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SP15 Periodontology > In Office Local Therapy > Flashcards

In Office Local Therapy Flashcards

1
Q

What things occur in periodontal diseases

A 
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
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2
Q

These produce biological molecules that may act directly on host tissues

A

periodontal pathogens

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3
Q

These two things produced by the host may cause tissue injury

A

inflammatory and immune mediators

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4
Q

What are the three goals of periodontal therapy

A

remove bacterial deposits from tooth surface
shift the pathogenic microbiota to more health related flora
decrease inflammation and probing depth

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5
Q

What are three limitations of subgingival mechanical therapy involving bacteria

A

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)

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6
Q

What are five limitations of subgingival mechanical therapy

A

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

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7
Q

Antimicrobial agents can do what two things

A

fight bacteria and bacterial byproducts

modify host response

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8
Q

In which three cases are systemic antibiotics indicated for with periodontal diseases

A

aggressive periodontitis
periodontitis with secondary systemic involvement
some types of chronic periodontitis

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9
Q

What are four concerns with systemic antibiotic usage

A

patient compliance
side effects
development of bacterial resistance
poor outcome due to low concentration in the pocket

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10
Q

What are three host modulatory agents (systemic)

A

bisphosphonates
non-steroidal anti-inflammatory drugs (NSAID)
low-dose tetracycline

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11
Q

This is incorporated into bone and incapacitates the osteoclast thereby reducing bone resorption

A

bisphosphonates

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12
Q

In which diseases are bisphosphonates indicated

A

Paget’s
hypercalcemia
osteoporosis
metastatic bone disease

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13
Q

What are two side effects of bisphosphonates

A

osteomalacia

allergic reactions

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14
Q

What effect does bisphosphonates have on bone density and attachment loss

A

modest effect on bone density

little or no effect on attachment loss

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15
Q

This inhibits the biosynthesis and release of prostaglandin in cells

A

NSAIDs

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16
Q

What are some side effects of taking NSAIDs

A

gastrointestinal ulceration
allergic reactions
gastrointestinal and renal toxicity

17
Q

What effect does NSAIDs have on bone density and attachment loss

A

reduces gingival inflammation

modest effects on attachment levels

18
Q

This is a low (sub-antimicrobial) dose of doxycycline hyalite - 20mg

A

Periostat

19
Q

Periostat concentrates where

A

in the GCF and uses cementum as reservoir

20
Q

What does periostat inhibit

A

the tissue destructive enzymes (MMP-8)

21
Q

What is the results of periostat on attachment levels

A

increased attachment levels on average by 0.5mm, decreased PD and BOP

22
Q

These are currently not recommended to treat perio diseases due to possible site effects

A

NSAIDs

23
Q

True or False

Can we apply antimicrobials locally?

A

Yes, local delivery of the active ingredient into pocket

24
Q

What are some characteristics of applying antimicrobials locally

A

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

25
Q

What are some strengths of contorolled delivery

A 
rate control >24 hours release
active over multiple days
active only at the site
high concentrations
low total dose
applied by therapist
26
Q

What are four examples of periodontal local delivery devices

A

fibers
strips or compacts
films
injectable systems

27
Q

What are two examples of injectable systems of periodontal local delivery devices

A

microparticles and PLGA

gels

28
Q

What are three subgingival delivery of antimicrobial agents

A

chlorhexidine
doxycycline
minocycline

29
Q

This is a collagen gel as a carrier with chlorhexidine as an active material

A

periochip

30
Q

This is a co-polymer carrier with doxycycline as the active material

A

atridox

31
Q

What is an indication for local antimicrobial delivery

A

localized slight to moderate chronic periodontitis patient with limited amount of sites that are unresponsive to non-surgical therapy

32
Q

When should local antimicrobial therapy be considered

A

should be considered as ADJUNCTIVE therapy to SRP for limited sites with ≥5mm probing depths

33
Q

What are three contraindications for local antimicrobial delivery

A

allergies to specific antimicrobial reagent
several sites/mouth with residual periodontal pockets following SRP
applications without performing SRP

34
Q

What did the one study find different between chlorhexidine/SRP and just SRP

A

the mean difference in probing depths was 0.42mm

35
Q

What did the one study find different between minocycline/SRP, SRP/vehicle, and SRP

A

statistically significant reduction in probing depth reduction with SRP + minocycline compared with other groups
maintained though 9 months

36
Q

What determines the local outcome compared to a complete dentition

A

local outcome depends on greater level of oral hygiene

37
Q

These two things are not recommended by ADA and AAP

A

hydrogen peroxide gel

oils

38
Q

these two sites may be treated with locally delivered antimicrobials

A

localized non-responding sites and localized recurrent disease

39
Q

these two things are ESSENTIAL for success

A

mechanical debridement before the application of the agent

plaque control after therapy

SP15 Periodontology (9 decks)

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