Systemic antimicrobials part 2 Flashcards
to refresh new 2017 classification of periodontitis and revisit aggressive periodontitis and management introduce case and different forms and features concept of staging and grading
How do we manage periodontitis
Along with RSD we do not give antibiotics
What is the strategy which we adopt for periodontitis
Mechanical removal in clinic but as well as removal at home
How do we stage periodontitis
Stages 1-4
What is included in stage 1 perio
Initial periodontitis
What is stage 2 perio
Moderate periodontitis
What is stage 3 perio
Severe periodontitis with possible additional tooth loss
What is stage 4 periodontitis
Severe periodontitis with possible loss of the dentition
How do we grade periodontitis
Grade A
Grade B
Grade C
What does grade A mean
Slow progression
What does grade B mean
Moderate progression
What does grade C mean
Rapid progression
How do we manage patients who would have formally been diagnosed with aggressive periodontitis
Continuing to manage cases in the same way as before but they are now classified as STAGE III OR IV
And grade C
How is aggressive periodontitis staged and graded now
Stage III and IV
and grade C
How does we manage aggressive periodontitis
Adjunctive systemic antibiotic at the corrective phase of therapy- for certain cases
Mechanical debridement first
What are the features of 1999 classification of chronic periodontitis
Most prevalent in adults
CAL of 1-2mm on incisors and molars in 39% of 15 year old Caucasians
78% indopakistani
Slow to moderate progression and exacerbation
Slow to moderate progression
Modifying factors include
Treat in 3 phases
Where do we measure CAL
From the CEJ
What equals the CAL
The gingival recession and the PPD
What’s the the secondary features of aggressive periodontitis
Amounts of microbial deposits inconsistent with severity
Elevated proportions Aggregatibacter actinomycetemcomitans (A. a)
and in some populations, P. gingivalis may be elevated
Phagocyte abnormalities
Hyper-responsive macrophage phenotype, including elevated levels of PGE2 and IL-1Beta
Progression of attachment loss and bone loss may be self arresting
what are the features of localised aggressive periodontitis according to 1999 classification
Circumpubertal onset
Robust serum antibody response to infecting agent (Aggregatibacter actinomycetemcomitans, A.a)
Localised first molar/incisor presentation
interproximal attachment loss CAL on at least two permanent teeth, one of which is a first molar, and involving no more than two teeth other than first molars/incisors
what notes do we need to consider for localised aggressive periodontitis
history and exam-BPE
do periodontitis indicies
take radiographs if necessary
early detection is important
how do we carry out BPE for under 18
UR6,UR1,UL6
LR6,LL1,LL6
what codes can we use for 7-11 ages
bpe codes of 0,1,2
when can we use all bpe codes
12+ when permanent teeth erupted
what does a bpe of 0 mean
healthy
what does bpe of 1 mean
BoP
what does bpe of 2 mean
calculus or PRF
WHAT DOES A BPE of 3 mean
shallow pocket 4mm or 5mm
what does a BPE of 4 mean
deep pocket 6mm or more
what do we also see in localised aggressive periodontitis clinical and radiographic features
Localised first molar/incisor presentation- first teeth to come into the mouth
Clinical attachment loss (CAL)
Deep pockets in association with CAL
Gingival inflammation may/not be evident
Alveolar bone loss
angular defects incisors
arc shaped bone loss first molars
often symmetrical distribution Right/Left
what is the features of generalised aggressive periodontitis
Usually affects age <30 yrs, may be older
Poor serum antibody response to infecting agents (notably Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis)
Pronounced episodic nature of destruction of attachment and alveolar bone
Generalised interproximal attachment loss CAL affecting at least three teeth other than first molars and incisors
what are the difference in chronic and aggressive periodontitis
Initial cause related therapy (GDP can do both)
follow same basic principles for both types
Corrective therapy* (Consider Specialist for Aggr P)
consider adjunctive systemic antibiotics in conjunction with further non-surgical therapy or periodontal surgery
Supportive therapy* (GDP can do for both)
more frequent recalls for Aggressive periodontitis
what antibiotics do we currently use for adjunctive systemic antibiotics
metronidazole 400mg + amoxycillin 500mg, t.i.d for 7 d is supported
what do we prescribe if the patient is allergic to metronidazole or amoxycillin
Azithromycin 500 mg o.d, for 3 days
what is the prognosis of aggressive periodontitis
Improves with
early,correct diagnosis;appropriate therapy
frequent recall/monitoring after therapy
Elimination of associated microorganisms is requirement of success
Extractions may be indicated
Burn out MAY occur without therapy
what is periodontitis
chronic inflammatory disease associated with dysbiotic plaque biofilms and characterised by progressive destruction of tooth supporting apparatus.
what are the primary features of periodontitis
loss of periodontal tissue support manifest through clinical attachment loss (CAL); radiographically assessed bone loss; presence of periodontal pocketing; gingival
what should a periodontitis diagnosis contain
DID
definition: of periodontitis based on CAL of two adjacent teeth
identification: of the form of periodontitis eg periodontitis, periodontitis as a manifestation of a systemic disease,netrotizing
description: of the presentation and aggressiveness of the disease by STAGE AND GRADE
which bacteria cause necrotising ulcerative gingivitis
mixed bacterials infections caused by anaerobes- fusiform spirochaetes complex
where is fusiform spirochaetes form
large numbers found in slough and necrotic tissue at the surface of the ulcer
how do we manage necrotising periodontal disease
1.Removal of supra and sub gingival deposits – ultrasonic scaling. 2. Systemic antibiotic – Metronidazole tablets 200mg, three times daily for 3 days 3. Chlorhexidine mouth rinse
what do we need to consider in the management of periodontal abscess
vitality?
can we achieve drainage?
are there systemic effects?
occlusal forces can be reduced?
what do we need to consider when we have patients with poorly controlled diabetes
cytokine release by chronic stimulation of the LPS sand periodontopathogenic organisms may amplify the magnitude of the advanced glycation end product
what should we consider when looking at patients with infective endocarditis
antibiotic prophylaxis IS NO LONGER GIVEN ACCORDING TO NICE GUIDELINES
what is periostat
sub antimicrobial dose which is given after certain dental diseases
what dosage of periostat do we give
low dose doxycycline 20mg 2x daily
how long do we give periostat for
extended use, at least 3 months as adjunct to Scaling & Root Surface Debridement
is periostat recommended in the UK
NO
what are the non antibacterial effects of tetracyclines
Concentrates in GCF Binds to root surface Slow release Fibroblast stimulation Osseous induction Anticollagenase (inhibits matrix metalloproteinases)
