Treatment And Management Of Gingival And Perio Diseases Flashcards
What is the definition of periodontal diseases
A group of diseases affecting the periodontal tissues, representing an immune reaction (innate and adaptive) to adjacent microbial plaque
What does periodontitis start as
Periodontitis
Why are antibiotics not commonly given out for periodontal disease
Antimicrobial resistance
Periodontal health is…
The outcome of the balance between bacteria of the dental plaque and the host immune system
The periodontal disease develops from…
The interaction of dental biofilm with the immune system of the host which brings implications for the treatment
What are the treatment strategies for periodontal disease
- mechanical disruption
- systemic antibiotics or local Antimicrobials
- host modulation therapy
What is the main goal of periodontal treatment
- plaque control
- removal of plaque retention factors
What is a score of 0 for periodontal disease
Pockets <3.5mm
No calculus/overhangs, no bleeding on probing (black band entirely visible)
What is a score of 1 for periodontal disease
Pockets <3.5mm
No calculus/overhangs, bleeding on probing (black band visible)
What is a score of 2 of Peridontal disease
Pockets <3.5mm
Supra or subgingival calculus/overhangs (black band entirely visible)
Describe a score of 3 for periodontal disease
Probing depth 3.5-5.5mm
Black band partially visible, indicating pocket of 4-5mm
What is a score of 4 for periodontal disease
Probing depth >5.5mm
Black band disappears indicating a pocket of 6mm or more
Describe a score of * in periodontal disease
Furcation involvement
What is the difference between supragingival biofilm and sublingual biofilm
Supragingival plaque on tooth’s surface, subgingival plaque in the pocket below the gingival
What are the two terms used that manage plaque in periodontal disease
Supra gingival PMPR
Sub gingival PMPR
What does PMPR stand for
Professional mechanical plaque removal PMPR
Describe step 1 of the treatment plan for periodontal disease
Control of local (calculus, overhangs ect) systemic (diabetes, smoking)
Risk factors
Supragingival professional mechanical plaque removal (PMPR)
Describe the initial phase in periodontal treatment
- examination and proper diagnosis
- oral hygiene instruction
- elimination of the local retentive factors mostly overhanging fillings and calculus
- PMPR
Additionally
- extracting teeth with bad prognosis
- endodontic treatment (endo-perio lesions)
- initial occlusal correction (early contacts and traumatic occlusion)
Give some examples of what oral hygiene instruction you would give for periodontal disease
- tooth brushing technique, modified bass technique
- flossing
- interdental brushes
What can be used for supra-gingival PMPR
Sonic scalers
Ultrasonic scalers - piezoelectric and magnetostrictive
What is the working edge of the scaler
Lateral surfaces 2-3 last mm of the tip
What angle should the scaler tip be placed at
0-15 degrees angle between the working edge and the tooth’s surface, slight pressure applied
Describe step 2 of non surgical periodontal therapy
- subgingival PMPR
- teeth splinting
- further correcting of traumatic occlusion
- dentine hypersensitivity prevention
- reinforcement of OH
- controlling modifiable risk factors
What are some advantages of local antimicrobials
Reduced systemic dose
High local concentration
Superinfections such as clostridium difficile, unlikely
Drug interactions unlikely
Site specific
Patient compliance not an issue as applied by healthcare provider
Can utilise agents which can be utilised systemically eg chlorexidine
What are some disadvantages of local antimicrobials
- expensive
- still require RSD or biofilm disruption
- limited indications
Name some local Antimicrobial antibiotics
1) arestin - 1mg minoyccline HCL microspheres
2) atridox - doxycycline hyclate 10%
3) elyzol - 25% metronidazole
What is periochip
A small chip containing the Antimicrobial agent chlorohexidine digluconate, it eliminates the disease causing bacteria and is used in combination with mechanical removal of plaque in the treatment of chronic periodontal disease in adults
What happens if there is improvement after 8 weeks of step 2
PPD < mm without BoP
Maintenance phase
What happens if there is improvement but still some residual pockets after 8 weeks of step 2 completion
A) targeted PMPR
B) surgery step 3
What happens if there is no improvement after 8 weeks of step 2 completion
Repeat the treatment from the beginning
What is step 3 of periodontal treatment
Step 1 and 2 plus
Periodontal surgery - access flap, resecrective, regenerative
Only in cases with suitable patient tooth and defect factors
In certain cases - repeated subgingival instrumentation
Describe step 4 of periodontal treatment and management
Supportive periodontal therapy (SPT)
Risk adapted intervals 3-12 months
Continuous monitoring of local and systemic risk factors
PMPR
Give some examples of host modulation therapy
1) anti-cytokine and biological therapies
2) lipid mediators of resolution of inflammation
3) small molecules compounds
4) biphosphonates
