Immune Mediated Perio

Question 1

Give brief overview of periodontitis regarding new classification?

Answer 1

Inflammatory condition affecting supporting tissues of teeth
Multifactorial aetiology
Use staging - how much periodontium lost
Grade - speed of which destruction happening

Question 2

What is mechanism of immune mediated perio?

Answer 2

Imbalance between host response and bacteria
In disease shift to dysbiosis
Genetic response - genetic PNMs can cause ‘allergic’ reaction to bacteria

Question 3

If pt has genetic factors will they always have perio?

Answer 3

No - bacteria is a risk factor which pt can control via meticulous OH

Question 4

What can influence host response?

Answer 4

Stress, diet, exercise, sleep, smoking

Question 5

How does stress and diet affect host response?

Answer 5

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

Question 6

Common features seen in perio?

Answer 6

Pt otherwise healthy
Rapid attachment loss and bone destruction
Familial aggreagation

Question 7

Secondary features of perio?

Answer 7

Microbial deposits not consistent w/ destruction
Phagocyte abnormality
Hyper responsive inflam/immune response

Question 8

How does genetic polymorphism play role perio?

Answer 8

PMN defect can result severe periodontal disease

Hyper-responsive PMN

Question 9

What is involved in clinical examination?

Answer 9

PPD, PI, BI, recession, attachment loss (PPD and REC), mobility and furcation
Additional: radiographs, vitality

Question 10

What might you see to indicate deep pocketing?

Answer 10

Purple ‘halo’ of gingiva

Question 11

How are implants subjected to perio?

Answer 11

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)

Question 12

Are antibiotics indicated for use in immune mediated perio?

Answer 12

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

Question 13

When would prescribe ab in immune mediated perio?

Answer 13

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

Question 14

Different in hand instrumentation and ultrasonic scalers?

Answer 14

No different in effectiveness

May save 20-50% time if use ultrasonic

Question 15

Aim perio tx?

Answer 15

BI less 10% and no pocket above 4mm (toothbrushing can influence 4mm)

*bi - shows active disease

Question 16

What is suppuration?

Answer 16

Pus - can often be seen w/ immune mediated disease

Question 17

What factors influence complete calculus removal?

Answer 17

Extent of disease
Anatomical factors
Skill of operator and instruments used

Question 18

What factors are involved in pt failure?

Answer 18

Poor motivation/ co-operation
Pt circumstances
Pt medical history

Question 19

What factors are involved in operator failure?

Answer 19

Incorrect diagnosis

Inadequate non-surgical tx

Question 20

What factors involved in anatomical failure?

Answer 20

Multiple intra-bony defect >3mm
Furcation involvement
Difficult anatomy tooth/ bone/ root
Difficult access

Question 21

When would periodontal surgery be used?

Answer 21

Aggressive cases
Anatomical sites require surgical correction
Will require complex rehabilitation

Question 22

How does role of bacterial influence review recalls?

Answer 22

Bacteria takes 12 weeks to form colony biofilm - allows more destructive bacteria to take course - need 3 month review

Question 23

What is needed for referral acceptance into secondary care?

Answer 23

Referral inc: BPE, summary tx provided and response, detail known risk factor (inc smoking history), evidence monitoring pt

Question 24

What tx has to be undertaken by GDP for acceptance into secondary care?

Answer 24

OHI instruction

Supragingival S+P

Question 25

Criteria for pt to be accepted into secondary care?

Answer 25

BPE 3 or 4
Advance chronic periodontitis or aggressive
Medical condition, hx or syndrome affect perio status
Good OHI and compliance
GDP must monitor and maintain pt