Mod 7 Test 2 Flashcards
What are 3 types of fulcrums
intraoral, extraoral, advanced
Describe a standard intraoral fulcrum
ring finger on stable tooth
same arch
control and support
decreases stress to the hand
what are elements of a extraoral fulcrum
-broad surface area of contact
extended grasp of instrument
appropriate pressure onto skin of pts face
what are the advantages of extraoral fulcrums
-access to deep pockets
access to max molars
improves parallelism of lower shank
neutral wrist position
what are the disadvantages of extraoral fulcrums
operator may feel unstable or feel like strength is decreased
do extraoral fulcrums decrease control
no
control is not dependent on what
closeness of grasp to area of instrumentation
what creates a controlled stroke
fulcrum pressure
what is an advanced fulcrum
variations of extra and intra fulcrums to gain access to deep pockets
what kind of intraoral advanced fulcrums are there
modified, cross arch, finger on finger, stabilized or finger assist
what kind of extraoral advanced fulcrums are there
palm up or folded knuckle, palm down or chin cup
what are advantages of advanced fulcrums
-access to deep pockets
access to max molars
improves parallelism of lower shank
neutral wrist position
what are disadvantages of advanced fulcrums
- requires greater amt of muscle coordination and instrumentation skills
- greater chance of instrument stick
- decreased tactile
- not tolerated by pt
- may require direct vision
what are qualities of a split fulcrum
weak, results in finger action adn doesnt allow for deep access into pockets
Periodontal disease is the leading cause for
tooth loss and malpractice
what are the inflammatory cells of perio disease*
lymphocytes, PMN, macrophages and auxillary cells
what is chemotaxis*
the process which attracts inflammatory cells to areas of the body by stimuli such as trauma and microbial presence
what are substances produced by stimulated immune cells*
cytokines
what do cytokines stimulate the release of*
inflammatory cells
what do inflammatory cells intiate*
collegen destruction (bacterial and connective tissue, perio fibers)
what is mechanical treatment is
root debridement
how much bacteria remains after mechanical tx
10-20%
what are the highly specific uses of systemic antibiotic therapy
-aggresstive perio, perio that doesnt respond to tx, perio abcess
what are the types of systemic antibiotics
penicillin, tetracycline, erythromycin, metronidazol, clindamycin
what is the drug of choice for perio tx and why
tetracycline, bc it stays highly concentrated in crevicular fluid
what are examples of adjunctive chemical therapy (systemic)
tablets, capsues
what are kinds of topical adjunctive chemical therapies
rinse (CHX, listerine)
dentifrice (prevident, colgate total)
sub ging. irrigation
control release devices
what are the disadvantages of systemic therapy
allergic rxn, bacterial resistance, side effects GI
what are the contraindications of systemic therapy
pregnancy, nursing, children, allergy
What is a product that utilizes enzyme suppression therapy
periostat
how does periostat work
inhibits collegenase from beginning the inflammatory response
how is perio stat delivered
low dose systemically delivered tx
what is periostat
doxycyline 20 mg 2x day
what does a submicrobial dose of periostat produce
enzyme inhibition
what happens if you go over 20 mg 2x day for periostat
starts to work like an antibiotic which we sont want
what is local antimicrobial therapy
placement of antibioitic or antimicrobial agent at a periodontal site (of infection)
what are qualities of local antimicrobial therapys
highly concentrated
time released over several days
no worries for pt complianc
what are local antimicrobial agent produx
atridox, perio chip, arestin
what is atridox
doxycycline
what is periochip
no an antibioits, is CHX which is antimicrobial
what is arestin
minocycline
what is substantivity of a microbial agent
ability of an agent to be:
bound to the pellicle and tooth surface
relased over a period of time
retention of potentcy
when could you use the perio chip
if a person has a tetracycline allergy
what product is in perio chip
2.5 mg of CHX in a biodegradable gelatin mix that doesnt require refridgeration
how is the periochip released
40% of the drug is released in 24 hrs
how is perio chip placed
with cotton pliers
what is the tx time of perio chip
7-10 days
what are the contraindications for perio chip
pregnancy, nursing, allergy, children
what is atridox
10% doxycycline hylcate
how is atridox dispensed
2 syringes- syringe A has liquid polymer Syringe B has doxycyline powder
how is atridox delivered into pocket
insert syringe into pocket, can pack with instrument
why should you bring a pt back in to check atridox
it can leave behind a fiber
what is the tx time of atridox
7-10 days
what are the disadvantages of atridox
perio dressing may be required, learning curve, not for perio abcessses, chx sensitivity
what are the contraindications of atridox
pregnancy, tetracycline sensitivity
what are the advantages of atridox
no potential for developing bacterial resistance, ease of application
what is arestin
minocyline hydrochloride 1mg, polymer microspheres in powder form
what does arestin attach to
tooth and sulcus wall
what kind of effect does arestin have
antimicrobial
what is the tx time for arestin
14 days
what are the advantages of arestin
no dressing or mixing, ease of application, 2 year shelf life
what are the advantages of local antimicrobial therapy
-concentration up to 100x higher than systemic
delievered where needed
release over time
no systemic involvement
when do you utilize local perio medicaments
intial Non surg therapy, at the re evaluation appt, at the re tx appt, at the maintentance appt
