Systemic Antimicrobials in Periodontal Therapy 2 (NAIK) Flashcards
What has periodontitis now been classified into in the new 2017 classification?
- Necrotising periodontal disease
- Periodontitis
- Periodontitis as a manifestation of systemic disease
What is necrotising ulcerative gingivitis caused by?
spirochaetes and fusiform bacteria (fusospirochaetal complex)
Do we have an indication to use antibiotics when treating necrotising ulcerative gingivitis?
YES
What do we do about diagnosing patients who would formerly have been diagnosed with aggressive
We expect that they will be classified as stage III or IV and grade C in the new system
What are some of the features of chronic periodontitis?
- Most prevalent in adults
- Clinical attachment loss of 1-2mm on incisors/molars
- Slow to moderate progression+ exacerbations
- Plaque aetiology
- Destruction is consistent with local factors
Which ethnic groups have a higher prevalence of chronic periodontitis?
Indo Pakistanis
Do we prescribe systemic antibiotics to a patient suffering from chronic periodontitis?
No unless they are suffering from systemic spread of the disease
What is clinical attachment loss?
it is the distance from the CEJ to the base of the pocket/sulcus
Which land mark is hard to find in the mouth?
Cemento enamel junction
How do we calculate the clinical attachment loss if the patient has recession?
You need to add the probing depth to the amount of recession
What problems are associated with measuring CAL in patients with gingival overgrowth?
It is hard to determine where the CEJ is
How do we calculate the clinical attachment loss if the patient has gingival overgrowth?
You need to do probing depth - the amount of gingival overgrowth
How do we over come the difficulty of locating the CEJ on patients with gingival overgrowth?
We recording probing pocket depth and then look at the radiographic bone loss
What are the common features of aggressive periodontitis?
- The patient is healthy except for having periodontitis
- Theres rapid attachment loss and bone destruction
- There’s familial aggregation
List the secondary features of aggressive periodontitis
- Microbial deposits amount that are inconsistent with the severity of periodontal tissue destruction
- Theres elevated promotions of Aggregatibacter actinomycetemcomitans (and in some populations p, gingivlais may also be elevated)
- Phagocyte abnormalities
- Hyper responsive macrophage phenotype including elevated levels of PGE and IL-1Beta
- Progression of attachment loss and bone loss may be self arresting
If, when you are a GDP, you come across a patient with aggressive periodontitis what would you do?
Refer them to a specialist
In the old specification n what is meant by localised aggressive periodontitis?
It describes rapid destruction of the periodontium at a young age
Give some features specific to localised aggressive periodontitis
- Circumpubertal (teenagers) onset
- Robust serum antibody response to infecting agent (aggregatibacter actinomycetemocomitans A.a)
- Localised first molar/incisor presentation
- Interporximal attachment loss CAL on at least. 2 permanent teeth (one of which is a the 1st molar)
How do we diagnose localised aggressive periodontitis?
- Do a history
- take BPEs which should flag warning
- Do perio indices with periodontal probe
3, Take radiographs where justified
How do we take BPEs of patients under 18
We do a simplified BPE
We use index teeth
List the index teeth we can use when taking a simplified BPE of a patent under 18
UR6 UR1 UL6 LR6 LL1 LL6
Which bPE codes do we use for patients ages 7-11 yrs
BPE codes 0,1,2
What are the concerns based around using index teeth?
What if a non index tooth has destruction it wont be recorded
What are the clinical features of localised aggressive periodontitis?
- Localised first molar/ incisor presentation
- Clinical attachment loss
- Deep pockets in association with CAL
- Alveolar bone loss
- gingival inflammation may or many not be evident
Why is destruction localised to the first molar/incisors in localised aggressive periodontitis?
As thy are the first teeth to erupt in the mouth
Where do you measure clinical attachment loss from?
Cemento enamel junction to the base of the pocket/ sulcus
What Ould see on a radiograph of a patient with localised aggressive periodontitis?
- Angular defects incisor
- Arc shaped bone loss first molar
- Often symmetrical distribution (mirror image present)
Is the amount of plaque always consistent with the amount of periodontal destruction in a patient with localised periodontitis?
NO
How do we describe generalised aggressive periodontitis using the new classification?
Stage 3 or 4
Grade C
Give some features specific to generalised aggressive periodontitis
- Usually affects patients under 30 yrs but may be older
- Poor serum antibody repose to infecting agents (notably Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis)
- Pronounced episodic nature of destruction of attachment and alveolar bone
- Generalised interporximal attachment loss and CAL affecting at least three teeth other than the first molars and incisors
What are the key principles fro managing aggressive periodontitis?
- Early diagnosis
- Establish a CORRECT diagnosis
- Check if theres ant underlying modifying or systemic factor that needs managing
- Suppres the infected organisms by giving OHI and mechanical scaling
Name the 3 stages of therapy for aggressive periodontitis
- initial cause related (can be done at the GDP)
- corrective
- supportive
What should we consider using when carrying out corrective therapy for aggressive periodontitis?
Consider using systemic antibiotics
What is the aim of corrective therapy when treating aggressive periodontitis?
To disrupt the biofilm on the root surface in conjunction with adjunctive systemic antibiotics
How can we disrupt the biofilm on the root surface when carrying our corrective therapy for aggressive periodontitis?
Root surface Debridement
Describe a typical corrective therapy plan for treating aggressive periodontitis
2 visits fro half mouth RSD one week apart
Debate about prescribing antibiotics in first appointment
IF needed prescribe antibiotics at the end of the 2 visit
Which systemic antibiotics to we prescribe to patients in the corrective phase when treating aggressive periodontitis?
metronidazole 400mg thrice daily for 7 days + amoxycillin 500mg, three times a day for 7 days
What would prescribe to a patient that is allergic to amoxycillin when treating aggressive periodontitis?
Azithromycin 500 mg once a day for 3 days
What is the mode of action of amoxycillin?
Disrupts the cell wall
What is the mode of action of metronidazole ?
Disrupts nucleic acid synthesis
What is the mode of action of Azithromycin?
Disrupts ribosomes
What does initial therapy fro aggressive periodontitis include?
- Extracting teeth with a hopeless prognosis
- Fit immediate dentures where you have extracted
- OHI
What is prognosis?
The likely outcome of the therapy you have decided
When does the prognosis of aggressive periodontitis improve?
With early, correct diagnose sand appropriate therapy
With frequent recall and monitoring after therapy
What are the differences between aggressive and chronic periodontitis?
- pattern of destruction
- Age of onset
- Rate of progression
- Relative amount of plaque and calculus
- Host facts
- Microbiology
What is periodontitis?
It is a chronic inflammatory disease associated with the dysbiotic plaque biofilm and characterised by progressive destruction of tooth supporting apparatus
What are the primary features of periodontitis?
- Loss of periodontal tissue supra manifest through clinical attachment loss
- radiographically assessed bone loss
- Presence of periodontal pocketing
- Gingival bleeding
What are some other reasons a patient may have CAL of >3mm ?
- Gingival recession of traumatic origin
- Dental caries extending from the cervical area of the tooth
- The presence of CAL on the distal aspect of a second molar
- AN endodontic lesion draining though the marginal periodontium
- the occurrence of a vertical tooth fracture
According to the new 2017 classification what is the definition of a periodontist cased?
It is based on detectable CAL loss at two non adjacent teeth
What is a PCP10 probe used for?
to measure CAL and probing depth
