Periodontal treatment outcomes and adjunct treatment Flashcards
Goals of periodontal therapy?
Preserve and maintain dentition
- improve and maintain oral hygiene
- stabilise chronic condition
- reduce pocket depths
- reduce BOP
- reduce inflammation
- prevent loss of mobile teeth
- reduce risk of systemic diseases associated with periodontitis
Why try to reduce pocket depths?
The deepest part of deep pockets are inaccessible biofilms, the only way to remove this is with professional intervention.
By reducing PPD the whole pocket becomes accessible and the patient can control it themselves = easier to clean and less inflammation
What should be considered at periodontal review?
Assess response to OHI
Patient compliance
Reassess risk factors
Patient perception of treatment success
How is periodontal tissue response assessed during review?
Full periodontal assessment PPD BOP Recession Attachment levels Mobility Suppuration Furcation
Why are PPDs not reviewed before 3 months?
Gives time for tissues to heal
What suggests a successful periodontal treatment?
Reduced probing depths
Reduced BOP
Reduced inflammation
Formation of LJE
What will occur within a few hours of RSI?
Acute inflammatory reaction in pocket wall
Describe healing after RSI
a) 1-2 days
b) 1-2 weeks
c) 3-6 weeks
d) several months
a) epitheliasagtion of pocket wall
b) epithelial re-attachment commences at base of pocket, new gingival sulcus forms, gingival recession
c) formation of functionally-orientated collagen replacing granulation tissue, continued reduction in PPD
d) continued maturation of connective tissues, bone infill in infra bony defect
How much PPD reduction should you expect following RSI in initial PPD of 4-6mm?
1-1.5mm
How much PPD reduction should you expect following RSI in initial PPD of 7+mm?
2-3mm
In initial PPD 4-6mm, you expect 1-1.5mm reduction in PPD after RSI. The expected attachment gain is only 0-0.5mm. Why is this?
There is also a reduction in inflammation
Can periodontitis be stabilised with treatment?
Yes, when the patient engages well and shows optimal OH
How do you determine whether treatment has been successful?
Re-diagnose using flow chart
- stability, risk factors may change
If the patients periodontal treatment has been successful and is classed as currently stable or remission what should eb done next?
Supportive periodontal therapy
If a patient has undergone non-surgical periodontal therapy and has 5-6mm pockets without BoP then how would this be classified?
Stable or in remission
Why is supportive periodontal therapy undertaken?
Life-long treatment - must be monitored
If a patient has undergone periodontal treatment but is still classed as currently unstable at review what should you do next?
Further treatment is required
- further non surgical periodontal therapy (RSI)
- adjunct treatment
- refer to specialist
- surgery
When should periodontal patients be referred to specialist care?
No response to previous optimally completed treatment
Deteriorating periodontal condition after previous non-surgical management
Medical history affects clinical management - head and neck cancer, immunocompromised, bleeding disorder
When do you consider adjunctive treatemnt?
Unresponsive to non-surgical periodontal treatment
Rapidly progressing disease
Acute conditions
What are local adjuncts?
Antimicrobials given locally to enhance treatment outcome
Advantages of localised adjunct (antimicrobial therapy)
Localised = targeted treatment - penetrate base of pocket
Deliver therapeutic levels
Les systemic exposure
Less dependant on compliance
What are periochips? What type of perio treatment is this classed as?
Localised adjunct therapy
Adjunct to RSI, left in pocket and release antimicrobial
Chlorhexidine dissolved in chip, left in pocket, not removed
Problems with use of antimicrobials (systemic adjuncts) to manage peridontal disease
> 500 oral bacterial species indentified
small no. = perio
resistance
Current protocol for prescribing antibiotics for adults in rapidly progressing periodontal disease
Amoxicillin 500mg 3 times a day and metronidazeol 400mg 3x a day for 7 days adjucnt to RSI
What kind of acute conditions may signify adjunct antimicrobial therapy?
Acute periodontal abscess
Necrotising gingivitis
Necrotising periodontitis
Name another type of systemic adjunct therapy aside from antimicrobials
Host response modulation
What is host response modulation?
Modifying destructive aspects of inflammatory host response that develops in periodontal tissues as a result of subgingival plaque
Aims to reduce tissue destruction and stabilise periodontium by down regulating destructive or regulating protective components
Describe the mode of action of doxycycline (a host response modulator)
Inhibit matrix metalloproteinases
Prescription of doxycycline
20mg 2x a day fro 3 month periods
