Systemic antimicrobials part 2

Question 1

How do we manage periodontitis

Answer 1

Along with RSD we do not give antibiotics

Question 2

What is the strategy which we adopt for periodontitis

Answer 2

Mechanical removal in clinic but as well as removal at home

Question 3

How do we stage periodontitis

Answer 3

Stages 1-4

Question 4

What is included in stage 1 perio

Answer 4

Initial periodontitis

Question 5

What is stage 2 perio

Answer 5

Moderate periodontitis

Question 6

What is stage 3 perio

Answer 6

Severe periodontitis with possible additional tooth loss

Question 7

What is stage 4 periodontitis

Answer 7

Severe periodontitis with possible loss of the dentition

Question 8

How do we grade periodontitis

Answer 8

Grade A
Grade B
Grade C

Question 9

What does grade A mean

Answer 9

Slow progression

Question 10

What does grade B mean

Answer 10

Moderate progression

Question 11

What does grade C mean

Answer 11

Rapid progression

Question 12

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

Answer 12

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

Question 13

How is aggressive periodontitis staged and graded now

Answer 13

Stage III and IV

and grade C

Question 14

How does we manage aggressive periodontitis

Answer 14

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

Question 15

What are the features of 1999 classification of chronic periodontitis

Answer 15

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

Question 16

Where do we measure CAL

Answer 16

From the CEJ

Question 17

What equals the CAL

Answer 17

The gingival recession and the PPD

Question 18

What’s the the secondary features of aggressive periodontitis

Answer 18

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

Question 19

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

Answer 19

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

Question 20

what notes do we need to consider for localised aggressive periodontitis

Answer 20

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

Question 21

how do we carry out BPE for under 18

Answer 21

UR6,UR1,UL6

LR6,LL1,LL6

Question 22

what codes can we use for 7-11 ages

Answer 22

bpe codes of 0,1,2

Question 23

when can we use all bpe codes

Answer 23

12+ when permanent teeth erupted

Question 24

what does a bpe of 0 mean

Answer 24

healthy

Question 25

what does bpe of 1 mean

Answer 25

BoP

Question 26

what does bpe of 2 mean

Answer 26

calculus or PRF

Question 27

WHAT DOES A BPE of 3 mean

Answer 27

shallow pocket 4mm or 5mm

Question 28

what does a BPE of 4 mean

Answer 28

deep pocket 6mm or more

Question 29

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

Answer 29

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

Question 30

what is the features of generalised aggressive periodontitis

Answer 30

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

Question 31

what are the difference in chronic and aggressive periodontitis

Answer 31

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

Question 32

what antibiotics do we currently use for adjunctive systemic antibiotics

Answer 32

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

Question 33

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

Answer 33

Azithromycin 500 mg o.d, for 3 days

Question 34

what is the prognosis of aggressive periodontitis

Answer 34

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

Question 35

what is periodontitis

Answer 35

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

Question 36

what are the primary features of periodontitis

Answer 36

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

Question 37

what should a periodontitis diagnosis contain | DID

Answer 37

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

Question 38

which bacteria cause necrotising ulcerative gingivitis

Answer 38

mixed bacterials infections caused by anaerobes- fusiform spirochaetes complex

Question 39

where is fusiform spirochaetes form

Answer 39

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

Question 40

how do we manage necrotising periodontal disease

Answer 40

``` 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 ```

Question 41

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

Answer 41

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

Question 42

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

Answer 42

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

Question 43

what should we consider when looking at patients with infective endocarditis

Answer 43

antibiotic prophylaxis IS NO LONGER GIVEN ACCORDING TO NICE GUIDELINES

Question 44

what is periostat

Answer 44

sub antimicrobial dose which is given after certain dental diseases

Question 45

what dosage of periostat do we give

Answer 45

low dose doxycycline 20mg 2x daily

Question 46

how long do we give periostat for

Answer 46

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

Question 47

is periostat recommended in the UK

Answer 47

NO

Question 48

what are the non antibacterial effects of tetracyclines

Answer 48

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