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Periodontics > Exam 3 - Non-surgical Therapy > Flashcards

Exam 3 - Non-surgical Therapy Flashcards

1
Q

What measurement identifies how much dental plaque (undisturbed oral biofilm) we accumulate per day?

A

82 to 200 um/day

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2
Q

If the effect of chlorhexidine was tested on undisturbed dental plaque following 1 min of exposure, what time period showed the most significant effect?

A

6 hr plaque.
- the effect of CHX on 24 and 48 hr place was limited to the outer layer. Middle and inner layers were not appreciably affected.

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3
Q

After SRP, what was the mean reduction in probing depth for the following probing depths

PD 7mm

What about mean gain in CAL?

A

PD 0.03 mm
PD 4-6 mm –> 1.29 mm
PD >7mm –> 2.16 mm

CAL:
PD -0.34 mm
PD 4-6mm –> 0.55 mm
PD >7mm –> 1.19 mm

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4
Q

List the instruments in order of their mean distance from the instrument limit to maximum pocket depth.

A 
Gracy Curette (1.25 mm)
Traditional Ultrasonic (1.13 mm)
Ultrasonic Perio Insert (0.78 mm)
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5
Q

List the problems of restricted access

A 
Probing depth
Furcations
Root proximity
Root flutings
CEJ relationships
Restorations
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6
Q

Clinical protocol for non-surgical therapy

A
  1. OHI
    • Electric power toothbrush
    • Interproximal cleaning (flows, waterpik)
    • Rinse with CHX twice daily
  2. SRP with local anesthesia
  3. Low Dose Doxycycline (periostat)
    Smokers
  4. Re-evaluation at 4-6 weeks post-SRP
    • Retreat residual sites of >5mm (SRP or Site-specific drug delivery)
  5. If desired response is not achieved then consider surgical treatment
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7
Q

Low Dose Doxycycline was originally marketed as what?

A

Periostat

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8
Q

Name the dosage for Periostat

A

20 mg, #180 tabs, q. 12 h.

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9
Q

Describe the reasoning for 20 mg of dosage per tablet of Doxycycline

A

There is no bacterial effect at this dosage. However, doxycycline (like all tetracycline family) chelate calcium and other metals such as Zn and Mg. Therefore, the tetracycline drugs have the ability to inactivate matrix metalloproteinase - specifically the collagenases and gelatinizes produced by PMNs and macrophages

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10
Q

Where would you perform SRP + Local delivery of antimicrobial

A
  1. Pockets of > or = 5mm
  2. Maintenance patients with isolated PD of 5-6 mm
  3. Early stage periodontal abscess
  4. PD at the distal-facial line-angle of 2nd molars related to 3rd molar extractions
  5. Ailing implants (peri-implantitis)
  6. Furcations
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11
Q

3 locally delivered antimicrobials that are commercially available?

A
  1. Periochip
  2. Atradox
  3. Arestin
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12
Q

Describe Periochip

A

Chlorhexidine gluconate in a polymerized polylactic acid disc

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13
Q

Describe Atradox

A

Doxycycline in a poly-lactide gel that polymerizes on contact with water

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14
Q

Describe Arestin

A

1 mg of minocycline micro encapsulated in a poly-glycolide-co-lactide dry powder

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15
Q

To be effective, a locally delivered antimicrobial must do what 5 things?

A
  1. Kill or inhibit the appropriate target microbes
  2. Reach the disease site
  3. Achieve adequate concentration for effectiveness
  4. Achieve appropriate duration of effect
  5. Have few side effects and/or cause no harm to the patient
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16
Q

What microbes are susceptible to minocycline at concentrations of 2-8 ug/ml

A 
Porphyromonas gingivalis
Prevotella intermedia
Fusobacterium nucleatum
Eikenella corrodens
Aggregatibacter actinomycetemcomitans
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17
Q 
Mouth Rinse in its ratings of the following factors to treat Chronic Periodontitis?
1- Reach disease site
2- Achieve adequate concentration
3- Achieve adequate duration of effect
4- Kill/Inhibit target microbes
5- Does not harm patient
A 
1 - Poor
2 - Good
3 - Poor
4 - Poor
5 - Good
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18
Q 
Sub gingival irrigation in its ratings of the following factors to treat Chronic Periodontitis?
1- Reach disease site
2- Achieve adequate concentration
3- Achieve adequate duration of effect
4- Kill/Inhibit target microbes
5- Does not harm patient
A 
1 - Good
2 - Good
3 - Poor
4 - Fair
5 - Good
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19
Q 
Systemic Antibiotics in its ratings of the following factors to treat Chronic Periodontitis?
1- Reach disease site
2- Achieve adequate concentration
3- Achieve adequate duration of effect
4- Kill/Inhibit target microbes
5- Does not harm patient
A 
1 - Good
2 - Fair
3 - Fair
4 - Good
5 - Fair
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20
Q 
Locally Delivered Antimicrobial in its ratings of the following factors to treat Chronic Periodontitis?
1- Reach disease site
2- Achieve adequate concentration
3- Achieve adequate duration of effect
4- Kill/Inhibit target microbes
5- Does not harm patient
A 
1 - Good
2 - Good
3 - Good
4 - Good
5 - Good
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21
Q

Describe the load of Arestin

A

1 mg of minocycline micro encapsulated in a poly-glycolide-co-lactide dry powder

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22
Q

GCF concentration of Arestin at following times:

  • time of application
  • Day 3
  • Day 14
  • Day 28
A
  • 90,000 ug/ml at time of application
  • 3,250 ug/ml at day 3
  • 340 ug/ml at day 14
  • 10-20 ug/ml at day 28
23
Q

Open Flap Debride (4-6 mm pocket)

  • Reduction in PD
  • Change in CAL
A

Reduction: 3.00 mm

Change in CAL: 1.50 mm

24
Q

SRP + Arestin (4-6 mm pocket)

  • Reduction in PD
  • Change in CAL
A

Reduction: 1.65 mm

Change in CAL: 1.05 mm

25
Q

SRP treatment (4-6 mm pocket)

  • Reduction in PD
  • Change in CAL
A

Reduction: 1.30 mm

Change in CAL: 0.55 mm

26
Q

SRP + Atridox (4-6 mm pocket)

  • Reduction in PD
  • Change in CAL
A

Reduction: 1.20 mm

Change in CAL: 0.88 mm

27
Q

SRP + Actisite (4-6 mm pocket)

  • Reduction in PD
  • Change in CAL
A

Reduction: 1.10 mm

Change in CAL: 1.00 mm

28
Q

SRP + PerioChip (4-6 mm pocket)

  • Reduction in PD
  • Change in CAL
A

Reduction: 0.90 mm

Change in CAL: 0.55 mm

29
Q

Average Non-Surgical Therapy (4-6 mm pocket)

  • Reduction in PD
  • Change in CAL
A

Reduction: 1.23 mm

Change in CAL: 0.81 mm

30
Q

Systemic antibiotics commonly used as adjuncts in the treatment of aggressive periodontitis include:

A 
Amoxicillin (Amoxil or Trimox)
Metronidazole (Flagyl)
Tetracycline HCl (Sumycin)
Doxycycline (Virbramycin)
Clindamycin (Cleosin)
Amoxicillin + Clavulanic Acid (Augmentin)
Azithromycin (Zithromax or Z-pak)
31
Q

Advantages in use of systemic antibiotics in the treatment of chronic periodonititis

A
  1. Affects bacterial reservoirs
  2. Targets multiple sites of infection
  3. Reduces chair time required to treat patients
  4. Absorb into soft tissues adjacent to infected site
  5. Penetrates to base of infected pocket
  6. Wide choice of different antibiotics
32
Q

Disadvantages in use of systemic antibiotics in the treatment of chronic periodontitis

A
  1. Allergy
  2. Gastrointestinal intolerance
  3. Patient compliance
  4. Potential for drug interactions
  5. Cost to patient
  6. Inability to penetrate an intact biofilm
33
Q

Problem of patient compliance of medications at 6 hours, 8 hours, 12 hours and 24 hours
(used in comparison to diabetics/insulin = 60% and Seatbelts = 70%

A

q. 6 h = 27%
q. 8 h = 40%
q. 12 h = 60%
q. 24 h = 75%

34
Q

Common side effects of systemic antibiotics

A
  1. Gastrointestinal
  2. Nausea
  3. Photosensitivity
  4. Bacterial Resistance
  5. Esophagitis
  6. Candidiasis
35
Q

What four systemic antibiotics may cause candidiasis as a side effect

A

Tetracycline HCl
Doxycycline
Minocycline
Amoxicillin

36
Q

Clinical reasons for failure of systemic antibiotic therapy

A
  1. Patient non-compliance
  2. Inability to penetrate infection
  3. Inability to eradicate source of infection
  4. Cost to patient
  5. Inability to penetrate an intact biofilm
37
Q

Treatment of chronic periodontitis by SRP + Arestin results in what?

A

significant decreases in levels of serum hsCRP and IL-6

38
Q

Treatment of chronic periodontitis by SRP + sub-antimicrobial dose doxycycline results in what?

A

significant decreases in levels of GCF-MMPs (8 & 9), sCRP, HDL, and apolipoprotein-A (Apo-A)

39
Q

What phase of treatment leads to most subsequent treatment decisions?

A

Re-evaluation

40
Q

Where do most changes in the treatment plan occur?

A

During Re-evaluation

41
Q

During Re-evaluation, what things are evaluated?

A
  1. Review Medical History
  2. Visual Examination
  3. Probing Depths
  4. Gingival Recession
  5. Clinical Attachment Levels
  6. Plaque control
  7. Bleeding on Probing
  8. Mucogingival Defects
  9. Furcation Involvements
  10. Mobility/Fremitus/Occlusion
  11. Caries
42
Q

What 4 decisions are made during the Re-evaluation

A
  1. Control or re-address primary etiology
  2. Control or re-address etiologic modifying factors
  3. Proceed to Phase II (surgical therapy)
  4. Place in compromised maintenance therapy
43
Q

List possible etiologic modifying factors

A
  1. Systemic disease
  2. Smoking
  3. Caries
  4. Diet
  5. Overhangs
  6. Occlusion
  7. Medications
  8. Parafunctional habits
44
Q

During reevaluation, if a patient has improved to a level where the disease is stable and not other treatment is indicated, proceed to what phase?

A

Maintenance phase

45
Q

During reevaluation, if there has been no improvement or disease is not stable, then proceed to:

A

Personalized Re-treatment

46
Q

During Personalized Re-treatment, if sites are getting deeper or no improvement or if several sites are still exhibiting bleeding on probing, then proceed to:

A

Antimicrobial therapy (Systemic or Local)
Surgery
Combination

47
Q

What is the most critical phase of successful periodontal therapy?

A

Maintenance

48
Q

Treatment decisions in maintenance are based on?

A

Changes in probing depths
Presence of bleeding/plaque
Progressive loss of clinical attachment

49
Q

During Maintenance, if probing depths are stable and there is no BOP, what do you do?

A

Routine Treatment, review OHI

Same recall interval

50
Q

During Maintenance, if probing depths are stable but there IS BOP, what do you do?

A

Review OHI
Re-scale and root plane bleeding sites
Consider local delivery of antimicrobials
Consider shortening recall interval

51
Q

During Maintenance, if probing depths increase and BOP increases, what do you do?

A 
Review OHI
Re-scale and root plane
Consider adjunctive therapy
    - Locally delivered or systemic antibiotics
Referral to a periodontist
52
Q

How long is the normal interval between periodontal maintenance appointments

A

Every 3 months
- Time needed for pockets to re-infect is three months. i.e, pathogenic bacteria will begin to repopulate a pocket of >4 mm at 60+ days

53
Q

T or F, Patients referred to a periodontist will generally be placed on an alternating maintenance schedule

A

True. patient will see GP every second appointment

Periodontics (10 decks)

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