In Office Local Therapy Flashcards
What things occur in periodontal diseases
destruction of PDL resorption of the alveolar bone migration of the JE along root surface changes in the morphology of gingival tissues BOP gingival recession periodontal pocket formation specific bacterial colonization within the subgingival area
These produce biological molecules that may act directly on host tissues
periodontal pathogens
These two things produced by the host may cause tissue injury
inflammatory and immune mediators
What are the three goals of periodontal therapy
remove bacterial deposits from tooth surface
shift the pathogenic microbiota to more health related flora
decrease inflammation and probing depth
What are three limitations of subgingival mechanical therapy involving bacteria
bacterial migration from root surfaces not accessed by instrumentation
bacteria can colonize gingival epithelial cells and connective tissues
bacteria can live in dentinal tubules (RP can open tubules and push microbes into the tubules)
What are five limitations of subgingival mechanical therapy
apical migration from supragingival plaque/other infected sites
root anatomy
contours of the lesions
poor oral hygiene causing supragingival plaque recurrence
refractory/non-responding sites/cases
specific bacteria that invade soft tissue
Antimicrobial agents can do what two things
fight bacteria and bacterial byproducts
modify host response
In which three cases are systemic antibiotics indicated for with periodontal diseases
aggressive periodontitis
periodontitis with secondary systemic involvement
some types of chronic periodontitis
What are four concerns with systemic antibiotic usage
patient compliance
side effects
development of bacterial resistance
poor outcome due to low concentration in the pocket
What are three host modulatory agents (systemic)
bisphosphonates
non-steroidal anti-inflammatory drugs (NSAID)
low-dose tetracycline
This is incorporated into bone and incapacitates the osteoclast thereby reducing bone resorption
bisphosphonates
In which diseases are bisphosphonates indicated
Paget’s
hypercalcemia
osteoporosis
metastatic bone disease
What are two side effects of bisphosphonates
osteomalacia
allergic reactions
What effect does bisphosphonates have on bone density and attachment loss
modest effect on bone density
little or no effect on attachment loss
This inhibits the biosynthesis and release of prostaglandin in cells
NSAIDs
What are some side effects of taking NSAIDs
gastrointestinal ulceration
allergic reactions
gastrointestinal and renal toxicity
What effect does NSAIDs have on bone density and attachment loss
reduces gingival inflammation
modest effects on attachment levels
This is a low (sub-antimicrobial) dose of doxycycline hyalite - 20mg
Periostat
Periostat concentrates where
in the GCF and uses cementum as reservoir
What does periostat inhibit
the tissue destructive enzymes (MMP-8)
What is the results of periostat on attachment levels
increased attachment levels on average by 0.5mm, decreased PD and BOP
These are currently not recommended to treat perio diseases due to possible site effects
NSAIDs
True or False
Can we apply antimicrobials locally?
Yes, local delivery of the active ingredient into pocket
What are some characteristics of applying antimicrobials locally
needs to be applied easily
need a carrier (preferably a resorbable)
need to be delivered at high concentration
needs to stay at high concentration and released slowly for a certain time
side effects (allergies, GI problems) should be minimal
