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CSA > Systemic antimicrobials part 2 > Flashcards

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

1
Q

How do we manage periodontitis

A

Along with RSD we do not give antibiotics

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2
Q

What is the strategy which we adopt for periodontitis

A

Mechanical removal in clinic but as well as removal at home

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3
Q

How do we stage periodontitis

A

Stages 1-4

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4
Q

What is included in stage 1 perio

A

Initial periodontitis

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5
Q

What is stage 2 perio

A

Moderate periodontitis

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6
Q

What is stage 3 perio

A

Severe periodontitis with possible additional tooth loss

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7
Q

What is stage 4 periodontitis

A

Severe periodontitis with possible loss of the dentition

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8
Q

How do we grade periodontitis

A

Grade A
Grade B
Grade C

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9
Q

What does grade A mean

A

Slow progression

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10
Q

What does grade B mean

A

Moderate progression

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11
Q

What does grade C mean

A

Rapid progression

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12
Q

How do we manage patients who would have formally been diagnosed with aggressive periodontitis

A

Continuing to manage cases in the same way as before but they are now classified as STAGE III OR IV
And grade C

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13
Q

How is aggressive periodontitis staged and graded now

A

Stage III and IV

and grade C

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14
Q

How does we manage aggressive periodontitis

A

Adjunctive systemic antibiotic at the corrective phase of therapy- for certain cases
Mechanical debridement first

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15
Q

What are the features of 1999 classification of chronic periodontitis

A

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

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16
Q

Where do we measure CAL

A

From the CEJ

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17
Q

What equals the CAL

A

The gingival recession and the PPD

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18
Q

What’s the the secondary features of aggressive periodontitis

A

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

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19
Q

what are the features of localised aggressive periodontitis according to 1999 classification

A

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

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20
Q

what notes do we need to consider for localised aggressive periodontitis

A

history and exam-BPE
do periodontitis indicies
take radiographs if necessary
early detection is important

21
Q

how do we carry out BPE for under 18

A

UR6,UR1,UL6

LR6,LL1,LL6

22
Q

what codes can we use for 7-11 ages

A

bpe codes of 0,1,2

23
Q

when can we use all bpe codes

A

12+ when permanent teeth erupted

24
Q

what does a bpe of 0 mean

A

healthy

25
Q

what does bpe of 1 mean

A

BoP

26
Q

what does bpe of 2 mean

A

calculus or PRF

27
Q

WHAT DOES A BPE of 3 mean

A

shallow pocket 4mm or 5mm

28
Q

what does a BPE of 4 mean

A

deep pocket 6mm or more

29
Q

what do we also see in localised aggressive periodontitis clinical and radiographic features

A

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

30
Q

what is the features of generalised aggressive periodontitis

A

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

31
Q

what are the difference in chronic and aggressive periodontitis

A

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

32
Q

what antibiotics do we currently use for adjunctive systemic antibiotics

A

metronidazole 400mg + amoxycillin 500mg, t.i.d for 7 d is supported

33
Q

what do we prescribe if the patient is allergic to metronidazole or amoxycillin

A

Azithromycin 500 mg o.d, for 3 days

34
Q

what is the prognosis of aggressive periodontitis

A

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

35
Q

what is periodontitis

A

chronic inflammatory disease associated with dysbiotic plaque biofilms and characterised by progressive destruction of tooth supporting apparatus.

36
Q

what are the primary features of periodontitis

A

loss of periodontal tissue support manifest through clinical attachment loss (CAL); radiographically assessed bone loss; presence of periodontal pocketing; gingival

37
Q

what should a periodontitis diagnosis contain

DID

A

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

38
Q

which bacteria cause necrotising ulcerative gingivitis

A

mixed bacterials infections caused by anaerobes- fusiform spirochaetes complex

39
Q

where is fusiform spirochaetes form

A

large numbers found in slough and necrotic tissue at the surface of the ulcer

40
Q

how do we manage necrotising periodontal disease

A 
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
41
Q

what do we need to consider in the management of periodontal abscess

A

vitality?
can we achieve drainage?
are there systemic effects?
occlusal forces can be reduced?

42
Q

what do we need to consider when we have patients with poorly controlled diabetes

A

cytokine release by chronic stimulation of the LPS sand periodontopathogenic organisms may amplify the magnitude of the advanced glycation end product

43
Q

what should we consider when looking at patients with infective endocarditis

A

antibiotic prophylaxis IS NO LONGER GIVEN ACCORDING TO NICE GUIDELINES

44
Q

what is periostat

A

sub antimicrobial dose which is given after certain dental diseases

45
Q

what dosage of periostat do we give

A

low dose doxycycline 20mg 2x daily

46
Q

how long do we give periostat for

A

extended use, at least 3 months as adjunct to Scaling & Root Surface Debridement

47
Q

is periostat recommended in the UK

A

NO

48
Q

what are the non antibacterial effects of tetracyclines

A 
Concentrates in GCF
Binds to root surface 
Slow release
Fibroblast stimulation
Osseous induction
Anticollagenase  (inhibits matrix metalloproteinases)

CSA (51 decks)

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