System Adjuncts To Periodontology Treatment

Question 1

Define what periodontal diseases are.

Answer 1

Bacterially-induced, immune mediated inflammatory diseases of the tissues supporting the teeth.

Question 2

Define what healthy sites of periodontium present as.

Answer 2

1. Well defined
2. Precisely orchestrated
3. Effective immune response.

Question 3

Define what diseased sites of periodontium present as.

Answer 3

1. Exacerbated
2. Uncontrolled
3. Detrimental immune response

Question 4

Give 3 prerequisites for periodontal disease initiation and progression.

Answer 4

1. The virulent periodontal pathogens (adhesins, co-aggregation, invasion, factors that cause tissue damage)
2. The local environment
3. Host susceptibility (gene polymorphism, PMN defects, smoking, diabetes, immunosuppression).

Question 5

Which 2 pathogens in terms of the microbiology of periodontal diseases are always prevalent?

Answer 5

1. P. ginigvalis, T. forsythia, T. denticola - periodontal pathogens that produce virulence factors.
2. Aggregatibacterium actinomycetemcomitans b. - seen in severe perio.

Question 6

In periodontal health, gingivitis and periodontitis, what 3 features are present in microbiology?

Answer 6

health:
1. Symbiotic biofilm.
2. Host-microbe homeostasis.
3. Intact bone

gingivitis:
1. Intact bone.
2. Modest inflammation

periodontitis:
1. Periodontal pocket / GCF.
2. Subgingival dysbiotic biofilm.
3. Severe inflammation
4. Resorbed bone

Question 7

When treatment planning a periodontally diseased patients what are the 3 stages?

Answer 7

1. Cause-related therapy - identifying risk factors, eliminating infection by non-surgical methods.
2. Corrective therapy - pockets form, can be corrected by RSD - surgical debridement.
3. Supportive periodontal therapy - maintenance, OHI, regular attendance.

Question 8

With use of the BSP guidelines, how is a diagnosis statement read for periodontitis?

Answer 8

1. Extent
2. Periodontitis
3. Stage
4. Grade
5. Stability
6. Risk factors

Question 9

What is meant by periodontal adjunctive treatments?

Answer 9

These are therapeutic interventions that are used in addition to conventional periodontal therapy.

Can be divided into:

1. Systemic adjuncts

These are systemic medications.

2. Locally delivered adjuncts

These are delivered directly into the site of periodontal disease activity via the periodontal pocket.

Question 10

Give 3 indications for the need of periodontal adjunctive treatments.

Answer 10

1. Acute periodontal conditions (necrotising periodontal diseases, abscesses)
2. Virulent periodontal pathogens
3. Susceptible hosts

Question 11

Give 2 examples of virulent periodontal pathogens.

Answer 11

1. P. gingivalis
2. Aggregatibacter actinomycetemcomitans

Question 12

Give 2 features of virulent periodontal pathogens.

Answer 12

1. Invasion of periodontal tissues and dentinal tubules - this means they can hide from conventional periodontal treatment.
2. Infectogenomics - the tropism of bacteria to susceptible hosts - e.g. the highly leukotoxic JP2 clone of A.a: evolutionary aspects, epidemiology and etiological role in aggressive periodontitis.

Question 13

Give 4 features of a susceptible host i.e. a host susceptible to virulent periodontal pathogens.

Answer 13

1. Hyperinflammatory phenotype
2. Low plaque index
3. No significant local or systemic factors.
4. Increase levels of proinflammatory cytokines, causing an increase in inflammation, and an increase in the growth of pathogens.

Question 14

Give 2 ways periodontal adjuncts are enforced.

Answer 14

1. Antimicrobials
2. Host modulation via anti-inflammtory, tetracyline, metmorfin etc.