ICS Autumn Midterm: Perio pharm & tx planning Flashcards
what are the 3 types of periodontal pharmacotherapeis
topical, local (irrigation, sustained release) and systemic
11 antimicrobials
phenolic compounds peroxide enzymes fluoride quaternary ammonium compounds (CPC) chlorine dioxide sodium hypochlorite sanguinarine alexidine octinidine chlorhexidine
what is peridex
chlorhexidine brand name ; second generation of mouthwash- with substantivity
what is substantivity
lasting salivary concentration of the antimicrobial (chlorhexidine/peridex) over time
what are the types of plaque scores
silness and loe plaque index
disclosing agents
(can motivate patients)
what is the silness and loe plaque index criteria
3- plaque fills gingival embrasure
2-plaque visible at gingival margin (GM)
1- plaque on explorer at GM
0- no plaque on explorer at GM
what are second generation antimicrobials
CHX, and octinidine
what is a first generation antimicrobial
CPC quaternary ammonium compounds, & listerine
stannous fluoride?
in the study of GI (gingival index) over time what were the restults
second generation did better than the first generation
(first gen- listerine, cpc, I THINK sanguinarine too? it went
chlorhexidine>sanguinarine>listerine>CPC
gi looks at levels of inflammation
what is the chlorhexidine dosage
2x daily (1/2 fl oz) for 30 seconds
what are the side effets of chlorhexidine
extrinsic staining, taste alteration, increased supragingival calculus, oral irritation
what is totalsf toothpaste
-replaced the old formula of triclosan and a copolymer PVM/MA, NOW it has .45% stannous fluoride with zinc phosphate (s.f. is a antimicrobial)
- decreased plaque 8.5%
- decreased gingivitis 26%
- decreased calculus 56%
what are used in local delivery/irrigation?
- water
- chlorhexidine
- dilute sodium hypochlorite
- dilute povidone-iodine
what are the 4 brands of local sustained release systems in order of when they came out
(professional use not for patient use)
- actisite-1994
- periochip-1998
- atridox-1998
- arestin-2001 : WE USE IT in clinic
what is actisite?
type of local sustained release irrigation system from 1994 (first type)
- ethylene/vinyl acetate fiber.
- copolymer
- biocompatible
- flexible
what is periochip?
(literal chip thing you pack into gums)
- 5 mg chlorhexidine gluconate
- 4 mmx 5 mm x 350 um chip
- <1 minute to insert
- no bacterial resistance
- controlled release
- bioabsorbable
reduce pocket depth but not antibitoic?
what is atridox
- controlled-release product injected into pockets
- doxycycline hyclate (10%)
- 50 mg doxycycline
- 2 syringe system
- coe-pak/octyldent
- bioabsorbable
what is in arestin? how do you use it
what we use in clinic!!
- minocycline 1mg
- microsphere technology
- bioabsorbable
- easy to place/use (no reconstitution, no refrigeration)
- sustained drug delivery
HOW TO USE:
cartridge attach to handle, remove tip from cartridge , place subgingivally and express arestin from the cartridge.
what are 2 types of systemic perio therapies
antibiotics and host modulation
what are systemic antibiotics used for w/perio?
- acute infections (perio abscess)
- aggressive periodontitis
- refractory periodontitis (non responsive periodontitis)
when should antibiotics (systemic) NOT be used
NOT for chronic periodontitis!
what are typical antibiotics for periodontitis and their dosages
- metronidazole (500 mg/TID/8 days)
- ciprofloxacin (500 mg/BID/8 days)
- metronidazole and amoxicillin (250 mg/TIG 8 days fo each) MOST COMMON
- metronidazole and ciprofloxacin (500 mg.BID/8 days of each)
- doxycycline (100-200mg/QD/21 days)
- clindamycin (300 mg/tid/8days)
what is host modulation therapy? example?
systemic medication for perio
-host response is what causes the inflammation and destruction, so it tries to modulate that response itself.
PERIOSTAT
what is periostat/whats in it and what does it do?
host modulation therapy
- doxycycline hyclate– LOW DOSE 20 mg, antibiotic but not used that way. used twice daily, chronic dosing (at least 3 months on it)
- meant to be in addition to scaling and root planning (same with EVERYTHING THO)
- has anti collagenase activity
- no shift in microflora!!
- no emergence of resistant flora
what is dentin hypersensitivity /what is it in response to
how does it relate to periodontal disease
- short, sharp pain arising from exposed dentin in response to stimuli typicallyy thermal, evaporative, tactile, osmotic or chemical and which cant be ascribed to any other form of dental defect/pathology
- its both a symptom of periodontal disease AND a side effect of certain periodontal therapies
what is hydrodynamic theory
-stimuli cause movement of fluid within dentin tubules. this stimulates mechanoreceptors in dentin tubules which stimulates A delta nerve fibers in pulp–> pain
what do COLD/HEAT cause in the hydrodynamic theory
cold causes outward flow of fluid away from the pulp
heat causes slower inward movement towards the pulp
how does the tubule density in the dentin impact hypersensitivity?
MORE DENSE =MORE SENSITIVITY
about 8x more dense in sensitive dentin than in non
diameter of tubules tends to be larger too in sensitive dentin
thinkk of hypersensitivity as a CEJ phenomenon (where density of dentinal tubules is the greatest!!!!!!
what 2 things have to occur for dentin hypersensitivity
-dentin has to become exposed (lesion localization) and dentin tubule system has to be opened up (lesion initiation)
How can “lesion localization” occur?
can expose dentin by:
- gingival recession
- attrition
- abrasion
- erosion
how can “lesion initiation” happen?
can open up tubules with:
- toothbrushing
- toothpaste
- root instrumentation
- dietary
- others
what to consider when someone has hypersensitivty?
- caries?
- cracked teeth?
- new restoration?
- occlusal trauma?
- bleaching?
list the therapies for root hypersensitivity
(btw root H and dentin H are the same-cej)
these mostly are for sealing tubules:
- potassium nitrate
- strontium chloride
- arginine and calcium carbonate
- calcium sodium phosphosilicate
- fluorides/fluoride varnish
- glutaraldehyde-hema varnish
- oxalates
- bonding agents/cervical restorations
- surgical root coverage
- laser therapy
- endodontic therapy
define excellent to good, fair to guarded, and poor to hopeless categories
excellent to good: <20% bone loss, phsyiologic mobility, shallow probing depths, up to class I furca involvement
Fair to guarded: 20-40% bone loss, some mobility, class I to II furcas, 5-7 mm probings, variable response to therapy
Poor to hopeless: >40% bone loss, class II to III furcas, probing >8mm, poor response to therapy
what are perio treatement phases ? (prelim, 1-4) general
- preliminary (urgent care; acute, caries control)
- phase I (disease control)
- re-evaluation
- phase II (surgical)
- phase III (restorative)
- phase IV (supportive)
what are some emergency perio issues
periodontal abscess, pericoronitis (around wisdom tooth), necrotizing gingivitis (used to be ulcerative), acute periapical infections
what is involved in phase I therapy? whats another term for it
etiotropic phase
- plaque control
- diet
- scaling and root planning/scale and polish
- caries control
- occlusal therapy
- provisional splinting
when do you do scaling/root planning vs scale and polish?
scaling and root planning: patient with loss of attachment and gingival inflammation
scale and polish: patient with gingival inflammation and NO loss of attachment
what comes after periodontitis diagnosis
intiial therapy scaling and root planning and home care, then re evaluation 4-8weekslater
what occurs at a re-evaluation for perio?
RE CHECK:
- probing depths
- mobility
- gingival margin position (and loss of attachment)
- adequacy of attached gingiva
- plaque control
- tissue response? (color, consistency,contour, bleeding,texture)
what are 4 types of perio surgeries
- resection
- regeneration (grafts)
- perio plastic surgery
- crown lengthening
what are types of phase III therapies
restorative phase
- final restorations
- fixed and removable prosthodontics
- implants
what are suportive treatments/how often is it done?
SPT every 3 months for ppl with periodontitis!
oral hygiene, scaling /rp, polishing, chemical irrigation
typically periodontist and generalist each do every other spt
how often should there be care for gingivitis
no LOA :
6 months
