Locally Delivered Antimicrobial Adjuncts To Subgingival PMPR Flashcards
Evidence for microbial aetiology
Periodontal disease has a microbiological aetiology
Koch’s postulate modified by Socransky (1979) for criteria for the evidence of microbiological basis to periodontal disease
Mechanical debridement limitations
Poorer treatment outcomes for sites with furcation involvement compared to molar flat surfaces and non molar teeth
In 600 patients maintained for an average of 22 years, the majority of teeth lost were molars with furcation involvement
Mechanical therapy may fail to remove periodontal pathogens
Microorganisms may remain in which oral tissues despite thorough mechanical debridement?
Microorganisms may remain in the following oral tissues despite thorough mechanical debridement.
•Sub epithelial gingival tissue
•Crevicular epithelial cells
•Located in the connective tissue
•Altered cementum and dentinal tubules
•Sub gingival calculus
•Anatomical features
•Colonisation of dorsum of tongue, tonsils and oral mucosa
Microorganisms may remain in the following oral tissues despite thorough mechanical debridement, therefore what do we use to target the residual bacteria?
Adjunctive agents
What is the host response to bacterial invasion and what is the consequences of this?
The host response to bacterial invasion is by mounting an inflammatory response which acts as a double edge sword by causing further periodontal destruction.
Why is the use of adjunctive agents important in treatment outcomes?
Adjunctive agents target the inflammatory response of the host and this would benefit the treatment outcomes because an inflammatory response causes further periodontal destruction
Potential Adjuncts to Professional Mechanical Plaque Removal
What is available?
Potential Adjuncts to Professional Mechanical Plaque Removal
Are they effective: what’s the evidence?
What is the UKS3 guidelines?
S3 level methodology - combined the assesment of formal evidence from 15 systemic reviews with a representative group
- it accounts for health equality, environmental factors and clinical effectiveness
- it encompasses 62 clinical recommendations for the treatment of stage 1-3 periodontitis based on a. Step wise process mapped to the 2017 classification
Clinical significance of the S3-level guidelines
To combine the evaluation of formal evidence, grading and synthesis with the clinical expertise of a broad range of stakeholders to form clinical recommendations
It is implemented for direct applicability in the uk healthcare system
Who was the S3-level guidelines developed by
European federation of periodontology (EFP)
Define periodontitis
Periodontitis is characterized by progressive destruction of the tooth- supporting apparatus.
Primary features of periodontitis
Its primary features include the loss of peri- odontal tissue support manifest through clinical attachment loss (CAL) and radiographically assessed alveolar bone loss, presence of peri- odontal pocketing and gingival bleeding
Pathophysiology of periodontitis
Periodontitis is a chronic multifactorial inflammatory disease asso- ciated with dysbiotic dental plaque biofilms.
A case of clinical periodontal health is defined by
A case of clinical periodontal health is defined by the absence of inflammation [measured as presence of bleeding on probing (BOP) at less than 10 % sites] and the absence of attachment and bone loss arising from previous periodontitis.
A case of clinical gingivitis case is defined by
A gingivitis case is defined by the presence of gingival inflammation, as assessed by BOP at ≥10 % sites and absence of detectable attachment loss due to previous periodontitis.
Localised gingivitis is defined as 10 %-30 % bleeding sites, whilst generalized gingivitis is defined a >30 % bleeding sites
A periodontitis case is defined by
A periodontitis case is defined by the loss of periodontal tissue support, which is commonly assessed by radiographic bone loss or interproximal loss of clinical attachment measured by probing.
Other meaningful descriptions of periodontitis include:
the number and proportions of teeth with probing pocket depth over certain thresholds (commonly ≥4 mm with BOP and ≥6 mm), the number of teeth lost due to periodontitis, the number of teeth with intrabony lesions and the number of teeth with furcation lesions.
An individual case of periodontitis should be further characterized using a matrix that describes the .. and … of the disease.
stage and grade
Stage is largely dependent upon the … of disease at presentation, as well as on the anticipated complexity of … … , and further includes a description of … and … of the disease in the dentition.
Severity
case management
extent and distribution
Grade provides supplemental information about … of the disease including a history-based analysis of the … of periodontitis progression; assessment of the … for further progression; analysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient.
Biological features
Rate
Risk
The staging, which is dependent on the … of the disease and the anticipated complexity of case management, should be the basis for the patient’s … based on the scientific evidence of the different therapeutic interventions
Severity
treatment plan
The grade, since it provides supplemental information on the patient’s … and rate of progression, should be the basis for individual planning of care
risk factors
Criteria for defining stages of periodontitis
Criteria for defining grades of periodontitis
After completion of periodontal therapy, a stable periodontitis patient has been defined by gingival health on a reduced periodontium
What would be BOP
(bleeding on probing in <10 % of the sites; shallow probing depths of 4 mm or less and no 4 mm sites with bleeding on probing).
When, after completion of periodontal treatment, these criteria are met but bleeding on probing is present at >10 % of sites, then the patient is diagnosed as a stable periodontitis patient with gingival inflamma- tion.
Sites with persistent probing depths ≥4 mm which exhibit BOP are likely to be … and require …
It should be recognized that successfully treated and stable periodontitis patients will remain at … of recurrent periodontitis, and hence if gingival inflammation is present adequate measures for … should be implemented to prevent … periodontitis.
unstable
further treatment.
increased risk
inflammation control
recurrent