Lecture 4- non-surgical therapy- in office local therapy

Question 1

in perio diseases, …. produce biological molecules that may act directly on host tissue and …. produced by host may cause tissue injury

Answer 1

periodontal pathogens

inflammatory and immune mediators

Question 2

limitations of subgingival mechanical therapy

Answer 2

bacteria can colonize in connective tissue/epithelial cells

bacteria can live in dentinal tubules (root planing can push them in there)

bacterial migration apically, not reached by instrumentation

root anatomy

poor oral hygiene (recontamination)

Question 3

when are systemic antibiotics for periodontal diseases indicated

Answer 3

aggressive periodontitis

periodontitis w/ secondary systemic involvement

some types of chronic periodontitis

Question 4

concermes for systemic antibiotics for periodontal diseases

Answer 4

patient compliance
side effects
develop. of bact. resistance
poor outcome due to low concen in pocket

Question 5

host modulatory agents (systemic)

Answer 5

bisphosphonates
NSAIDs
low dose tetracyclines

Question 6

action of bisphosphonates

Answer 6

incorporated into bone and incapacitates the osteoclast thereby reducing bone resorption

Question 7

what are bisphosphonates indicated for

Answer 7

Paget’s disease
hypercalcemia
osteoporosis
metastatic bone diseases

Question 8

side effects of bisphosphonates

Answer 8

osteomalacia and allergic reactions

Question 9

bisphosphonates effect for periodontitis?

Answer 9

modest effect on bone density and little to no effect on attachment loss

(do not use in everyday practice, still in research)

Question 10

NSAIDS actions

Answer 10

inhibit biosynthesis and release of prostaglandins in cells

Question 11

side effects of NSAIDs

Answer 11

GI ulceration
allergic rxns
GI and renal toxicity

Question 12

NSAIDs effect on periodontitis?

Answer 12

reduce gingival inflammation however effects on attachment levels are modest

Question 13

as soon as NSAIDs are discontinued….

Answer 13

inflammation comes right back so this is not practical

Question 14

what is periostat?

Answer 14

low (sub-antimicrobial) dose of doxycycline hyclate- 20mg daily for 3 months

Question 15

what does periostat do?

Answer 15

concentrates in GCF and uses cementum as a reservoir

inhibits the tissue destructive enzymes (MMP-8)

Question 16

what was seen when Periostat was used adjunctvely with SRP over 9 months?

Answer 16

increased attachment levels by 0.5mm, decreased PD and BOP

no resistance reported

Question 17

requirements for an antimicrobial that we can apply locally?

Answer 17

easy to apply
needs carrier (preferably resorbable)
deliv. at high concen.
stay at high concen./released slowly
minimal side effects

Question 18

3 subgingival delivery of antimicrobial agents

Answer 18

chlorhexidine (periochip) – disolvable gelatin matrix film/chip

doxycycline (atridox) – biodegradable, flowable PLA gel

minocycline (arestin) – PLA/PGA powder

Question 19

After SRP, a Periochip can be placed in the pocket. What is the carrier for periochip? And what is the active material?

Answer 19

collagen gel (gelatin(

chlorhexidine

Question 20

how deep must the pocket be to use a periochip?

Answer 20

5mm

Question 21

After SRP, a Atridox can be placed in the pocket. What is the carrier for Atridox? And what is the active material?

Answer 21

co-polymer

doxycycline