nonsurgical therapy in-office local therapy Flashcards
tissue breakdown is generally initiated at _
thus, additional oral hygiene tools/products other than regular toothbrush are necessary
interproximal sites
patient compliance plays a major role in short/long term success of the Tx
Periodontal diseases
Destruction of PDL, resorption of the alveolar bone and migration of the JE along the root surface
changes in the morphology og gingival tissues, BOP, gingival recession, and or periodontal pocket formation
specific bacterial colonization within the subgingival area
Gingival inflammation and bleeding
Pocket formation
That is what disease is
As the pocket gets deep the flora changes to more disease microflora (gram negative) -
They have endotoxin like LPS
Periodontal Diseases
_ produce biological molecules that may act directly on host tissue
_ produced by the host may cause tissue injury
periodontal pathogens produce biological molecules
inflammatory and immune mediators produced by the host may cause tissue injury
Periodontal Therapy
~remove bacterial deposits from tooth surface
~shift the pathogenic microbiota to more health related flora
~decrease inflammation and probing depth
how
mechanical scaling and root planing
surgery
sometimes mechanical isn’t enough though
limitations of SubG mechanical therapy
~bacterial migration from root surfaces not accessed by instrumentation
~bacteria can colonize gingival epithelial cells and connective tissues
~bacteria can live in the dentinal tubules - root planning opens tubules and pushes microbes into them
~apical migration from suprag plaque/other infected sites
Some bacteria and byproducts will penetrate into tissues
Cementum is like a sponge and absorbed that shit
We have to think more than just mechanical Tx
Specfic bacteria like AA
AA penetrates into soft tissue
antimicrobial agents
~fight with bacteria and bacterial byproducts
~modify host response
Only one antimicrobial
We want to fight the bacteria and their byproducts and modify the host response
(get rid of bleeding and inflammed tissues)
do we give systemic antibiotics for periodontal diseases
concerns? ~patient compliance ~side effects - GI ~development of bacterial resistance ~poor outcome due to low concentration in the pocket
We don’t give antibitoics to every patient-It has to be specific
Every time we scale and root plane We release bacteria into the blood
some types of periodontitis, periodontitis with secondary systemic involvement
Host Modulatory agents - systemic
bisphosphonates
NSAID
low-does tetracyclines
Bisphosphonates - generally use this why they have bone related cancers - and side effect is jaw necrosis - if I do this procedure the wound may not heal
Will help reduce bone resorption
don’t quite use them yet
NSAID - good thing to control bleeding after getting rid of bacteria - as long as you take it works
As soon as you stop taking it, stops working
Tetracycline - works as host modifier agent of the host response
incorporated into bone and incapacitates the osteoclast thereby reducing bone resorption
indicated for Tx of Paget’s Disease, hypercalcemia, osteoporosis, metastatic bone diseases
side effects include osteomalacia(softening of the bones) and allergic reactions
modest effect on bone density and little or no effect on attachement loss
bisphosphonates
modest effect on bone density and little or no effect on attachment loss
inhibit the biosynthesis and release of prostaglandins in cells
side effects inclusde GI ulceration, allergic reactions, GI and renal toxicity
reduce gingival inflammation however effects on attachement levels are modest
NSAID
reduce gingival inflammation however effects on attachment levels are modest
DON’T USE TO TX, just help maybe
Periostat - local low (sub-antimicrobial) dose of _ - 20mg
concentrates in GCF and uses cementum as reservior
inhibits the tissue destructive enzymes (MMP-8)
-Neutrophil collagenase, also known as matrix metalloproteinase-8 (MMP-8) or PMNL collagenase (MNL-CL), is a collagen cleaving enzyme
tested adjunctively to SRP over 9 months
-increased attachment levels on average by 0.5mm, decreased PD and BOP
no resistance reported
doxycycline hyclate
daily For 3 months
A lot of sites with bleeding
Do nonsurgical tx with bleeding every where and no risk of developing antibiotic resistance
So low of a dose
what is a PerioChip
Chlorhexidine 2.5mg disolvable gelatin matrix film/chip
Have to have a pocket to use the periochip
It won’t stay in in a swallow 5mm pocket
Have to do nonsurgical tx first and at the reval we might use
Before we decide to use this we have to do SRP again and then place this
Atridox - Doxycycline what is it
biodegradable, flowable PLA gel
co-polymer carrier with doxycycline as active ingredient
special glue to seal the pockets
which local treatment is available here at the school
stat sig. reduction in probing depth
Minocycline - Arestin - PLA/PLGA powder
Special syrine - buy it with a little cup
Yellow little particles - feels like sand
After scaling - weill release into the pocket
indication for local antimicrobial delivery
which stage of perio?
localized slight to moderate chronic periodontitis stage I and II, with limited amount of sites that are unresponsive to non-surgical therapy
greater than equal to 5mm probing depths
5-6mm probing deep have to be localized
Should be considered adjunctive therapy to SRP or will be malpractice
Have to do scaling again because Mechanical is limited and can’t get everything
Soft tissue loves this and will seal the little plaque that’s deep apically
Has to be adjunctive with SRP
Have to do SRP same appointment
