Perio Flashcards
(111 cards)
1
Q
What is periodontitis?
A
Periodontists is a multi factorial, inflammatory diseases associated with dysbiotic microbial dental biofilms and characterised by non-reversible progressive periodontal tissue destruction. It manifests through: CAL, radiographically assessed alveolar bone loss, presence of periodontal pocketing, gingival bleeding and leads eventually to tooth loss.
2
Q
What are the main points of the old, Non-specific Plaque Hypothesis?
A
- All plaque bacteria are equally pathogenic
- Quantity of plaque determines the pathogenicity
- Host has threshold capacity to detoxify bacterial products
- Disease develops if threshold is surpassed
Treatment: non-specific mechanical removal of total amount of plaque
3
Q
What are the main points of the Specific Plaque hypothesis?
A
- Due to advancement of microbiological technologies, specific bacteria that are believed to be pathological to the periodontium were isolated
- Not all plaque is equally pathogenic
- Presence and increase of specific microorganism causes more destruction
Treatment: targeting and elimination of specific microoganisms using antimicrobials
4
Q
What are the main points of the ecological plaque hypothesis?
A
- Disease is the result of an imbalance in the total micro-flora due to ecological stress
- Quantitative plaque increase changes local micro-environment promoting the growth of specific pathogens, qualitative shift
- Ecological factors such as the presence of nutrients and essential cofactors, pH and redox potential
Treatment: prevention of dental caries, modification of micro-environment to prevent nourishment of pathogens
5
Q
Explain, briefly, the Yellow, orange and red groups that were suggest by Dr. Socranky research of 1998. Please include the names of at least 3 different bacteria in all of the groups.
A
- The yellow, orange and red groups are suggested groups of bacteria that are associated with periodontal health and pathology
- Yellow group - include: S. Mitis, S. Oralis and S, Snagius - are early coloniser groups that are related to healthy periodontium
- Orange group - include: P.Intermedia, P.Nigrescens and F. Nucleatum - are late coloniser that are believed to be an intermediate step and are able to facilitate red group (the most pathogenic group) in binding in the periodontal pocket
- Red group - include: P. Gingivalis, T.Forsythia, T. Denticola - believed to be the most pathogenic group
6
Q
What is the microbial virulence?
A
Virulence is defined as the degree of pathogenicity of the ability of the organism to cause disease measured in experimental procedures.
Organism need to:
- Attach and colonise
- Multiply and gain access to appropriate nutrition
- Evade host defences
- Propagate
7
Q
What is A. Actinomycetemcomitans?
A
A. Actinomycetemcomitans or AA is a gram negative anaerobe that is associated with localised aggressive periodontitis.
Able to produce high level os leukotoxins thus causes the lysis of PMNs.
It is equiped with adhesis and invasisn which means it can penetrate the tissue and attach to the space it has penetrated
8
Q
What is P.Gingivalis?
A
P. Gingivalis is a gram negative anaerob that is associated with periodontits (around 79-90% of perio cases will have this bacteria)
Main cause of the inflammation to the tissue - release of endotoxin (name: P.Gingivalis LPS)
Contains invasins, adhesins and also collagenases which degrade connective tissue.
9
Q
What are the main points of the Keystone Pathogen Hypothesis & Polymicrobial synergy and Dysbiosis Model?
A
- Keystone pathogens (e.g. P.Gingivalis) trigger inflammation even in low numbers
- Causes normal microbiome to become dysbiotic
- Manipulation of native immune responses of host
- Inflammatory byproducts sustain dysbiotic microbiota
Treatment: host modulation in adjunct to direct antimicrobial measures
10
Q
What are inflammophilic bacteria?
A
Bacteria that are able to propagate using by-products of inflammation
11
Q
What are the stages of the IMPEDE model
A
Stage 0 - gingival and periodontal health
Stage 1 - gingival inflammation
Stage 2 - Polymicobial emergence
Stage 3 - Inflammation - mediated dysbiosis - initial perio
Stage 4 - Late stage periodontitis
12
Q
What is the consensus on how periodontal destruction actually occur?
A
It is widely believed that periodontal destruction occurs due to effects of the immune response and not directly due to bacteria. 80 immune response, 20 bacteria.
13
Q
What is the aetiology of periodontitis?
A
- Predominance of PMNs in pocket epithelium/activation in connective tissue
- Elevated activity of macrophages
- Plasma cells dominate the infiltrate
- Increase of pro-inflammatory cytokine production (like IL-6 and IL-8 and more)
- This results in disturbed tissue homeostasis leading to destruction of collagen, connective tissue matrix and bone
- This results in true pocket development from the junction epithelium
14
Q
What are MMPs?
A
Matrix metalloproteinases (MMPs) are a large family of calcium-dependent zinc-containing endopeptidases, which are responsible for the tissue remodeling and degradation of the extracellular matrix (ECM), including collagens, elastins, gelatin, matrix glycoproteins, and proteoglycan.
They are regulated IL-6 and IL- 8.
They are released by many cells like PMNs.
15
Q
What causes bone resorption?
A
- RANKL - produced by osteocytes in large quantities, due to stimulation of pro-inflammatory cytokines like IL-6 and IL-8, able to activate osteo clasts - bone resorbing cells
- RANK - receptor on osteocalst - binding site of RANKL
- OPG - scavenger receptor that prevents RANKL binding thus preventing bone resorption
RANKL:OPG ratio: relative amount regulate the bone turn over
16
Q
What is the importance of T helper cells in periodontitis?
A
They help to propagate the process of secretion of pro-inflammatory cytokines and messengers
17
Q
What is a risk factor?
A
Health risk factor are attributes, characteristics or exposures that increase the likelihood of a person developing a disease or health disorder.
18
Q
What are some of the pre-disposing factors for periodontitis?
A
Any factor that result in retention of biofilm or prevents ts removal thus predisposing for disease progression.
E.g.:
Anatomical factors: root proximity, tooth malposition, concavities and furcation
Aquired/Iatrogenic factors: overhangs, open contacts and appliances
All this needs to happen in a susceptible host.
19
Q
What are modifying or systemic factors?
A
They are factors that modify disease expression and may influence disease progression by altering host’s immune response
e.g. in periodontitis: smoking and diabetes
20
Q
How does smoking increases the risk of periodontitis and by how much on average does it increase the instance of periodontitis according to latest studies?
A
The mechanisms:
1. Chronic reduction in blood flow and vascularity
2. Increase the prevelance of potential periodontal pathogens in the sulcus
3. Shift in neutrophil function towards destructive activities
4. Shift to a dysbiotic, pathogen enriched microbiome
5. Affects PMNs making them more aggrevated
6. Increase the number of aggravated T cells that produce inflammatory cytokines
It increases the risk of periodontitis by 85%!
Smoking cessation has beneficial effect on therapy outcomes and disease progression - this should be attempted for patient with nicotine dependence/
21
Q
What are two useful statistics to give to a smoker patient in order to discourage them from smoking?
A
- Regular smokers have around 50% less improvement in clinical parameter after nonsurgical therapy
- Regular smoker have 2x implant failure rate compared to nonsmokers
22
Q
How does diabetes increases the risk of periodontitis and by how much on average does it increase the instance of periodontitis according to latest studies?
A
- No solid evidence of causal relationship between poorly controlled diabetes and periodontal microbial dysbiosis in humans, but there some evidence in vitro thus it is biologically plausible
- Osteogenesis reduction due to apoptosis of osteoblasts and PDL fibroblasts
- Increase in RANKL expression and OPG expression is decreases
- Increase in collagenase activity
It increases the risk of periodontitis by 3x to 4x!
Multidisciplinary control and treatment of diabetes is ESSENTIAL to treatment of periodontitis.
23
Q
What can be seen intraorally in a patient with diabetes and perio?
A
- No specific phenotypic features
- Pronounced clinical and radiographic signs
- Signs of progression
- Multiple reoccuring periodontal abscesses
- Unpredictable responses to therapy
- Increases risk of future attachment loss
If you suspect undiagnosed or poorly controlled diabetes, refer to GP for further investigations or management
24
Q
What is the relationship between diabetes and periodontitis?
A
There is a bi-directional relationship between diabetes and periodontitis, meaning improvement in diabetes improve periodontitis but also improvement in periodontitis improve diabetes!
25
What are the common genetic defect that may cause periodontitis?
1. Neutrophil disorders
2. Single nucleoitd polymorphisms
Periodotitis is associated with variations in up to 20 genes.
Most forms of periodontitis are polygenic, being caused by a combination of genetic and environmental factors.
26
How do you write a diagnostic statement for diabetes?
1. Type of periodontal disease
2. Disease extent
3. Stage
4. Grade
5. Current disease status
6. Risk factor profile
E.g.
Periodontitis: generalized (65%), Stage III (CAL <10 mm), Grade C (HbA1c 8.9%), currently unstable (PPD <8mm, BOP 45%).
Risk factors: uncontrolled diabetes (HbA1c 8.9%), smoking 20 cig/day, high strss levels (change in work)
27
How do we calculate clinical attachment loss?
Pocket depth + recession or pocket depth - over growth or pocket depth
28
Is periodontal disease rare ?
No - very very common - both gingivitis and perio are pretty common
29
What is prevalence?
It refers to the total number of individuals in a population who have a disease or health condition at a specific period of time, usually expressed as a percentage of the population.
30
What is incidence?
It refers to the number of individuals who develop a specific disease or experience a specific health-related event during particular time period.
31
What have the 70-80s research into Sri Lankan tea labourers showed us?
1. 10-15% resist periodontitis
2. 10-15% have rapid progression
3. 70-80% have moderate progression
32
How can you link back the instances of severe periodontitis with the current classification standards?
It was discovered, that on avergaere, people with sever cases of periodontists have attachment loss of around 0.45mm per annum.
Thus in the new classification, Grade C (fast progressing) is considered to be when an individual has a rate of progression of more than 2mm per 5 years (5 x 0.45)
33
What is one of the findings from studies relating to periodontal health in Australia?
Rates of periodontitis have remained relatively the same yet the tooth retention rate has been improving
34
What levels are we aiming at when we are discussing a plaque index?
We are aming at below 20% as it is essential for stable periodontal and peri-implant health over the long-term.
35
What BOP score are we aiming to achieve?
BOP score of less or equal to 20% because that is associated with significantly lower risk of CAL progression and want the score to decrease continuously and keep stable.
36
What the Community Periodontal Index of Treatment Needs codes and what treatment do they need?
Code 0 - healthy - treatment: home care
Code 1 - bleeding on probing but no attachment loss - treatment: oral hygiene instructions
Code 2 - calculus present + BOP - treatment: calculus removal and scaling + OHI
Code 3 - pockets of below 5 mm - treatment: calculus removal and scaling + OHI
Code 4 - pockets of above 6 mm - treatment: complex therapy + calculus removal and scaling + OHI
37
What is the first group of systemic diseases and conditions that relate to periodontitis?
They are some rare/uncommon systemic diease and conditions that cause a profound loss of periodontal tissues and usually early onset (may be in deciduous teeth).
Periodontitis might be one of the signs of these diseases.
Some of these disorders are:
1. Genetic disorders:
1.1. Down syndrome - aetiology not known but there is a link with damped immune function - occurs in adolescence in term of perio
1.2. Leukocyte adhesion deficiency syndrome - PMNs can no longer integrate - related to the integrin beta2 receptor thus GP will test for that - usually can be observed in child hood in terms of periodontitis
1.3 Papillion LeFevre Syndrome - reduces PMN function (NETosis) - results in early onset periodontitis in 1-5 year olds
1.4 Cyclic neutropenia - reduction in number of PMNs every 21 days for 3-4 days - reduction of periodontal tissue expected
1.5 Primary immunodeficiency diseases - not known
1.6 Plasminogen deficiency - enlarged and ulcerated gingiva with white membrane
1.7 Multiple metabolic & endocrine disorders
2. Aquired Immunodeficiency diseases:
2.1 Aquired neutropenia
2.2 HIV infection - increased risk of opportunistic infections like necrotising periodontal diseases and other
3. Inflammatory disease:
3.1 Inflammatory Bowl Disease
3.2 Arthritis
38
What is the second group of systemic disease and conditions that relate periodontitis?
They are some relatively common systemic conditions that have a moderate impact on prevalence / severity of priodontitis.
These diseases usually have an influence on the parthenogenesis of periodontal disease.
Some of these disease and disorders are:
1. Diabetes
2. Obesity
3. Osteoporosis
4. Arthritis - could through are process of inflammatory aggravation called citrulination
5. Stress and depression
6. Hypertension - maybe but probably not - but people with perio are more likely to have hypertension
39
What is the third group of systemic disease and conditions that relate to peridontitis?
They are systemic or local conditions that mimic periodontitis and cause destruction of periodontal attachment. They are independent of plaque induced periodontitis and cause periodontal tissue damage through other mechanisms.
Some of these disease and disorders are:
1. Neoplasm that originate from the gingival and may resemble perio
2. Giant cell granuloma and many other very rare diseases that may mimic symptoms and signs of perio
40
What are some of medications that have a negative impact on the periodontal tissue?
1. Anticancer chemotherapy - leads to neutropenia
2. VEGF inhibitors - delay wound healing but still needed for chemo
41
What are some of the medications that have a positive impact on the periodontal tissue?
1. NSAIDs - general anti-inflammatory effect
2. Anti-TNF therapies
42
What is the theory of "direct pathway" that connects periodontal health with systemic health?
It believed that due to increased number of bacteria and smaller barrier to penetrate (ulcerated epithelial pocket lining).
1. The ulcerated periodontal pocket liing acts as a gate for viable bacteria, bacterial toxins/componetns
2. It results in frequent transient bacteremia
3. And could result in substantial systemic inflammatory response
This pathway also goes via other organs and systems like during swallowing or inhalation.
Important to understand that systemic bacteraemia as a result of periodontal infection is rare.
There is actually a way you can calculate periodontal inflamed surface area thus it is important to reduce that area with treatment.
43
What is the theory of indirect pathway?
It also relates to the periodontal inflamed surface area.
It is a theory that states that affects on the systemic health from periodontal disease result due to pro-inflammatory mediators that are involved in periodontitis.
Less plausible than the direct pathway.
44
What is the association between periodontitis and atherosclerotic coronary vascular disease?
AVD is the most common form of death worldwide.
It is a result of vascular inflammation and subintimal lipid accumulation which could result in build up of atheroma, stenosis of the valves, rupture of blood vessels and thrombosis.
There is some evidence to suggest there is association between the A.a. bacteria and P. Gingivalis being recovered from human atheromas. Thus an increase in those bacteria may result in increases risk of atheromas. These bacteria may effect the endothelia walls, immune function, impact macrophage function through different mechanisms.
45
What are some of the steps that need to be taken for a patient with AVD as soon as they have been diagnosed with the condition?
1. Periodontal health needs to be assesed
2. A treatment plan with focus on prevention should be constructed
3. Combination of at home and in chair procedures must be performed to maintain good periodontal health thus reduce the risk of AVD worsening
46
What is the association between periodontitis and diabetes?
Periodontitis and diabetes have a bilateral relationship thus an improvement in one of them may result in improvement of the other
The process of periodontitis affecting diabetes:
1. Periodontal infection causes elevation of serum pro-inflammatory cytokines
2. Systemic inflammation leads to insulin resistance by blocking insulin receptors
3. Bacterial dissemination may alter b cell secretion through b-cell dedifferentiation - also enzymes produced by P.Gingivalis may reduce glucose-induced insulin production
4. There are also some evidence that P.Gingivalis may cause gut dysbiosis but take it with a grain of salt
47
What to do if a patient has uncotrolled diabetes?
You should do non-surgical treatment ad collaborate with GP and inform patient that perio help with diabtes
48
What is prognosis?
A prognosis s a prediction of the probable course duration, and outcome of a disease based on a general knowledge of the pathogenesis of the disease and the presence of is factors for the disease.
Prognosis is establish after diagnosis.
49
What s the difference between prognostic factors and risk factors?
Prognostic factors are characteristics that predict the outcome once the disease is present.
Risk factors are characteristics that put an individual at increased risk of developing a disease.
Sometime they are the same but sometimes they are different
50
How can we separate the types of prognosis?
1. Overall prognosis - genetic conditions, patient compliance, age, patient expectation
2. Individual prognosis - local prognostic factors (tooth positions, ppd, furcation etc.) and prosthetic/restorative factors (caries, endodontic status etc.)
51
What is the system of tooth prognosis by Nibali?
It is a very objective system that involves
1. Bone loss
2. Furcation and modbility
3. PAI score
52
When should we extract a tooth?
Only teeth with hopeless prognosis and that are not favourable
53
When would you suggest an immediate extraction?
1. Due to pain
2. Due to acute abscesses
3. If patient request due to other treatment like ortho
54
What is favourable periodontal disease progression?
It is when the periodontal status of the tooth can be stabilised with comprehensive periodontal treatment and periodontal maintenance. Future loss of periodontal supporting tissue in unlikely.
55
What is questionable periodontal disease progression?
It is when the periodontal status of the tooth is influenced by local and systemic factors that may or may not be able to be controlled. The periodontium can be stabilised.
56
What is unfavourable periodontal disease progression?
It is when the periodontal status of the tooth is influenced by local and/ or systemic factors that cannot be controlled.
57
What is the hopeless periodontal disease progression?
Only extraction may help
58
What i an important factor to consider with extractions?
They are reversible.
59
What are some of the goals of periodontal treatment?
1. Absence of pain
2. Reduction and elimination of infections and inflammation
3. Cessation of attachment loss and gain of attachment
4. Restoration of physiologic bone and gingival contour to aid plaque control
5. Satisfactory function and aesthetic for the individual
60
How can you categories your perio treatment goals?
1. Immediate goals
2. Intermediate goals
3. Long term goals
Remember - patient must know that periodontal treatment is not a one off - it is continuous
61
What are the steps of periodontal treatment for good and fair prognosis teeth?
1. Initial therapy
2. Revaluation or reassessment of prognosis
3. Surgical or maintenance phase
62
What are the steps of periodontal treatment for questionable and unfavourable teeth?
1. Plan potential abutment for rem/fixed prosthesis
2. IF NOT, Initial therapy
3. Revaluation or reassessment of prognosis
4. Surgical (when pocket depth above 6mm) or maintenance phase (if pocket depth are below 6mm after treatment)
63
How to set up a case report for perio?
1. Reason for referral
2. CC
3. MHx
4. DHx
5. Family Hx
6. Diagnosis
7. Oral hygiene
8. Establishing goals and motivation
9. Prognosis
10. Treatment plan
11 Treatment
64
How to set up a provisional treatment plan for perio?
1. Emergency phase - e.g. exo
2. Systemic phase - e.g. control systemic diseases
3. Initial phase - e.g. testing and debridement
4. Surgical phase - regenerative surgery
5. Restorative phase - temporary crowns
6. Maintenance phase - depending on risk close recall or normal recall
65
What are acute periodontal conditions?
They are conditions that are:
1. Rapid in development
2. Cause pain/discomfort
3. Rapid tissue destruction
4. Usually a result of infection
e.g. hepatic gingival stomtitis, necrotising gingivitis/periodontitis
66
What happens if a patient shows up to the initial treatment appointment with an active herpes cold sore?
Might need to postpone the treatment as the disease is in it's most contageous stage - similar to other diseases like COVID 19
67
Would you give antibiotic prophylaxis to patient before root planing?
Yes you would if they have an underlying health condition.
68
What is the objective of the initial phase of therapy?
The objective is to achieve clean and infection free conditions for the oral environment by removal of soft and hard deposits and any retentive points and factors that might propagate them
69
What are the steps to the initial phase of treatment for Stage I-III of periodontitis?
1. Patient self care and removal of biofilm by patient with - behavioral modification, mechanical (like brushing and using of inderdental brushes or other methods) and chemical (mouthrinse and oral irrigation)
2. Supragingival scaling and reduce predisposing factors such as bad restorations - the evidence suggest that are not preffered way i.e 1 quadrant per session or half the mouth per session
70
What can you provide for pain management
for perio procedures?
1. LA
2. Topical
3. Mouth rinse using cepacaine
71
What is the relationship between the pocket depth and the average percentage of root surface debrided?
With the increase of pocket depth - the amount of debridement usually goes down even with experienced operators
72
What are some of the difficulties with subgingival root plaining?
1. Macromorphology of the roots - e.g. the mesial forcation of the upper sixes is quite deep and hard to get
2. Micromorphology of the cellular cementum
3. Irregular of the base of the pocket
Even with these problems, subgingival debridement seen to be incredibly useful in causing a reduction in bacteria levels and pathogenic bacteria like P.Gingivalis reduces
73
What are some of the factors that may impact outcome of non-surgical periodontal therapy?
1. Smoking
2. Number of roots on the tooth
3. Plaque levels
74
What is one of the ways periodontal pocket repairs after the subgingival debridement?
Repair through long junctional epithelium:
It is a restoration of the continuity in the wound or defect area, without regeneration of the originally intact tissues from and function for example long junctional epithelial attachment with new collagen fibers parallel to it. Thus the periodontal pocket closes up.
Some of the tissue may actually reattach but it important for those tissues to not be infected.
75
What are some of the side effects of non-surgical therapy
1. Reduction in gingival tissue due to reduced oedema - increase in th black triangle between teeth
2. Increase in dentine hypersensativity due to damaged cementum that covers dentinal tubules
3. OH may causes reduction in dentine like making those wedge like
76
What are some of the complexity factors could occur in the periodontium?
1. Pocket depth and type (supraboney or infraboney)
2. Vertical bone loss
3. Furcation ivolvment
4. Ridge defects
5. Masticatory dysfunction
77
What determines the morphology of alveolar bone loss?
Width of interdental septa, disease progression and time that determine the morphology of bone loss. Wide interdental septa result in vertical bone loss and slim result in horizontal bone loss.
78
What are some of the complexity factors could occur in the periodontium?
1. Pocket depth and type (supraboney or infraboney)
2. Vertical bone loss
3. Furcation involvement
4. Ridge defects
5. Masticatory dysfunction
79
What are some of the common boney defects and how would you describe them?
1. 3 Wall defect - balcony-like defect
2. 2 wall defect - 2 roots of adjacent teeth are connected ( a little bit) or where is 2 walls of the defect
3. 1 wall defect - might manifest itself as a v shape with a single wall
All defects must undergo non-surgical therapy.
The defects can be accessed using horizontal strokes, mini-currettes or special ultrasonic scalers.
80
What are some of the aetiology of furcation involvement?
1. Periodontitis
2. Endodontic infection
3. Iatrogenic - rct perforation
4. Anatomy - like enamel pearls
81
What are some of the anatomy that we must know for furcation involvement?
1. Root fornix - the upper morst area of the furcation close to the crowns
2. Root trunk - the area between the CEJ and the fornix
3. Root divergence - the degree of separation between the roots
82
What is the advantage of a short root trunk length for furcation debridement?
A short root trunk length results in earlier furcation exposure but has better accessibility for treatment
83
Why do class 2 and 3 furcations have bad prognosis?
Because of biofilm accumulation and hardness of debridement
84
What are the advantages of access flap debridement?
1. Improved access for professional instrumentation
2. More efficient calculus removal
3. Significant clinical improvements
85
What are other techniques that could be useful in improving the oral hygiene caee for furcations for a patient?
Tunneling technique - surgical exposure of inter-radicular space. Most common complication - root caries.
Root resection - for a patient with RCT and class 3 furcation
86
What are some of the surgical procedures we can do for class II furcation?
Something like Guided Tissue Regeneration
87
What factors determine physiologic mobility of teeth?
The physiological mobility os determined by the height of the alveolar bone and the width of the PDL
88
What occurs in the primary occlusal trauma and how does it affect the periodontal health?
1. There is excessive occlusal force
2. This results in acute inflammation and compression
3. This lead to bone resoprtion and widening of the PDL with no clinical attachment loss
4. When occlusal forces removed - PDL goes to normal
89
What occurs in the secondary occlusal trauma and how does it affect the periodontal health?
1. Excessive occlusal force applies to healthy teeth, healthy gingiva on a reduced periodontium
2. SImilar addaption and widening of the PDL with no clinical attachment loss
3. When forces removed some bone apposition might occur
BUT when untreated periodontitis is involved:
1. The occlusal forces may cause damage to the connective tissue supporting the teeth
2. When occlusal trauma remove attachment is lost
90
What are clinical signs of occlusal trauma?
1. Increased tooth mobility
2. Tooth migration
3. Fremitus positive
4. Wear facets disproportionate to age or diet
Radiographicaly:
1. Widened PDL space
2. Angular bone loss
3. Thickened supporting alveolar bone
91
How should we treat mobile teeth?
1. Treat the cause
2.Periodontal surgery
3.Splinting - remember to adjust the occlusion
92
What are the 2 main ways to apply antibiotics for periodontitis?
1. Local - to the site
2. Systemic - through the blood stream
93
What are the disadvantages of supragingival antibiotic application?
It does not create subgingival penetration thus will not greatly affect bacteria which affect periodontal disease.
94
What are the advantages and disadvantages of subgingival antiobitc application?
Advantages
1. high local concentration
2. Fewer side effect
3. Improved compliance
Disadvantages:
1. GCF clearance
2. Reinfection from untreated sites
3. Limited product availability
95
What are the advantages and disadvantages of systemic administration of antibiotics
Advantages:
1. can reach periodontal tissue
2. Easily available
Disadvantages:
1. Variable local concentration
2. Resistance
3. Systemic side effects
96
What is the recomendation in terms of use of oral antiseptics in conjunction with periodontal treatment?
They may be considered, in some cases, as adjuncts to mechanical debridement - cases like patient who cant perform proper mechnanical plaque control post surgery or necrotising periodontal disease or people with saviour arthritis
97
What are some of the challenges faced with use of antibiotic therapy on periodontal bacteria?
1. There are thousands different types of periodontal bacteria present - hard to choose one antibiotic
2. The bacteria reside within a biofilm thus they are harder to reach - THUS BIOFILM NEEDS TO BE REMOVED AND ANTIBIOTICS ADMINISTERED 24 HOURS POST DEBRIDEMENT
98
What is the common combination of anti-biotics used to treat periodontal disease?
Metronidazol & amoxicillin which is known as Winkelhoff cocktail - it is the most researched combination and also does produce clinically significant improvements
99
What are the recommendations of anti-biotic prescription for periodontal disease in Australia?
Amoxicillin 500 mg orally, 8-hourly for 7 days PLUS Metronidazole 400 mg orally, 12-hourly for 7 days
100
What are some of the antibiotic side effects?
1. Gastrointestinal effects
2. Allergies
3. Headache while drinking alcohol
101
What patient should get anti-biotic therapy?
1. Young patient
2. Generalised severe periodontitis patient
3. Patients with systemic diseases
4. Rapidly progressing form
5. Refractory/therapy-resistant forms of periodontitis
102
What are some of the direct method of application of different substance for periodontal treatment?
1. Periochip - application of a smal gelatin chip with Chx
2. Local administered anti-biotic
Still adjunct to normal debridement
Could be use for local periodontis
103
When should you recall the patient after completion of the innital phase of dembridment and provision of at home OHI?
After around 12 weeks in order to give the periodontium the chance to heal
104
What should you do after the patient has come back after the 12 weeks?
1. Review MHx and risk factors
2. Assess the OH performance
3. Periodontal examination
4. Re-evaluation - caries check, restorative and implant status
5. Supportive periodontal therapy session - the aim of therapy is to have pocket of no more than 4 mm
6. The third step can be taken aswell after another reassessment - this involves teeth that did not respond to therapy well and may need to address those remaining point of biofilm accumulation
7. If the pocket are more than 6mm, surgeyr may be needed
105
What is supportive periodontal treatment?
It is treatment that plans to maintain already achieved goals with improvement of periodontal health. Patient should come back for assessment every 3-12 months depending on their risk profile )high risk - come every 3 months, low risk - every 12 months)
106
How can we evaluate risk of periodontal disease progression in the patient?
There dirrent matrix you can use to determine the recall frequency - a common one is the PRA (periodontal risk assessment) and it can be accessed online.
Preio-tools.com seems like the website to go to to find different matrix that may assist you.
107
What are the steps to a good supportive periodontal treatment session?
1. Patient greeting and interview
2. Review of medicla history
3. Existing factors evaluation and counselling
4, Clinical examination and re-evaluation: Oral Path, OH status, Perio exam, Caries check, fix-pros check
5. Hygiene
6. Motivation
7. ALWAYS BOOK ANOTHER APPOINTMENT
108
Shouldyou probe all the teeth at SPT session
YES of course you should to understand the health of pockets - but you can choose not to do a brand new perio chart unless you find some findings
109
What would you mention to a patient who has periodontitis?
1. Periodontitis - a disease that destroys the bone underneath the tooth
2. Usually occurs from bacteria aggrevating the gums
3. Aggrevating the gums leads to inflammatory condition - gingivitis
4. When gingivitis is present with some underlying risk factors such as smoking, diabetes or immunuesupressed organism - periodontitis is caused
5. Periodontitis is caused by the immune system trying to fight off the bacteria in the plaque - but not bring very mindful of the surrounding tissue
6. Unfortunatley periodontitis is irreverisble - but if proper treatment - it can be slowed down or even arrested - thus we need to collaborate on this issure
110
What kind of model of progression is periodontitis believed to be?
Linear destruction model or burst destruction modle.
Phases of remission and exacerbation.
111
