Flashcards in Perio III Deck (95):
There are more bacteria than cells in a human body by a factor of _____
Undisturbed oral biofilm grows at ____to _____ micrometers/day
82 - 200
CHX can affect plaque that's been in place from 24-48 hours.
CHX can affect 6 hour plaque
If PD is over 7mm, what is the average reduction in PD after Scaling and Root Planing?
If PD is over 7mm, what is the average reduction CAL after Scaling and Root Planing?
What is the main function of Scaling/Root Planing?
Decreases surface area
What is the deepest Scaling and Root Planing generally goes on the root?
*even if PD much bigger than 5 mm
6 problems of Restricted Access when Scaling/Root planing
Periodontal _____ lesions can limit soft tissue management
Perio OHI clinical protocol:
Waterpik (or floss)
SRP is part of Perio clinical protocol and is done with ______
What low dose antibiotic is preferred?
What is the dose?
When is the re-eval post-SRP?
At 4-6 weeks SRP, what sites are re-treated after re-eval?
In what 2 ways?
greater than 5 mm
SRP, Site-specific drugs
When are surgical treatments considered in the Perio Clinical Protocols?
Post re-eval, after second SRP, site specific drugs, etc if response not achieved
Low Dose Doxycycline (originally Periostat) is 20 mg doxy, _____ tabs, every ____ hours
20 mg concentration of doxy has no bacterial effect, but does chelate metals (Ca, Zn, Mg) and inactivates ________
The matrix metalloproteinases inactivated by low dose Doxy are what 2 specific products?
Produced by what 2 specific cells?
*so low-dose Doxy fights our own immune system and its degrading factors
When is it appropriate to use SRP + Local delivery?
6 conditions SRP + local delivery can be used:
Pockets greater than 5mm
Maintenance PD 5-6mm
Early perio abscess
PD distofacial 2M's for 3M extraction
3 locally delivered Antimicrobials (brand names)
What is in PerioChip:
1 mg minocycline (powder)
In terms of reaching the disease site, achieving adequate concentration and duration, killing the target microbe, and not harming the patient, Locally Delivered antimicrobials are the best
(when compared to mouth rinse, subgingival irrigation, and systemic antibiotics)
Arestin is __mg of _____ in powder
GCF concentration minocycline after Arestin therapy:
3 days out:
5 bacteria that are susceptible to minocycline (Arestin) concentrations at 2-8 ug/ml
Low dose doxy targets cytokines, prostanoids, MMP's and therefore inhibits _____ and _____ metabolism
Local antimicrobial + Low Dose Doxy goes after both microbial challenge and CT/Bone metabolism
It is possible to get a pocket reduction of 3mm, but more realistically it will be ____mm.
Pocket reduction of ___mm is not realistic
Open Flap Debride can get a Pocket Reduction of ___mm
SRP + Arestin reduction in PD:
SRP + Atridox:
SRP + PerioChip:
(bout half mm less reduction in CAL)
What systemic antibiotic is the drug of choice in treatment of Agressive Perio?
Other than Amoxicillin, name 6 drugs prescribed for Aggressive Perio:
Metronidazole (NOT w/ EtOH)
Amoxicillin + Clavulanic Acid (Augmentin)
Azithromycin (Z-pak not used much any more)
The advantages of systemic antibiotics is wide dispersement, reduction of chair time to treat pts, and a wide range of drugs to choose from.
What is the primary disadvantage to systemic antibiotic use for chronic perio?
Aside from compliance, allergy, GI problems, DDI's, cost and the inability to penetrate intact ______ are disadvantages for systemic antibiotic use for chronic perio.
Frequency (of taking drug) and compliance are inversly related
GI, nausea, photosensitivity, bacterial resistance, _____, and ______, are common side effects of systemic antibiotics.
Name 4 antibiotics commonly prescribed for systemic use in perio
Systemic antibiotics has a positive effect on ____
What antibiotic combination has the greatest effect on CAL?
This reduces CAL by ___mm
Best results are obtained when prescribed for ____ days
Amoxicillin + Metronidazole
*either aggressive or chronic
Systemic antibiotics should be used in most pts with periodontitis
Systemic antibiotics should be used in conjunction with _____ treatment over a period of 7 days
SRP + Arestin decreases ______ and _______
SRP + low dose Doxy degreases what 4 things?
Most changes in a perio Tx plan occur when?
After all non-surgical therapy is considered in the Re-Evaluation, what are the 3 options?
Control Etiology (or modifying factors)
Surgical Therapy (phase II)
Compromised maintenance therapy
When should the pt proceed to a Maintenance Phase?
If the pt is not stable upon re-evaluation, then proceed to...
What are the 3 options in Personalized Re-treatment?
What is the most critical phase of successful periodontal therapy?
Maintenance visit: If PD is stable with no BOP, then Tx is routine - review OHI with same recall interval. If PD same but BOP is present, what is the Tx course?
SRP on bleeding sites
Consider - local antimicrobials
Consider - shortening recall intervals
Maintenance visit: PD and BOP increase
Adjuctive therapy (local/systemic antibiotics)
***Refer to Periodontist
Why is Perio maintenance interval 3 months?
Re-infections of pockets happens around 3 months
*referrals tend to alternate GP/Periodontist
The only exception to initiating Tx without a Tx Plan:
A Tx Plan is a working ______
An emergency begins a Treatment Plan at the _____ phase
After the Urgent Phase is the ______ Phase
Regular re-care examinations (reassessments):
What is the Initial Therapy (Phase I) for Gingivitis?
Med consult (if needed)
scale and polish
re-eval 4-6 wks
phrophylaxis every 6 months if disease resolved
Mild Chronic Periodontitis has Inflammation extending to the ______.
Attachment loss ____mm from CEJ
Radiographic bone loss less than ____%
Class I or no furcation involvement
Initial (phase I) therapy for Mild Chronic Periodontitis:
Med consult (if needed)
SRP w/ anesthesia
Re-eval 4-6 weeks
3-4 month maintenance interval (depending on OH)
Moderat Chronic Periodontitis has inflammation extending to the _____.
Attachment loss ___mm from CEJ
PD ___ mm
Radiographic bone loss ___% to ___%
Class I or II furcations
Class I and II mobility
Moderate Chronic Periodontitis Initial Therapy (Phase I):
Med consult if indicated
Re-eval 4-6 weeks
Locally delivered antimicrobials in 5-6mm pockets
Advanced Chronic Periodontitis has inflammation extending to the bone, bleeding on provocation, attachment loss greater than ___ mm from CEJ
PD greater than ___mm
Radiographic bone loss greater than ___%
Class I, II, or III furcation
Class I, II, or III mobility
Advanced Chronic Periodontitis: Med consult if needed, OHI, SRP, 2-4 appointments, Re-eval in 4-6 weeks, locally delivered antimicrobials in ___mm residual pockets, and referral to periodontist
***this is exactly the same treatment as Moderate Chronic Periodontitis
What is prognosis without treatment?
What type of prognosis takes into account what effect the periodontal treatment will have on the course of the disease?
What type of prognosis anticipates the results of perio treatment and forecasts for the success of a prosthetic restoration?
What prognosis is given prior to the initial phase of Treatment and may change according to the patient/tooth response?
Prognosis is divided into:
What is the single most important factor in the Overall Prognosis/Systemic Background?
Cigaretts smokers are __-___ times more likely than non-smokers to develop severe periodontitis
5 to 8 times
What 3 positive effects does 20 Minutes smoking cessation have?
BP drops to normal
Pulse rate drops to normal
Peripheral body temp increases to normal
What positive effect does smoking cessation have at 8 hours?
At 24 hours?
CO drops to normal
Chance of heart attack decreases
What positive benefit is seen related to smoking cessation at 2 weeks - 3 months?
At 1 to 9 months?
Circulation improves, lung function increases 30%
Coughing, sinus probs, breathing improve and Cilia Re-Grow
What positive benefit is seen by smoking cessation at 1 year?
Heart disease reduced 50%
Lung, oral, pharynx, esophageal cancer decreased 50%
*stroke reduced to non-smoker in 5-15 year range
What positive benefit is seen by smoking cessation at 10-15 years
Lung cancer similar to nonsmoker
heart disease like nonsmoker
What bacteria is increased by Type I diabetes?
What bacteria is increased by Type II diabetes?
What 2 consequences does diabetes have in the GCF?
Decreased PMN function
What vascular changes are seen in diabetes?
*decreases oxygen diffusion and waste elimination
How does diabetes impair wound healing?
Stimulates collegenase and alters collagen metabolism
Also limits production of Growth Factors
Untreated moderate/advanced periodontitis pt loses ___ teeth/yr
Treated w/ no maintenance loses ___ teeth/yr
Treated w/ maintenance loses ___ teeth/yr
Perio treatment is ___x as effective as no treatment
The level of oral hygiene at 1st treatment isn't as important as the level of OH at completion of initial phase of Tx (Phase I)
An inflammatory response and plaque calculus suggests a better prognosis
What has a better prognosis, chronic infection or perio abscess?
In SRP, what is the instrumentation limit?
5.52 mm *most of time calculus over 5 mm remains
PD is more important than CAL when determining prognosis
*invert - prognosis based on CAL
The ratio for a tooth with an average root length (13mm) is:
Individual tooth Prognosis Class I:
Prognosis based on tooth mobility
fair (slight mobility)
hopeless (severe mobility + depressive)
What's worse, a single rooted mobile tooth or multi rooted mobile tooth?
Multi-rooted tooth is worse
Prognosis can be Good, Fair, Poor Questionable, and Hopeless
Maxillary molars are lost more frequently than mandibular molars
The average tooth loss with furcations over a 20 year period is what?