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SP 16 - Perio Exam 1 > Non-surgical Therapy - In office local therapy > Flashcards

Non-surgical Therapy - In office local therapy Flashcards

1
Q

What are signs of Periodontal Disease?

A 
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
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2
Q

What two things cause damage in periodontal disease?

A

Periodontal pathogens

Inflammation and immune mediators

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3
Q

How do periodontal pathogens damage periodontal tissues?

A

Produce biological molecules that may act directly on the host

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4
Q

Inflammatory and immune mediators

A

Produced by the host may cause tissue injury

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5
Q

How does periodontal therapy work?

A

Remove bacterial deposits from tooth surface
Shift the pathogenic microbiota to more health-related flora
Decrease inflammation and probing depth

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6
Q

What are major types of periodontal therapy?

A

Mechanical scaling and root planing

Surgery

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7
Q

What are limitations of Subgingival Mechanical Therapy?

A

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

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8
Q

What can antimicrobial agents do to treat periodontal disease?

A

Fight with bacteria and bacterial byproducts

Modify host response

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9
Q

What are the indications for use of systemic antibiotics for periodontal diseases?

A

Aggressive Periodontitis
Periodontitis with secondary systemic involvement
Some types of chornic periodontitis

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10
Q

What are some concerns with systemic antibiotic uses?

A

Patient compliance
Side effects (GI issues, mixing with other meds)
Development of bacterial resistance
Poor outcome due to low concentrations in the pocket

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11
Q

What are some Systemic Host Modulatory Agents?

A

Bisphosphonates
Nonsteroidal antiinflammatory agents (NSAID)
Low-dose tetracyclines

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12
Q

How do bisphosphonates work?

A

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

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13
Q

When are bisphosphonates indicated?

A

For treatment of Paget’s disease, hypercalcemia, osteoporosis, metastatic bone diseases

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14
Q

How do NSAIDs work?

A

Inhibit the biosynthesis and release of prostaglandins in cells
Reduce gingival inflammation, but has modest effects on attachment levels

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15
Q

What are some side effects of of bisphosphonates?

A

Osteomalacia

Allergic reactions

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16
Q

What are some side effects of NSAIDs

A

GI ulceration
Allergic reactions
GI and renal toxicity

17
Q

Periostat

A

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

18
Q

Why are NSAIDs not recommended to treat perio disease?

A

Because of the possible side effects

19
Q

What are the different chemotherapies to modify host response?

A

NSAIDs (not recommended)

Sub-antimicrobial doxycycline

20
Q

What are the different ways to apply antimicrobials locally to fight perio disease?

A

Rinsing (chlorohexidine)
Irrigation
Others

21
Q

What are some important factors for local delivery of antimicrobials into the pocket?

A

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

22
Q

What are some strengths of controlled local delivery of antimicrobials to the pocket?

A

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

23
Q

What are the different types of periodontal local delivery devices?

A

Fibers
Strips and compacts
Films
Injectable systems

24
Q

What are the different types of injectable systems?

A

Microparticles

Gels

25
Q

What are the different Antimicrobial agents used in subgingival delivery systems?

A

Chlorohexidene
Doxycycline
Minocycline

26
Q

PerioChip

A

Collagen gel as a carrier with Chlorohexidine as the active material

27
Q

How big does the pocket have to be in order to be treated with a PerioChip

A

At least 5 mm - otherwise it won’t stay

28
Q

How and why are PerioChips used?

A

Used following SRP and irrigation
Tell patient not to floss for a week or so - they can floss
Pockets have to be 5mm deep (or deeper)

29
Q

Atridox

A

Co-polymer carrier with Doxycycline active matieral

It stay in the pocket for 10 days and is slowly released over time

30
Q

How is Atridox used?

A

Slowly release it into perio pockets
Remove the excess
Seal the pocket to keep it in

Done after SRP and irrigation - make sure pt doesn’t floss

31
Q

What are the indications for local antimicrobial delivery?

A

Localized slight to moderate chronic periodontitis with limited amount of sites that are unresponsive to non-surgical therapy
Should be considered adjunctive therapy to SRP for limited sites with ≥5mm pockets

32
Q

What are the contraindications for local antimicrobial delivery?

A

Allergies to specific antimicrobial reagents
Several sites/mouth with residual periodontal pockets following SRP
Applications without performing SRP

33
Q

What is the efficacy for Chlorohexidine local delivery in addition to SRP?

A

Patients in the study we went over had 0.42mm difference in probing depth after 6 months (significantly lower)

34
Q

What is the efficacy for Minocycline local delivery?

A

Statistically significant reduction in probing depths compared to groups with just SRP and SRP+vehicle

35
Q

What is the efficacy for Doxycycline local delivery?

A

Equal effectiveness as others

36
Q

Do outcomes of treatment depend on number of sites?

A

No - local outcome depends on the greater level of oral hygiene

37
Q

What types of local antimicrobial delivery are not recommended currently?

A 
Hydrogen Peroxide tray the patient applies themselves - tightens the gums and closes the pockets off, but doesn't remove plaque
Natural remedies (Aloe vera, Coconut oil) - not enough research
38
Q

What are the two major conclusions about local antimicrobial delivery from this lecture?

A

Localized non-responding sites and localized recurrent disease may be treated with locally delivered antimicrobials
Mechanical debridement before application of the agent and plaque control after therapy are essential for success

SP 16 - Perio Exam 1 (8 decks)

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