Periodontal Treatment 2 Flashcards
What is necrotising gingivitis/periodontitis?
- The most severe inflammatory periodontal disorder caused by plaque bacteria
- Rapidly destructive + debilitating
List some main features of necrotising gingivitis (2)
- Painful bleeding gums
- Ulceration + necrosis of the interdental papilla
What is vincents angina?
Disease of the throat (not periodontium)
What is necrotising ulcerative gingivitis (NUG)?
Common, non-contagious infection of the gums
- Acute form the usual course the disease takes
- If improperly tx’d NUG may become chronic and/or recurrent
What is necrotising ulcerative gingivitis?
Where the infection leads to attachment loss
What diseases are classified together under the term necrotising periodontal diseases? (2)
- NUG - Necrotising Ulcerative Gingivitis
2. NUP - Necrotising Ulcerative Periodontitis
Define necrotising stomatitis
Progression of NUP into tissue beyond the mucogingival junction
- Mostly in malnutrition + HIV infection (may result in denudation of the bone leading to osteitis and OAF)
Symptoms of necrotising stomatitis (4)
- Ulcerated + necrotic papillae + gingival margin resulting in a characteristic punched out appearance
- Ulcers covered by a yellowish, white or greyish sloughthing
- Lesions develop quickly and are very painful
- Bleeding readily provoked
Why are the ulcerations from necrotising stomatitis often associated with?
Deep pockets formation as gingival necrosis coincides with loss of crestal alveolar bone
Risk factors for necrotising periodontal disease (5)
- Psychological stress
- Sleep deprivation
- Poor OH
- Smoking
- Immunosuppression
Tx of acute disease
- Ultrasonic debridement
- Antibiotics - metronidazole
- Chlorrhexidine mouthwash
List the 3 tx strategies for periodontal disease
- Mechanical distribution
- Systemic antibiotics or local antimicrobials
- Host modulation therapy
Examples of mechanical distribution of biofilm (4)
- OHI
- Tooth brushing instruction
- Modified bass technique - Flossing
- Interdental brushes
- Supra+subgingival plaque control
What is a biofilm?
A bunch of micro-organisms in which cells adhere to each other on a surface
What cases do we consider to tx with systemi antibiotic with mechanical disruption of biofilm? (2)
- Aggressive periodontitis
2. Young people with grade B/C (fast progressing periodontitis)
Tx protocols for patients after initial HPT and with excellent OH
- OH
- Supragingival scaling + RSD of all sites indicated in 6PPC
- Start antibiotic regiment on the morning of the first RSD visit
- 500mg amoxicillin (3x a day for 7days)
- 200mg Metronidazole (3x a day for 7days)
What do patients who are allergic to amoxicillin or on warfarin get instad of amoxicillin/ metronidazole (2)
- 100mg doxycycline
- Once a day for 21 days with 200mg loading dose during 1st day
- - 500mg Azithromycin
- 1 a day for 3 days
Advantages of local antimicrobials (4)
- Reduced systemic dose
- High local concentrations
- Drug interactions unlikely
- Site specific
Disadvantages of local antimicrobials (3)
- Expensive
- Still require RSD or biofilm disruption
- Limited indications
Indications for using chlorrhexidine (local antimicrobial)
- Only persisting pockets >5mm
- Always with RSD
- Only in isolated pockets (if many deep perio pockets in 1 area OFD or systemic antibiotics combined with RSD is more beneficial)
- In cases of periodontal abscesses
What drugs can host modulation therapy involve?
Host modulation therapy not as successful
- Corticosteroids
- NSAIDs
- Anti-cytokine + biological therapies
- Bisphosphonates
