Non-surgical Therapy - In office local therapy Flashcards
What are signs of Periodontal Disease?
Destruction of PDL Resorption of Alveolar bone Migration of JE along root surface Changes in morphology of gingival tissues BoP Gingival recession Periodontal Pocket formation Specific bacterial colonization within subgingival areas
What two things cause damage in periodontal disease?
Periodontal pathogens
Inflammation and immune mediators
How do periodontal pathogens damage periodontal tissues?
Produce biological molecules that may act directly on the host
Inflammatory and immune mediators
Produced by the host may cause tissue injury
How does periodontal therapy work?
Remove bacterial deposits from tooth surface
Shift the pathogenic microbiota to more health-related flora
Decrease inflammation and probing depth
What are major types of periodontal therapy?
Mechanical scaling and root planing
Surgery
What are limitations of Subgingival Mechanical Therapy?
Bacterial migration from root surfaces not accessed by instrumentation
Bacteria can colonize gingival epithelial cells and CT (soft tissues)
Bacteria can live in dentinal tubules - root planning opens tubules and ‘pushes’ microbes into the tubules
Apical migration from supra-gingival plaque and/or other infected sites
Root anatomy
Contours of the lesions
Poor oral hygiene causing supragingival plaque recurrence (recontamination)
Refractory/non-responding sites/cases
What can antimicrobial agents do to treat periodontal disease?
Fight with bacteria and bacterial byproducts
Modify host response
What are the indications for use of systemic antibiotics for periodontal diseases?
Aggressive Periodontitis
Periodontitis with secondary systemic involvement
Some types of chornic periodontitis
What are some concerns with systemic antibiotic uses?
Patient compliance
Side effects (GI issues, mixing with other meds)
Development of bacterial resistance
Poor outcome due to low concentrations in the pocket
What are some Systemic Host Modulatory Agents?
Bisphosphonates
Nonsteroidal antiinflammatory agents (NSAID)
Low-dose tetracyclines
How do bisphosphonates work?
They are incorporated into bone and incapacitate osteoclasts thereby reducing bone resorption
Have modest effect on bone density and little or no effect on attachment loss
When are bisphosphonates indicated?
For treatment of Paget’s disease, hypercalcemia, osteoporosis, metastatic bone diseases
How do NSAIDs work?
Inhibit the biosynthesis and release of prostaglandins in cells
Reduce gingival inflammation, but has modest effects on attachment levels
What are some side effects of of bisphosphonates?
Osteomalacia
Allergic reactions
What are some side effects of NSAIDs
GI ulceration
Allergic reactions
GI and renal toxicity
Periostat
Low dose of doxycycline hyclate (20mg)
Concentrates in the GCF and uses cementum as a reservoir
Inhibits tissue destructive enzymes (MMP-8)
Increases attachment levels on average by 0.5mm, decreased PD, and BoP 9 months after SRP
Why are NSAIDs not recommended to treat perio disease?
Because of the possible side effects
What are the different chemotherapies to modify host response?
NSAIDs (not recommended)
Sub-antimicrobial doxycycline
What are the different ways to apply antimicrobials locally to fight perio disease?
Rinsing (chlorohexidine)
Irrigation
Others
What are some important factors for local delivery of antimicrobials into the pocket?
Easily applied
Need a carrier (preferably resorbeable)
Need to be delivered at high concentrations
Need to stay at high concentrations and released slowly
Side effects should be minimal
What are some strengths of controlled local delivery of antimicrobials to the pocket?
Rate control >24 hours release
Active over multiple days
Active only at the site (doesn’t effect other sites)
High concentrations (many times more than the MIC)
Low total dose
Applied by the therapist
What are the different types of periodontal local delivery devices?
Fibers
Strips and compacts
Films
Injectable systems
What are the different types of injectable systems?
Microparticles
Gels
