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ICS1 > ICS Autumn Midterm: Perio pharm & tx planning > Flashcards

ICS Autumn Midterm: Perio pharm & tx planning Flashcards

1
Q

what are the 3 types of periodontal pharmacotherapeis

A

topical, local (irrigation, sustained release) and systemic

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2
Q

11 antimicrobials

A 
phenolic compounds
peroxide
enzymes
fluoride
quaternary ammonium compounds (CPC)
chlorine dioxide
sodium hypochlorite
sanguinarine
alexidine
octinidine
chlorhexidine
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3
Q

what is peridex

A

chlorhexidine brand name ; second generation of mouthwash- with substantivity

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4
Q

what is substantivity

A

lasting salivary concentration of the antimicrobial (chlorhexidine/peridex) over time

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5
Q

what are the types of plaque scores

A

silness and loe plaque index

disclosing agents

(can motivate patients)

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6
Q

what is the silness and loe plaque index criteria

A

3- plaque fills gingival embrasure
2-plaque visible at gingival margin (GM)
1- plaque on explorer at GM
0- no plaque on explorer at GM

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7
Q

what are second generation antimicrobials

A

CHX, and octinidine

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8
Q

what is a first generation antimicrobial

A

CPC quaternary ammonium compounds, & listerine

stannous fluoride?

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9
Q

in the study of GI (gingival index) over time what were the restults

A

second generation did better than the first generation

(first gen- listerine, cpc, I THINK sanguinarine too? it went
chlorhexidine>sanguinarine>listerine>CPC

gi looks at levels of inflammation

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10
Q

what is the chlorhexidine dosage

A

2x daily (1/2 fl oz) for 30 seconds

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11
Q

what are the side effets of chlorhexidine

A

extrinsic staining, taste alteration, increased supragingival calculus, oral irritation

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12
Q

what is totalsf toothpaste

A

-replaced the old formula of triclosan and a copolymer PVM/MA, NOW it has .45% stannous fluoride with zinc phosphate (s.f. is a antimicrobial)

  • decreased plaque 8.5%
  • decreased gingivitis 26%
  • decreased calculus 56%
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13
Q

what are used in local delivery/irrigation?

A
  • water
  • chlorhexidine
  • dilute sodium hypochlorite
  • dilute povidone-iodine
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14
Q

what are the 4 brands of local sustained release systems in order of when they came out

A

(professional use not for patient use)

  • actisite-1994
  • periochip-1998
  • atridox-1998
  • arestin-2001 : WE USE IT in clinic
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15
Q

what is actisite?

A

type of local sustained release irrigation system from 1994 (first type)

  • ethylene/vinyl acetate fiber.
  • copolymer
  • biocompatible
  • flexible
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16
Q

what is periochip?

A

(literal chip thing you pack into gums)

  1. 5 mg chlorhexidine gluconate
    - 4 mmx 5 mm x 350 um chip
    - <1 minute to insert
    - no bacterial resistance
    - controlled release
    - bioabsorbable

reduce pocket depth but not antibitoic?

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17
Q

what is atridox

A
  • controlled-release product injected into pockets
  • doxycycline hyclate (10%)
  • 50 mg doxycycline
  • 2 syringe system
  • coe-pak/octyldent
  • bioabsorbable
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18
Q

what is in arestin? how do you use it

A

what we use in clinic!!

  • minocycline 1mg
  • microsphere technology
  • bioabsorbable
  • easy to place/use (no reconstitution, no refrigeration)
  • sustained drug delivery

HOW TO USE:
cartridge attach to handle, remove tip from cartridge , place subgingivally and express arestin from the cartridge.

19
Q

what are 2 types of systemic perio therapies

A

antibiotics and host modulation

20
Q

what are systemic antibiotics used for w/perio?

A
  • acute infections (perio abscess)
  • aggressive periodontitis
  • refractory periodontitis (non responsive periodontitis)
21
Q

when should antibiotics (systemic) NOT be used

A

NOT for chronic periodontitis!

22
Q

what are typical antibiotics for periodontitis and their dosages

A
  • metronidazole (500 mg/TID/8 days)
  • ciprofloxacin (500 mg/BID/8 days)
  • metronidazole and amoxicillin (250 mg/TIG 8 days fo each) MOST COMMON
  • metronidazole and ciprofloxacin (500 mg.BID/8 days of each)
  • doxycycline (100-200mg/QD/21 days)
  • clindamycin (300 mg/tid/8days)
23
Q

what is host modulation therapy? example?

A

systemic medication for perio
-host response is what causes the inflammation and destruction, so it tries to modulate that response itself.

PERIOSTAT

24
Q

what is periostat/whats in it and what does it do?

A

host modulation therapy

  • doxycycline hyclate– LOW DOSE 20 mg, antibiotic but not used that way. used twice daily, chronic dosing (at least 3 months on it)
  • meant to be in addition to scaling and root planning (same with EVERYTHING THO)
  • has anti collagenase activity
  • no shift in microflora!!
  • no emergence of resistant flora
25
Q

what is dentin hypersensitivity /what is it in response to

how does it relate to periodontal disease

A
  • short, sharp pain arising from exposed dentin in response to stimuli typicallyy thermal, evaporative, tactile, osmotic or chemical and which cant be ascribed to any other form of dental defect/pathology
  • its both a symptom of periodontal disease AND a side effect of certain periodontal therapies
26
Q

what is hydrodynamic theory

A

-stimuli cause movement of fluid within dentin tubules. this stimulates mechanoreceptors in dentin tubules which stimulates A delta nerve fibers in pulp–> pain

27
Q

what do COLD/HEAT cause in the hydrodynamic theory

A

cold causes outward flow of fluid away from the pulp

heat causes slower inward movement towards the pulp

28
Q

how does the tubule density in the dentin impact hypersensitivity?

A

MORE DENSE =MORE SENSITIVITY
about 8x more dense in sensitive dentin than in non
diameter of tubules tends to be larger too in sensitive dentin

thinkk of hypersensitivity as a CEJ phenomenon (where density of dentinal tubules is the greatest!!!!!!

29
Q

what 2 things have to occur for dentin hypersensitivity

A

-dentin has to become exposed (lesion localization) and dentin tubule system has to be opened up (lesion initiation)

30
Q

How can “lesion localization” occur?

A

can expose dentin by:

  • gingival recession
  • attrition
  • abrasion
  • erosion
31
Q

how can “lesion initiation” happen?

A

can open up tubules with:

  • toothbrushing
  • toothpaste
  • root instrumentation
  • dietary
  • others
32
Q

what to consider when someone has hypersensitivty?

A
  • caries?
  • cracked teeth?
  • new restoration?
  • occlusal trauma?
  • bleaching?
33
Q

list the therapies for root hypersensitivity

A

(btw root H and dentin H are the same-cej)
these mostly are for sealing tubules:

  • potassium nitrate
  • strontium chloride
  • arginine and calcium carbonate
  • calcium sodium phosphosilicate
  • fluorides/fluoride varnish
  • glutaraldehyde-hema varnish
  • oxalates
  • bonding agents/cervical restorations
  • surgical root coverage
  • laser therapy
  • endodontic therapy
34
Q

define excellent to good, fair to guarded, and poor to hopeless categories

A

excellent to good: <20% bone loss, phsyiologic mobility, shallow probing depths, up to class I furca involvement

Fair to guarded: 20-40% bone loss, some mobility, class I to II furcas, 5-7 mm probings, variable response to therapy

Poor to hopeless: >40% bone loss, class II to III furcas, probing >8mm, poor response to therapy

35
Q

what are perio treatement phases ? (prelim, 1-4) general

A
  • preliminary (urgent care; acute, caries control)
  • phase I (disease control)
  • re-evaluation
  • phase II (surgical)
  • phase III (restorative)
  • phase IV (supportive)
36
Q

what are some emergency perio issues

A

periodontal abscess, pericoronitis (around wisdom tooth), necrotizing gingivitis (used to be ulcerative), acute periapical infections

37
Q

what is involved in phase I therapy? whats another term for it

A

etiotropic phase

  • plaque control
  • diet
  • scaling and root planning/scale and polish
  • caries control
  • occlusal therapy
  • provisional splinting
38
Q

when do you do scaling/root planning vs scale and polish?

A

scaling and root planning: patient with loss of attachment and gingival inflammation

scale and polish: patient with gingival inflammation and NO loss of attachment

39
Q

what comes after periodontitis diagnosis

A

intiial therapy scaling and root planning and home care, then re evaluation 4-8weekslater

40
Q

what occurs at a re-evaluation for perio?

A

RE CHECK:

  • probing depths
  • mobility
  • gingival margin position (and loss of attachment)
  • adequacy of attached gingiva
  • plaque control
  • tissue response? (color, consistency,contour, bleeding,texture)
41
Q

what are 4 types of perio surgeries

A
  • resection
  • regeneration (grafts)
  • perio plastic surgery
  • crown lengthening
42
Q

what are types of phase III therapies

A

restorative phase

  • final restorations
  • fixed and removable prosthodontics
  • implants
43
Q

what are suportive treatments/how often is it done?

A

SPT every 3 months for ppl with periodontitis!

oral hygiene, scaling /rp, polishing, chemical irrigation

typically periodontist and generalist each do every other spt

44
Q

how often should there be care for gingivitis

A

no LOA :

6 months

ICS1 (23 decks)

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