Use of Adjuncts - Local and Adjuncts

Question 1

What is the definition of an adjunct?

Answer 1

Medications used to control bacteria present in the sub gingival areas or inside the periodontal tissue

Question 2

What are the 3 main pre-requisites to periodontal disease?

Answer 2

1) Virulent periodontal pathogens
2) Local environment
3) Host Susceptibility

Question 3

What are the 3 phases of treatment therapies?

Answer 3

1) Cause-Related Therapy = removing the causes, dental plaque causing the PPD is removed, removal of systemic factors

2) Corrective Therapy = correcting any problems, PPD leads to consequence predisposing to further tissue damage

3) Supportive Periodontal Therapy = maintenance phase, monitoring their OH and plaque formation

Question 4

What are the ideal treatment outcomes?

Answer 4

1) Make the disease stable
2) No probing depths greater than 4mm
3) Bleeding on probing < 10%
4) No BOP at 4mm sites

Question 5

What are the indications for use for adjuncts?

Answer 5

• Acute periodontal conditions such as PDL abscess or necrotising periodontal disease
• Patients with virulent periodontal pathogens
• Susceptible hosts

Question 6

Why do we need adjuncts to target certain virulent periodontal pathogens?

Answer 6

Root surface debridement doesnt help to remove these as they are within the periodontal tissues.

Question 7

What are the two main periodontal pathogens in periodontitis?

Answer 7

A.A
P.Gingivalis

Question 8

Why is periodontal disease not just treated by antimicrobials and conventional treatment is always needed?

Answer 8

• PDD is a chronic infection so one dose of antimicrobials
• PDD is caused by bacteria which is usually in the mouth anyway
• PDD is caused by dysbiotic biofilm meaning it is caused by many different bacteria

Question 9

What happens if RSD doesn’t induce any clinical improvements?

Answer 9

RSD cannnot induce environmental changes to maintain clinical improvements. The composition of the sub-gingival microbiota enough for susceptible individuals to become stable.
Adjunctive treatment options need to considered then including systemic antibiotics, probiotics, lasers and host modulators.

Question 10

Systemic Adjuncts:
What are the top 3 systemic adjuncts?

Answer 10

1) Amoxicillin + Metronidazole
- Amoxicillin affects mainly gram + and metronidazole affects anaerobic gram - bacteria.

2) Metrondiazole only
- 400mg 3x a day for 7 days

3) Azithromycin only - 3 days, 1 tablet of 500mg

Question 11

What are the 3 main characteristics that locally applied adjuncts need?

Answer 11

Assure compliance - as the antimicrobials are applied by dental professionals.
Minimal systemic exposure so minimal side effects occur
Drugs levels far exceed the minimum inhibitory concentration for periodontal pathogens.

Question 12

What is the main indication for locally applied adjuncts?

Answer 12

When conventional treatment is not enough and there are still inflamed pockets that are isolated in patients with good OH

Question 13

What are the main options of microbials which we can use?

Answer 13

• Metrondiazole (antibiotic)
• Chlorhexidine (anti septic)
• Tetracycline