severe and immune mediated perio Flashcards
What causes periodontitis?
Bacteria and host response
Host provides most variation seen
Disease shift to dysbiosis
Bacteria is a risk factor that pt can control
What is the host response in perio?
Stess (short/long term, poor coping strategy)
Diet
Exercise
Illness
Sleep
Smoking
What are common features of the host response?
Pt otherwise healthy
Rapid attachment loss and bone destruction
Familial aggregation
What are secondary features of the host response?
Microbial deposits not consistent w destruction
A. actinomycetemcomitans and P. gingivalis
Phagocyte abnormalities
Hyper responsive inflam/immune response
Attachment and bone loss self arresting
What are polymorphonuclear defects?
Associated w rapidly progressing perio
Chemotaxis, phagocytosis, bacterial killing
What are statistics of severe perio?
1/10 adults have stage III/IV
8/10 have stage I/II
45% adults have >4mm
What is the importance of diagnosis?
Medico legal
Early management priority
Tx modality
Early referral esp young pts
Should you use hand or sonic?
No difference in effectiveness
But sonic save 20-50% time
How might you manage subgingival PMPR?
Quadrants
Single stage full mouth
Same day full mouth
What are the aims of surgery?
Pocket reduction and elimination
Regeneration
What is required for a specialist referral to be accepted?
BPE score
Summary of tx provided + response
Known risk factors + details
Longitudinal monitoring evidence (w deteriorating pts)
OHI given (+ interdental)
Supra and sub PMPR
GDP still needs to see pt routinely and need to monitor and maintain for future
Who gets considered for specialist tx?
BPE code 3/4
Severe perio post tx
Rapid rate progression
Med history affecting status
Where surgery may be indicated
Perio-endo lesion
What are levels of care?
Level 1- level of competence as a minimum standard for GDPs in primary care
Level 2- clinicians w enhanced skills and experience
Level 3- specialist clinician on GDC register or by a consultant
