Exam 3 Non-surgical Therapy Flashcards
The effect of 0.2 % CHX on undisturbed 6 hr plaque vs 24 and 48 hr plaque is…?
- CHX effect on 6 hr was significant
- CHX effect on 24 & 48 hr plaque was limited to the outer layer
CHX facilitates __________ calculus buildup.
supragingival
What is scaling?
Removal of accretions of the tooth
What is root planing?
Removal of accretions on the root
SRP (soft tissue management) reduces ________ this is considered _____ therapy.
- inflammation
- initial
Need a minimum of ______ , or greater to do a SRP.
4mm
PD less than 3 mm
- 0.34 (a loss in CAL)
0. 03 mm Mean Reduction in probing depth
PD 4-6 mm* showed a mean PD reduction of ______ and a _______mean gain in CAL
***1.29mm SRP
0.55mm
PD > 7 mm* showed a mean PD reduction of ______ and a _______ mean in gain in CAL
***2.16 mm SRP
1.19 mm
What are the problems of restricted access?
1) Probing depth
2) furcations
3) root proximity
4) root flutings
5) CEJ relationships
6) Restorations
What is the clinical protocol?
1) Electric power toothbrush
2) Interproximal cleaning (floss, waterpik)
3) Rinise w/ CHX twice daily
4) Rinse w/ CHX 2 X
5) SRP w/ local anesthesia
6) Low dose doxycycline, 20 mg., #180 tabs, q 12 h (smoker)
7) Re-evaluation 4-6 weeks post SRP (retreat if needed)
8) If desired response is not achieved than consider surgical TX
What was Low Dose (Subantimicrobial) Doxycycline (Host Modulation) originally marketed as? dose?
- Periostat
- 20 mg of doxycycline, # 180 tabs, q. 12 h.
Will SRP affect infra bony lesions like horizontal and vertical bone loss?
No, it will no treat bone defects, it will only reduce inflammation.
At 20 mg concentration of doxycycline, what is the effect?
There is no bacterial effect at this dose.
The tetracycline drugs, doxycycline has the ability to ____________ matrix metalloproteinases- specifically ________________ and __________ produced by PMNs and macrophages.
- INACTIVATES
- COLLAGENASE
- gelatinases
SRP and local delivery of antimicrobials occurs when ? (6)
1) Pockets are greater than 5 mm
2) Maintenance patients with isolated PD of 5-6 mm
3) Early stage of periodontal abscess
4) PD at the distal-facial line-angel of 2nd molars related to 3rd molar extractions
5) Ailing implants (peri-implantitis)
6) Furcations
What are the names of commercially available site specific antimicrobials?
1) PerioChip
2) Atradox
3) Arestin
What is the PerioChip?
Chlorhexidine gluconate in a polymerized polylactic acid disc
What is Atradox?
Doxycycline in a poly-lactide gel that polymerizes on contact with water
What is Arestin?
1 mg of minocycline micro encapsulated in a polyglycolide-co-lactide dry powder
Arresting bind to the ______ space
subgingival
_________ is the most common and simplest locally delivered antimicrobials.
Arestin
Arrestin is placed in __________, ___________ after initial treatments, if certain areas didn’t ________ to therapy.
-It will decrease size of __________, does not ______ bone.
- Periopockets
- furcations
- respond
- inflammation
- increase
SRP + Arestin can be given to a pt with _________ chronic ____________ of ________ severity with PD of _________. 1 pk/day cigarette smoker.
- localized
- periodontitis
- moderate
- 4-6 mm
To be effective a locally delivered antimicrobial must have what 5 things
1) Kill or inhibit 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
Which 3 delivery systems reaches the disease site well and which 1 thing has poor prognosis?
Good = Sub gingival irrigation, Systemic antibiotics, locally delivered antimicrobials
Poor= Mouth rinse
Which 3 delivery systems achieve adequate concentration and which 1 thing has a fair prognosis?
Good= Mouth rinse, Sub gingival irrigation, and Locally delivered antimicrobial
Fair= Systemic ABX
Which delivery systems can achieve adequate duration of effect and which has a fair/poor prognosis?
Good= locally delivered antimicrobials
Poor= mouth rinse, sub gingival irrigation
fair= systemic antibiotics
Which delivery system can kill/inhibit target microbes?
good= locally and systemic delivered antimicrobials
fair= subginigval irrigation
poor= mouth rinse
Which delivery system does NOT harm patient?
good= Locally delivered antimicrobials, sub gingival irrigation, mouth rinse.
fair= Systemic ABX
Which microbes are susceptible to minocycline at concentrations of 2-8 micro/ml
1) P.g
2) Prevotella intermedia
3) Fusobacterium nucleatum
4) Eikenella corrodens
5) A.a
Low dose Doxycycline kocks out ________
-Mammalian MMP host response (cytokines, prostanoids, CT and bone metabolism)
Local antimicrobials pathogenesis?
1) Takes out the microbial challenge
2) Antigens
3) LPS
4) Other virulence factors
The deeper the pocket the more likelihood in ___________
Reducing the pocket
Non-surgical management of perio of a 7 mm reduced to __________
5mm
possibly 4 mm
Non-surgical management of perio of a 6 mm pocket reduced to _______
4 mm
possibly 3 mm
Non-surgical management of perio of a 5 mm pocket reduced to ________
3 mm
Which different periodontal therapy can provide the MOST reduction in PD?
**Open Flap Debride (3 mm in reduction!) **
[Note: 2nd best therapy = SRP + Arestin 1.65mm]
Which different periodontal therapy can provide the LEAST reduction in PD?
SRP + PerioChip
Non-surgical Therapy (4-6 mm) provides a _______ reduction in PD and ________ change in CAL
- 23 PD reduction ***
0. 81
Which systemic antibiotics are used as adjuncts in treatment of aggressive periodontitis ?
1) Amoxicillin (amoxil, trimox)
2) Metronidazole (Flagyl)
3) Tetracycline HCL (sumycin)
4) Doxycycline (Vibramycin)
5) Clindamycin (Cleosin)
6) Amoxicillin + Clavulanic Acid (Augmentin)
7) Axithromycin (Zithromax or Z-pak)
What are the advantages for the use of systemic ABX in the treatment of chronic periodontitis?
1) Affects bacterial reservoirs
2) Targets multiple sites of infection
3) Reduces chair time required to treat patients
4) Absorbs into soft tissues adjacent to infected site
5) Penetrates to base of infected pocket
6) Wide choice of different antibiotics
What are the disadvantages for the use of systemic ABX in the treatment of chronic periodontitis?
1) Allergy
2) Gastrointestinal intolerance
3) Patient compliance
4) Potential for drug interactions
5) Cost to patient
6) Inability to penetrate an intact biofilm
What are the common side effects of systemic antibiotics?
1) GI
2) Nausea
3) Photosensitivity
4) Bacterial resistance
5) esophagitis
6) candidiasis
Patients with periodontitis, what is the effect of systemically administered ABX as compared to controls on clinical measures of attachment level?
1) 26 RCTs
2) A more positive effect on CAL than control group
3) Combination of amoxicillin + metronidazole had a significant effect on attachment level (increased CAL by 0.4 mm)
4) Improvements in mean CAL were consistent for both chronic and aggressive periodontitis.
Systemic antibitiotics _________ in most patients with periodontitis.
NOT be used
When indicated as part of perio therapy, ____________ should be used in conjunction with _________
- systemic ABX
- SRP
For obtaining optimal outcomes, systemic ABX should be used at the time of _______________ and all treatment should be carried out preferable with _______ days
- SRP
- 7
Due to important public heath implications the use of ______________ should be redistricted and they should be used under the most ____________conditions
- Systemic antibiotics
- optimal
Clinical reasons for failure of systemic therapy includes what?
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
Treatment of chronic periodontitis by _________ plus ___________ results in significant _________ in levels of serum sCRP and __________
- SRP
- Arestin
- DECREASE
- IL-6
TX of chronic periodonitits by __________ and __________ dose doxycycline results in a signifiicant __________ in levels of GCF MMP, hsCRP, HDL and apolioprotein - A
- SRP
- Subantimicrobial dose
- decreases
Re-evaluation is ___________ and _________ phase of periodontal therapy
significant
decisive
Re-evaluation leads to _____________
___________ in the TX plan are decided upon this time
- MOST subsequent TX decisions
- Most changes
Periodontal re-evaluation (following phase I therapy)? (11)
1) Review medical history
2) visual examination (color, counter, consistency, and texture)
3) Probing depths
4) gingival recession
5) clinical attachment levels
6) plaque control
7) bleeding on probing
8) mucogingival defects
9) furcation involvement
10) mobility/fremitus/occlusion
11) caries
When would you treat decay with a perio patient?
Assess the patients condition, usually SRP first then treat decay, and reevaluation.
What are the periodontal re-evaluation decisions?
1) Control or re-address primary etiology
2) Control or re-address etiologic modifying factors
(systemic disease, smoking, caries, diet, overhangs, occlusion, medications, parafunctional habits)
3) proceed to Phase II (surgical therapy)
4) place in comprised maintenance therapy
If patient has improved to a level where the disease is _______ and no other treatment is indicated, then proceed to _____________ phase.
If there has been no improvement or disease is _____________, then proceed to ____________
- Stable
- Maintenance phase
- Not stable
- Personalized re-treatment
If sites are getting deeper or no improvement or if several sites are still exhibit bleeding on probing then proceed to _____________, ____________ , and ___________.
- Antimicrobial therapy (systemic or local)
- Surgery
- Combination
___________absolutely the ____________ phase of successful periodontal therapy.
- Maintenance
- Most critical
What is the treatment decisions for the Maintenance phase based on?
1) Changes in probing depths
2) Presence of bleeding/plaque
3) Progressive loss of clinical attachment
In the Maintenance Visit-Clinical parameters, probing depths that are stable and have no BOP require what treatment?
1) Routine treatment, review OHI
2) same recall interval
In the Maintenance Visit-Clinical parameters, probing depths that are stable and have WITH BOP require what treatment?
1) Review OHI
2) Re-scale and root plane bleeding sites
3) Consider local delivery of antimicrobials
4) Consider shortening recall interval
Both probing depths and BOP increases what?
1) Review OHI
2) Re-scale and root plane
3) Consider adjunctive therapy
(locally delivered or systemic antibiotics)
4) Referral to periodontist
Note: These indicate “activity”
Initially the interval between periodontal maintenance appointment is every ______ months
3
Time needed for pockets to re-infect is ________ months (i.e, pathogenic bacteria will begin to repopulate a pocket of > 4 mm at 60 + days)
3
Patient referred to a periodontist will generally be placed on an altering _____________.
i.e., patient will be see GP every ______ appointment.
- Maintenance schedule
- Second
Doxycycline and other ABX from tetracycline family inactivate PMNs and macrophages by chelation of what elements?
1) Zn
2) Mg
3) Calcium
