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Periodontology > Non-surgical periodontal treatment and adjunctive antibiotics > Flashcards

Non-surgical periodontal treatment and adjunctive antibiotics Flashcards

1
Q

What is involved in step 1 of non-surgical periodontal therapy

A
  • Education of periodontal disease process
  • Risk factor analysis - plaque, diabetes, smoking cessation, stress
  • Motivation and behaviour change - OHI
  • Basic mechanical scaling/PMPR of clinical crown
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2
Q

What plaque and bleeding scores would indicate and “engaging patient”

A
  • Plaque Scores < 20%
  • Bleeding scores < 30%
  • Or plaque/bleeding score improvement of 50%
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3
Q

What should we be removing with non-surgical mechanical therapy

A
  • Plaque (bacteria)

- Calculus (mineralised plaque)

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4
Q

AY BAWS CAN I HABE DE NOTE PLZ

A

Its practically hard to achieve removal of only plaque and calculus and we often leave behind sub-gingival calculus, PMPR should be atraumatic to soft and hard tissues of the periodontium

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5
Q

What is the difference between step 1 and step 2 perio therapy

A

Step 1: Supra gingival PMPR

Step 2: Sub-gingival PMPR

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6
Q

What complaints/comments can patients often have after non-surgical therapy

A
  • Gums have shrunk and teeth look longer
  • Gaps between teeth are really big now
  • Teeth are really sensitive
  • Gums bleed less
  • Teeth have firmed up
  • Teeth are more loose
    Consent is vital before treatment to avoid complaints
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7
Q

Describe some features of the healing response of non-surgical periodontal therapy

A
  • Inflammation resolution and pocket depth reduction
  • Recession and sensitivity
  • Long junctional epithelium attachment may occur
  • Repopulation with “healthier” less pathogenic microflora
  • Formation of new bone, new CT, new cementum and new attachment can occur but is unpredictable
  • Healing of JE takes around 1 week and for CT up to 4 weeks in which time probing should be avoided
  • Repair as opposed to regeneration
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8
Q

When should you reassess after non-surgical therapy

A

3 months

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9
Q

What can be considered a successful non-surgical periodontal therapy

A
  • Improvement plaque scores < 20%
  • An increased resistance to periodontal probing
  • Absence/reduction of bleeding (<10%)
    Clinical End Points:
  • No BOP
  • Pocket closure (PD<4mm.)
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10
Q

What teeth often show the best clinical improvement after initial treatment

A

Single rooted teeth tend to be better than molars

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11
Q

What improvements can you expect from non-surgical therapy

A
  • Reduction in redness, inflammation and bleeding
  • Deep sites respond with greater improvement than shallower pockets
  • The greatest rate of healing happens between 3 and 6 weeks after therapy
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12
Q

What is the function of an antiseptic

A

weakens and slows growth of bacteria

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13
Q

What is the function of an anthelminthic

A

It works against parasites - worms

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14
Q

What are the 3 mechanisms of bacterial resistance

A
  • Natural - bacteria naturally resistant to certain antibiotics
  • Spontaneous - random genetic mutation
  • Acquired - one species acquiring resistance from another
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15
Q

What questions should we ask before handing out antimicrobials

A

Are they absolutely necessary?

Can the infection be manage through mechanical drainage?

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16
Q

What are the side effects of antibiotics

A
  • Stomach upset (nausea and vomiting)
  • GI disorder (diarrhoea)
  • Headache
  • Metallic taste
  • General unwellness (irritability/flu)
  • Rashes
  • Total adverse events
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17
Q

What modes of action can antibiotics work with

A
  • Inhibition of cell wall synthesis
  • Inhibitors of protein synthesis
  • Inhibitors of nucleic acid synthesis
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18
Q

Name an antibiotic that works by inhibition of cell wall synthesis

A
  • Amoxicillin
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19
Q

Name an antibiotic that works by the inhibition of protein synthesis

A
  • Azithromycin

- Tetracycline/Doxycycline

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20
Q

Name an antibiotic that works by inhibition of nucleic acid synthesis

A
  • Metronidazole
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21
Q

What rationale can there be for the use of adjunctive antimicrobials

A
  • Primary aetiology of periodontitis is bacterial plaque
  • Periodontal pathogens can invade connective tissues
  • Oral niches of bacteria not reachable by non-surgical mechanical therapy
22
Q

What are only periodontal disease cases where we should consider prescribing antimicrobials

A

Acute gingival problems: - necrotising gingivitis/ periodontitis
- Abscesses where local drainage is not possible and there is systemic involvement (fever, lymph nodes swollen etc.)
Certain “forms” of periodontitis:
- Severe, rapidly progressing forms of the disease often correlated with specific forms of bacteria
- Grade C patients

23
Q

What single agent antibiotics can be prescribed for periodontitis

A
  • Amoxicillin
  • Metronidazole
  • Doxycycline
  • Azithromycin
24
Q

What dose for Amoxicillin is normally prescribed for periodontitis

A

500mg TDS

25
Q

What dose for Metronidazole is normally prescribed for periodontitis

A

400mg TDS

26
Q

What dose for Doxycycline is normally prescribed for periodontitis

A

200mg day 1 and then 100mg/day up to 21 days

27
Q

What dose for Azithromycin is normally prescribed for periodontitis

A

100mg once daily for 3 days

28
Q

What antibiotic combination can be prescribed for periodontitis

A

Amoxicillin (500mg TDS) + Metronidazole (400mg TDS) for 7 days

29
Q

What are local antimicrobials

A

These are antimicrobial medications that are administered or delivered at the site of action - usually straight into the pocket

30
Q

What are the advantages of using local antimicrobials

A
  • High doses directly on the site of required action
  • No risk of systemic side-effects
  • Assured compliance
31
Q

What are the disadvantages of using local antimicrobials

A
  • Doubts regarding substantivity (ability to stay within the target)
  • Antibiotic resistance and selection bacteria within the pocket
32
Q

How does chlorhexidine work

A

Due to the cationic CHX molecule that is rapidly attracted by -ve charge bacterial surface and causes membrane damage

33
Q

Why can chlorhexidine have disappointing results when used subgingivally

A

it has a short lived effect

34
Q

What are the potential side effects of using chlorhexidine as a local antimicrobial

A
  • Staining - esp. on anterior restorations
  • Taste distortion
  • Mucosal desquamation and parotid enlargement
35
Q

What is chlorhexidine’s effect on plaque

A

Im trine get you to say that it will only prevent plaque and not remove it

36
Q

AY BAWS CAN I HABE DE NOTE PLZ

A

Chlorhexidine is not for regular use and not a substitute for mechanical plaque removal

37
Q

What are the indications for the use of chlorhexidine

A
  • Unable to carry out mechanical plaque control before and following periodontal surgery
  • Inter-maxillary fixation (jaw fractures)
  • May also help control aphthous ulceration
38
Q

Name some local antimicrobials

A
  • Doxycycline
  • Minocyclin
  • Tetracycline fibres
  • Metronidazole

(mostly in the form of a gel except the fibres that slowly release tetracycline in the pocket)

39
Q

What is a periochip and how often might it need to be used

A

This is a 2.5mg chlorhexidine in gelatin capsule that degrades in 7-10 days

  • Bigger reductions seen in deeper pockets (obvs)
  • May need to apply every 3 months in maintenance
40
Q

What are the clinical features of necrotising gingivitis

A

Necrosis and ulceration of interdental papillae, gingival bleeding, pain, halitosis

41
Q

What are the clinical features of necrotising periodontitis

A

Necrosis and ulceration of interdental papillae, gingival bleeding, pain and halitosis but also includes periodontal attachment loss/bone loss and occasionally bone sequestrae

42
Q

What are some of the main bacteria that are involved in necrotising periodontal diseases

A
  • Spirochetes and fusiform bacteria

- P. intermedia, peptostreptococcus genus associated

43
Q

What are some of the risk factors of necrotising periodontal diseases

A
  • Malnutrition
  • Stress
  • Poor oral hygiene
  • Smoking/Alcohol
  • More common in HIV/AIDS patients
  • Compromised immune responses
44
Q

What are the management options for necrotising periodontal disease

A
  • Initial debridement under LA if possible
  • Prescribe chlorhexidine mouthwash
  • Consider antibiotics only if spreading infection or systemic involvement
  • 400mg Metronidazole 3x daily or Amoxicillin 500mg TDS for 3-5 days
  • Recommend analgesia
  • Periodontal follow up and prevention
45
Q

What is a periodontal abscess

A

Localised accumulation of pus located within the gingival wall of the periodontal pocket and microbiology similar to periodontal microflora

46
Q

Describe the onset and clinical features of acute periodontal abscesses

A
  • Develops and lasts for a few days or a week
  • Sudden onset of pain on biting/throbbing pain
  • Gingiva are red, swollen and tender
  • Pus and discharge from the gingival crevice
47
Q

Describe the clinical features of chronic periodontal abscesses

A
  • Longer lasting than acute perio abscesses and develops slowly, pain is usually of low intensity
  • Bad taste and discomfort
  • Tooth often tender to bite and mobile
  • Pus may be present and discharge from the gingival crevice/sinus in the mucosa overlying the affected root
48
Q

What are the aetiologies of periodontal abscesses

A
  1. Untreated/refractory periodontitis, during maintenance and following non-surgical scaling, periodontal surgery (therapy)
  2. Following systemic antimicrobials or use of calcium channel blockers (medications)
  3. In a non-periodontitis patient due to; impaction of foreign bodies, harmful chewing habits, orthodontics, gingival enlargement, perforations or root damage
49
Q

What are the management options for periodontal abscesses

A
  • Focus on removing the source of infection first
  • Establish drainage when possible, usually through the pocket
  • Mechanical debridement reduces the bacterial load and facilitates wound healing
  • Pyrexia, lymph node involvement or facial swelling may occasionally require the use of antibiotics
50
Q

When should we consider antibiotic regimens for periodontal abscesses

A

only if local measures fail to control systemic spread

51
Q

Where can you find the guidelines for antibiotic prescribing

A
  • FGDP

- SDCEP

Periodontology (12 decks)

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