
- 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
Describe the gingiva or primary dentition
- 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
Describe the radiographic assessment of the PDL and AB in primary dentition
- 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
What is the relationship between biofilm and inflammation in primay dentition?
- The amount of plaque biofilm does not correlate w/ level of inflammation
- Increase in plaque–> decrease in inflammation
What is the cause and treatment of eruption gingivitis?
- 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
What is the cause and treatment for pericoronal abscess?
- 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
What percentage of teenagers exhibit bleeding upon probing?
60%
Describe chronic pediatric periodontitis
- Rare, similar to that seen in adults
- Not detectable by visual exam
- Aggressive forms
- Necrotizing
What happens in more aggressive forms of pediatric periodontitis?
- 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
What are the two patters of aggressive forms of pediatric periodontitis?
- Molar incisor pattern
- Generalized pattern
WHat are the characteristics of molar incisor pattern?
- 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
What are the characteristics of generalized pattern of pediatric periodontitis?
- 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
What are recurrent apthous ulcers?
“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
What triggers apthous ulcers?
- 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
