Non-surgical periodontal treatment and adjunctive antibiotics Flashcards
(51 cards)
What is involved in step 1 of non-surgical periodontal therapy
- Education of periodontal disease process
- Risk factor analysis - plaque, diabetes, smoking cessation, stress
- Motivation and behaviour change - OHI
- Basic mechanical scaling/PMPR of clinical crown
What plaque and bleeding scores would indicate and “engaging patient”
- Plaque Scores < 20%
- Bleeding scores < 30%
- Or plaque/bleeding score improvement of 50%
What should we be removing with non-surgical mechanical therapy
- Plaque (bacteria)
- Calculus (mineralised plaque)
AY BAWS CAN I HABE DE NOTE PLZ
Its practically hard to achieve removal of only plaque and calculus and we often leave behind sub-gingival calculus, PMPR should be atraumatic to soft and hard tissues of the periodontium
What is the difference between step 1 and step 2 perio therapy
Step 1: Supra gingival PMPR
Step 2: Sub-gingival PMPR
What complaints/comments can patients often have after non-surgical therapy
- Gums have shrunk and teeth look longer
- Gaps between teeth are really big now
- Teeth are really sensitive
- Gums bleed less
- Teeth have firmed up
- Teeth are more loose
Consent is vital before treatment to avoid complaints
Describe some features of the healing response of non-surgical periodontal therapy
- Inflammation resolution and pocket depth reduction
- Recession and sensitivity
- Long junctional epithelium attachment may occur
- Repopulation with “healthier” less pathogenic microflora
- Formation of new bone, new CT, new cementum and new attachment can occur but is unpredictable
- Healing of JE takes around 1 week and for CT up to 4 weeks in which time probing should be avoided
- Repair as opposed to regeneration
When should you reassess after non-surgical therapy
3 months
What can be considered a successful non-surgical periodontal therapy
- Improvement plaque scores < 20%
- An increased resistance to periodontal probing
- Absence/reduction of bleeding (<10%)
Clinical End Points: - No BOP
- Pocket closure (PD<4mm.)
What teeth often show the best clinical improvement after initial treatment
Single rooted teeth tend to be better than molars
What improvements can you expect from non-surgical therapy
- Reduction in redness, inflammation and bleeding
- Deep sites respond with greater improvement than shallower pockets
- The greatest rate of healing happens between 3 and 6 weeks after therapy
What is the function of an antiseptic
weakens and slows growth of bacteria
What is the function of an anthelminthic
It works against parasites - worms
What are the 3 mechanisms of bacterial resistance
- Natural - bacteria naturally resistant to certain antibiotics
- Spontaneous - random genetic mutation
- Acquired - one species acquiring resistance from another
What questions should we ask before handing out antimicrobials
Are they absolutely necessary?
Can the infection be manage through mechanical drainage?
What are the side effects of antibiotics
- Stomach upset (nausea and vomiting)
- GI disorder (diarrhoea)
- Headache
- Metallic taste
- General unwellness (irritability/flu)
- Rashes
- Total adverse events
What modes of action can antibiotics work with
- Inhibition of cell wall synthesis
- Inhibitors of protein synthesis
- Inhibitors of nucleic acid synthesis
Name an antibiotic that works by inhibition of cell wall synthesis
- Amoxicillin
Name an antibiotic that works by the inhibition of protein synthesis
- Azithromycin
- Tetracycline/Doxycycline
Name an antibiotic that works by inhibition of nucleic acid synthesis
- Metronidazole
What rationale can there be for the use of adjunctive antimicrobials
- Primary aetiology of periodontitis is bacterial plaque
- Periodontal pathogens can invade connective tissues
- Oral niches of bacteria not reachable by non-surgical mechanical therapy
What are only periodontal disease cases where we should consider prescribing antimicrobials
Acute gingival problems: - necrotising gingivitis/ periodontitis
- Abscesses where local drainage is not possible and there is systemic involvement (fever, lymph nodes swollen etc.)
Certain “forms” of periodontitis:
- Severe, rapidly progressing forms of the disease often correlated with specific forms of bacteria
- Grade C patients
What single agent antibiotics can be prescribed for periodontitis
- Amoxicillin
- Metronidazole
- Doxycycline
- Azithromycin
What dose for Amoxicillin is normally prescribed for periodontitis
500mg TDS
