Immune Mediated Perio Flashcards
Give brief overview of periodontitis regarding new classification?
Inflammatory condition affecting supporting tissues of teeth
Multifactorial aetiology
Use staging - how much periodontium lost
Grade - speed of which destruction happening
What is mechanism of immune mediated perio?
Imbalance between host response and bacteria
In disease shift to dysbiosis
Genetic response - genetic PNMs can cause ‘allergic’ reaction to bacteria
If pt has genetic factors will they always have perio?
No - bacteria is a risk factor which pt can control via meticulous OH
What can influence host response?
Stress, diet, exercise, sleep, smoking
How does stress and diet affect host response?
Stress - increase cortisol levels - stop WBC reaching bacteria by chemotaxis
Diet - carb rich diet makes plaque matrix sticky and fat causing hypo-inflammatory response causing adipokines to be released
Common features seen in perio?
Pt otherwise healthy
Rapid attachment loss and bone destruction
Familial aggreagation
Secondary features of perio?
Microbial deposits not consistent w/ destruction
Phagocyte abnormality
Hyper responsive inflam/immune response
How does genetic polymorphism play role perio?
PMN defect can result severe periodontal disease
Hyper-responsive PMN
What is involved in clinical examination?
PPD, PI, BI, recession, attachment loss (PPD and REC), mobility and furcation
Additional: radiographs, vitality
What might you see to indicate deep pocketing?
Purple ‘halo’ of gingiva
How are implants subjected to perio?
More rapidly and severely affected - implant doesn’t have PDL
Bony healing against implant and only circumferential fibres (don’t insert like would on natural tooth)
Are antibiotics indicated for use in immune mediated perio?
Use appropriately - plaque score less 25%, not smoking and engaged
Exception: type II diabetic that has reduced plaque score but still 25% - can help break cycle in carefully selected pt
When would prescribe ab in immune mediated perio?
Ideally during first cycle of non-surgical
Given on completion RSD
Don’t overprescribe
Azithromycin 500mg 1x day 3 days
Amoxicillin 500mg and metronidazole 400mg TDS 7 days
Different in hand instrumentation and ultrasonic scalers?
No different in effectiveness
May save 20-50% time if use ultrasonic
Aim perio tx?
BI less 10% and no pocket above 4mm (toothbrushing can influence 4mm)
*bi - shows active disease
What is suppuration?
Pus - can often be seen w/ immune mediated disease
What factors influence complete calculus removal?
Extent of disease
Anatomical factors
Skill of operator and instruments used
What factors are involved in pt failure?
Poor motivation/ co-operation
Pt circumstances
Pt medical history
What factors are involved in operator failure?
Incorrect diagnosis
Inadequate non-surgical tx
What factors involved in anatomical failure?
Multiple intra-bony defect >3mm
Furcation involvement
Difficult anatomy tooth/ bone/ root
Difficult access
When would periodontal surgery be used?
Aggressive cases
Anatomical sites require surgical correction
Will require complex rehabilitation
How does role of bacterial influence review recalls?
Bacteria takes 12 weeks to form colony biofilm - allows more destructive bacteria to take course - need 3 month review
What is needed for referral acceptance into secondary care?
Referral inc: BPE, summary tx provided and response, detail known risk factor (inc smoking history), evidence monitoring pt
What tx has to be undertaken by GDP for acceptance into secondary care?
OHI instruction
Supragingival S+P
