Systemic Adjuncts To Perio Treatment - Use Of Adjuncts In Management Of Perio Overview

Question 1

What are periodontal diseases?

Answer 1

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

Question 2

In Healthy sites, what type of immune response is found

Answer 2

Question 3

In unhealthy sites what type of immune response is found

Answer 3

Also inflammation and osteoclasts

Question 4

Give 3 Prerequisites for Periodontal Disease Initiation and Progression

Answer 4

Question 5

What pathogens are present in periodontal diseases

Microbiology

Answer 5

P gingivalis
T Forsythia
T denticola
AA - Aggregatibacter actinomycetemcomitans

First three are red complex in socransky complex

Question 6

What are the stages from symbiotic microbiota to periodontitis

Answer 6

Bacteria that can evade host immune response -eg p gingivalis - uncouple inflammation from phagocytosis and promote acculturation of biofilm by disarming phagocytic activity -we are left unprotected

Question 7

In periodontitis 4 features related to microbiology

Answer 7

Periodontal pocket / GCF
Subgingical dysbiotic biofilm
Severe inflammation
Resorbed bone

DIFFERENT to three things for perio different to gingivitis

Question 8

Treatment planning
Treatment of periodontal disease can be split into three phases :

Answer 8

Question 9

3 phases of treatment planning perio

Answer 9

Question 10

With use of BSP guidelines how is diagnosis statement read for periodontitis

Answer 10

Question 11

BSP guidelines

Answer 11

Part from prev fc

Question 12

What is ideal treatment outcome for perio?

Answer 12

BOP less than 10%
PPD less than or equal to 4mm
No BOP at 4mm sites

Question 13

Which types of patients may need adjuncts from BSP criteria

Answer 13

Grade C patients - have rapid rate of progression

Calculate by percentage bone loss divided by patient age - should be more than 1 for grade c

Question 14

What are periodontal adjunctive treatments?
What are the categories of adjunctive treatment ?

Answer 14

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

Can be either:
1. Systemic adjuncts
- these are systemic medications

2. Locally delivered adjuncts
   - delivered directly into the site of periodontal disease activity, via the periodontal pocket.

Question 15

Indications for adjunctive treatment (3)

(Who may need adjunctive treatment?)

Answer 15

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

Question 16

Virulent periodontal pathogens
What are two virulent periodontal pathogens ?
What are two features of them?

Answer 16

P Gingivalis
AA - Aggregatibacter actinomycetemcomitans

2 features:
1) they can invade periodontal tissues and dentinal tubules
2) infectogenomics - people with specific genetic composition more likely eg JP2 clone of AA is associated with aggressive perio particularly in those of North African and African descent

Question 17

Give four features of a susceptible host

Answer 17

1. Hyperinflammatory phenotype
   2.Low plaque index
2. no significant local or systemic factors
3. macrophages produce higher number of proinflammatory cytokines - eg TNF-a, IL-1,IL-6 and IL-8 - which leads to increased inflammation - leads to further growth of perio pathogens

But still have severe perio

Question 18

Example of periodontal adjuncts

Give 2 ways periodontal adjuncts are wnforced

Answer 18