Non-surgical Therapy (E3,L1) Flashcards
SO COOL! How much does plaque (oral biofilm) grow per day?
82-200 micrometers per day!
YOU DO NOT SRP a Pocket of
less than 3 mm
Chlorhexidine has its greatest effect on plaque that has been present for ___ hours. It has less affect on ____ and ____ hour plaque.
6….less on 24 and 48 hour plaque. Just reaches outer layers
SRP can do great things- with a 4-6mm pocket the mean reduction in probing depth was about __mm and the mean gain in CAL was about __mm!
probing depth 1.29mm…CAL 0.55mm
SPR can do great things-with a 7mm or greater pocket, the mean reduction in probing depth was about __mm and the mean gain in CAL was about ___mm
probing depth 2.16mm…CAL 1.19mm
HOW LOW CAN THEY GO? Mean distance from instrument limit to max pocket depth (aka how short does this instrument come from reaching the bottom?) Gracy Curette
1.25 mm
HOW LOW CAN THEY GO? Mean distance from instrument limit to max pocket depth (aka how short does this instrument come from reaching the bottom?) Traditional Ultrasonic
1.1 mm
Are we going to be able to do SRP on a case with vertical bone loss? (aka infra boney lesions)
Nope
“Restricted Access” is considered to be a probing depth of more than __mm
5mm
What is the term for why PreMolars are difficult to clean?
they are “Fluted”
Clincial Protocol:: What comes after OHI?
SRP with Local Anesthesia
Clincial Protocol:: What are the 4 main things to educate the patient on regarding OHI in a PERIO clinic?
1.Electric Toothbrush 2.Interproximal Cleaning: floss 3.Interproximal Cleaning: waterpik 4.Rinse with CHX 2x/daily
What group of patients are specifically good for low dose Doxycycline tx?
SMOKERS!
Clincial Protocol:: What comes after OHI?
SRP with Local Anesthesia
Post SRP re-eval: we will retreat sites of >__mm. What are the two treatments? What happens with NO response??
> 5 mm…1. Another SRP 2. Site-specific Drug Delivery….surgical treatment next
What group of patients are specifically good for low dose Doxycycline tx?
SMOKERS!
When do you preform the RE-EVALUATION post SRP?
4-6 weeks
COOL, doxycycline mech of action: Chelating metals gives the drug the ability to inactivate ______…SPECIFICALLY _______ and _______ produced by PMNs and macrophages.
matrix metalloproteinases…specifically collagenases and gelatinases
What was the original marketing name for low dose Doxycycline? (before people got smart and started cutting the pills up)
PerioSTAT
COOL, doxycycline mech of action: at a ___ mg concentration there is no bacterial effect. However, doxycycline (like all the tetracycline family) chelate _____ and other metals such as ___ and ___.
20 mg….Calcium, Zn, Mg
COOL, doxycycline mech of action: Chelating metals gives the drug the ability to inactivate ______…SPECIFICALLY _______ and _______ produced by PMNs and macrophages.
matrix metalloproteinases…specifically collagenases and gelatinases
WHERE do we put local delivery drugs & do SRP?? pockets of > or equal to __mm
5mm
WHERE do we put local delivery drugs & do SRP?? maintenance patients with isolated PD of ____-___ mm
5-6mm
WHERE do we put local delivery drugs & do SRP?? Early stage periodontal _______
abscess
WHERE do we put local delivery drugs & do SRP?? PD at the _____-_____ line-angel of 2nd molars related to _____ extractions.
distal-facial…3rd molar extractions
WHERE do we put local delivery drugs & do SRP?? Ailing _____ and molars with ______ involvement.
implants and furcation involvement
What is Arestin?
1 mg of MINOcycline microencapsulated in a poly glycolide-co-lactide dry power
What is Atradox?
Doxycycline in a poly-lactide gel that polymerizes on contact with WATER
What is the limiting factor for sub gingival irrigation in the Tx of Chronic Periodontitis?
It doesnt achieve the Adequate DURATION of Effect
To be effective, Locally delivered antimicrobials must..Kill or inhibit the appropriate target _______
microbes
When rating delivery systems for Tx chronic Periodontits, what are the two best treatments?
- Locally Delivered Antimicrobial 2.Systemic Antibodies
Arestin study: What are the 3 of the 5 bugs that Minocyclene kills?
- PG (porphyromonas gingivalis) 2.PI (Prevotella Intermedia) 3.AA
Doxycyclene works to knock out connective tissue and bone ________. Local Antimicrobials work to knockout ________ challenge. Give both and you knock out both!!!
metabolism…microbial challenge
BOOM def on exam! 7mm pockets can definitely be reduced to ___mm, possibly reduced to ___mm, and no way reduced to __mm.
5mm yes, 4mm possible, 3mm go fuck yourself.
Arestin study: What are the 3 of the 5 bugs that Minocyclene kills?
- PG (porphyromonas gingivalis) 2.PI (Prevotella Intermedia) 3.AA
BOOM def on exam! 6mm pockets can definitely be reduced to ___mm, possibly reduced to ___mm
4mm yes, 3mm possible
BOOM def on exam! 5mm pockets can definitely be reduced to ___mm
3mm
What is the MOST EFFECTIVE SURGERY? How much does it reduce PD? How much does it change CAL?
“OPEN FLAP DEBRIDE” 3mm PD and 1.5mm gain in CAL!!!
2nd behind Open Flap Debride surgery, SRP + Arestin is the next effective treatment. What is its average reduction in PD and what is the avg gain in CAL?
1.65mm PD and 1.05mm increase in CAL
AGAIN!! PD>7 can be reduce on average about ____mm
2.16mm
Pt compliance- interesting! Pts being compliant about taking a drug every 6hrs = ___% and pt’s being compliant for ___%
6hr (1/4hrs)=25%…24hr = 75%
What are the 4 drugs that can cause Candadiasis?
TD MA 1.Tetracycline 2.Doxycycline 3.Minocycline 4.Amoxicillin
What are the 7 Systemic Antibiotics commonly prescribed as an adjunct to treat AGGRESSIVE periodontitis?
Amoxicillin (Amoxil TM or Trimox TM) • Metronidazole (Flagyl TM), Tetracycline HCl (Sumycin TM), Doxycycline (Vibramycin TM), Clindamycin (Cleosin TM), Amoxicillin + Clavulanic Acid (Augmentin TM), Azithromycin (Zithromax TM or Z-pak TM)
Pt compliance- interesting! Pts being compliant about taking a drug every 6hrs = ___% and pt’s being compliant for ___%
6hr (1/4hrs)=25%…24hr = 75%
What are the 4 drugs that can cause Candadiasis?
TD MA 1.Tetracycline 2.Doxycycline 3.Minocycline 4.Amoxicillin
___________ should NOT be used in most patients with periodontitis. WHAAAAT?
Systemic antibiotics…used for AGGRESIVE/SEVERE perio. use with SRP
________: A significant and decisive phase of periodontal therapy, Leads to most subsequent treatment decisions, MOST CHANGES in the treatment plan are decided upon at this time…Wait, WHEN do we do it again????
Re-evaluation..4-6 WEEKS AFTER Tx!!!!
What do we check in re-eval?
Ummm. Freaking EVERYTHING, all over again
Treatment of chronic periodontitis by SRP + sub-antimicrobial dose doxycycline results in a significant decreases in levels of GCF- ______ (______), _____, HDL, and apolipoprotein-A (APO-A).
MMPs (MMP-8 & 9)…hsCRP
________: A significant and decisive phase of periodontal therapy, Leads to most subsequent treatment decisions, MOST CHANGES in the treatment plan are decided upon at this time
Re-evaluation
What are the three treatments for the Personalized Re-treatment phase??
1.Antimicrobial Therapy (systemic or local) 2. Surgery 3.Combination
RE-EVAL: If patient has improved to a level where the disease is stable and no other treatment is indicated, then proceed to: ________ Phase
MAINTENANCE
RE-EVAL: If there has been no improvement or disease is not stable, then proceed to: ________ Phase
Personalized Re-treatment
What do you do when in maintenance phase your pt has BOP but STABLE PD’s? (4)
- Review OHI 2.Re-SRP 3.antimicrobials 4.shorten recall interval
In maintenance phase, if PD’s increase and there is BOP?
Refer to Periodontist! :)
In the Maintenance phase what are the three variables that you base your treatment on?
1.Changes in Probing Depths 2.Presence of bleeding/plaque 3.Progessive Loss of CAL
INITIALLY the interval between periodontal maintenance appointments is every __ months. (Time needed for pockets to re-infect is __ months (i.e., pathogenic bacteria will begin to repopulate a pocket of >4 mm at 60+ days))
3 months…3 months
Patientsreferredtoaperiodontistwillgenerally be placed on an _________ maintenance schedule
ALTERNATING
