Perio - Video 12

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Questions and Answers

Why is tetracycline effective in treating periodontal disease?

It is able to concentrate in the blood stream and reach all parts of the body

It is able to repair damaged gum tissue

It is able to kill all types of bacteria in the mouth

It concentrates in the gingival crevicular fluid, near the plaque bacteria (correct)

What is a benefit of doxycycline compared to other antibiotics?

It requires four doses per day

It is only effective against a narrow range of bacteria

It is only used for surgical periodontal treatment

It only requires one dose per day, improving patient compliance (correct)

What is the typical duration of antibiotic treatment for periodontal disease?

21 days

7 days

10 days

14 days (correct)

Why is it important to avoid alcohol consumption with metronidazole?

It can lead to unpleasant side effects Signup and view all the answers

When is local delivery antibiotics typically used?

For localized recurrent or residual pockets with inflammation Signup and view all the answers

What is the name of the locally delivered antibiotic that contains doxycycline?

Arrestin Signup and view all the answers

What is the goal of host modulation therapy?

To down regulate the destructive aspects of the host response Signup and view all the answers

When should host modulation therapy be used?

For chronic forms of periodontitis Signup and view all the answers

What is the key factor in the effectiveness of antibiotic treatment for periodontal disease?

The duration of the treatment Signup and view all the answers

Why is mechanical cleaning important in addition to antibiotic treatment?

It removes plaque and local factors that favor accumulation Signup and view all the answers

What is the primary goal of antibiotics in the treatment of periodontal disease?

To decrease the number of bacteria in the periodontal pocket Signup and view all the answers

When should antibiotics be used in the treatment of periodontal disease?

As an adjunct to mechanical debridement during phase one Signup and view all the answers

What type of periodontitis is most often treated with antibiotics?

Aggressive periodontitis Signup and view all the answers

What is refractory periodontitis?

A type of periodontitis that does not resolve with proper treatment Signup and view all the answers

Why should bactericidal and bacteriostatic drugs not be given at the same time?

Because they have opposite mechanisms of action Signup and view all the answers

What is the role of antibiotics in phase one of periodontal treatment?

To augment mechanical debridement Signup and view all the answers

What is the primary mechanism of action of bactericidal drugs?

Killing bacteria Signup and view all the answers

What is the link between aggressive periodontitis and a specific type of bacteria?

Aggressive periodontitis is linked to a specific type of bacteria Signup and view all the answers

What is the primary mechanism of NSAIDs in host modulation therapy?

Inhibit prostaglandins Signup and view all the answers

What is the primary mechanism of bisphosphonates in host modulation therapy?

Inhibit osteoclasts and osteoblasts Signup and view all the answers

What is the FDA-approved medication for host modulation therapy?

Subantimicrobial dose doxycycline Signup and view all the answers

What does subantimicrobial dose doxycycline inhibit?

MMPs Signup and view all the answers

What is the typical dosage for subantimicrobial dose doxycycline?

20 milligrams twice daily for three to nine months Signup and view all the answers

What is the purpose of occlusal correction in periodontal treatment?

To correct malocclusion Signup and view all the answers

What is traumatic occlusion?

Injury to the periodontium resulting from excessive occlusal forces Signup and view all the answers

What is fremitus?

Vibration of teeth upon closing Signup and view all the answers

What is the primary mechanism of EMD in periodontal treatment?

Promote periodontal regeneration Signup and view all the answers

What is the primary purpose of local host modulation therapy?

To promote periodontal regeneration Signup and view all the answers

What is the primary goal of occlusal therapy in Phase One?

To adjust the occlusal forces Signup and view all the answers

What is the purpose of a bite guard or occlusal guard?

To redistribute occlusal forces Signup and view all the answers

When is occlusal adjustment or corona plasti usually done?

After inflammation is resolved Signup and view all the answers

What is unit splinting used for according to the board exam?

To improve patient comfort and function Signup and view all the answers

What is the main purpose of furcation correction?

To make the furcation area more accessible for cleaning Signup and view all the answers

What is furcation plasti?

Opening up the furcation area to smooth it out Signup and view all the answers

What is the purpose of tunneling in furcation correction?

To remove bone and move the tissues down Signup and view all the answers

What is root amputation?

Cutting off a root Signup and view all the answers

What is the result of hemisection?

A tooth is retained as a pre molar Signup and view all the answers

Why is the distal buccal root of a maxillary first molar often chosen for root amputation?

Because it's the smallest root and provides minimal support Signup and view all the answers

Study Notes

Antibiotics in Periodontal Disease

Antibiotics aim to decrease the number of bacteria in the periodontal pocket, which makes sense because bacteria in plaque are the initiating factor in periodontal disease.
Antibiotics should only be used as an adjunct to mechanical debridement during phase one, which includes non-surgical options like plaque control, patient education, scaling, and root planing.
Antibiotics are most often employed in the aggressive form of periodontitis, and also in cases of refractory periodontitis that do not resolve despite proper treatment.
Remember, "A" for aggressive, and "A" for antibiotics.

Types of Antibiotics

Bactericidal and bacteriostatic drugs should not be given at the same time; bactericidal drugs kill bacteria, while bacteriostatic drugs stop their growth.
Tetracycline concentrates in the gingival crevicular fluid, making it effective in targeting plaque bacteria.
Doxycycline, a type of tetracycline, is often prescribed and only requires one dose per day, which may improve patient compliance.
The most common and effective antibiotic regimen for periodontal disease is a combination of amoxicillin and metronidazole, taken for 14 days.

Local Delivery Antibiotics

Local delivery antibiotics are used to target specific pockets that are not resolving, and are delivered directly into the affected area.
The specific guidelines for local delivery antibiotics (LDA) use are:
- Localized recurrent or residual pockets that are not going away
- Probing depths greater than or equal to 5 millimeters with inflammation
There are three commonly used locally delivered antibiotics: Arestin, Atridox, and PerioChip.
Remember, Arestin corresponds to minocycline, Atridox corresponds to doxycycline, and PerioChip corresponds to chlorhexidine.

Host Modulation Therapy

Host modulation therapy aims to down-regulate the destructive aspects of the host response to bacteria.
It is used as an adjunct to mechanical debridement, and should only be used in cases of chronic periodontitis.
There are three types of medicaments used in host modulation therapy: nonsteroidal anti-inflammatory drugs (NSAIDs), bisphosphonates, and sub-antimicrobial dose doxycycline.
Sub-antimicrobial dose doxycycline is the only FDA-approved and ADEA-accepted medication for host modulation therapy.

Local Host Modulation Therapy

Local host modulation therapy involves administering host-modifying agents directly into the affected area.
Examples of local host modulation therapy include enamel matrix proteins (EMD) and platelet-derived growth factor (PDGF).

Occlusal Correction

Occlusal correction is used to address traumatic occlusion, which can accelerate periodontal disease.
Articulating paper or occlusal indicating wax can be used to diagnose traumatic occlusion.
There are two types of traumatic occlusion: primary and secondary.
Primary traumatic occlusion is caused by excessive forces on a normal periodontium, while secondary traumatic occlusion is caused by normal occlusal forces on a reduced periodontium.
Fremitus is a vibration of teeth upon closing, and can be used to diagnose traumatic occlusion.

Treatment Options for Occlusal Correction

Treatment options for occlusal correction include occlusal adjustment, coronal plasty, and an occlusal appliance (also known as a bite guard).
Unit splinting is used to improve patient comfort and function, but is not indicated for fremitus unless it bothers the patient.

Furcation Correction

Furcation correction is used to address furcation involvement, which can make it difficult to keep the area clean.
There are four treatment options for furcation correction:
1. Furcation plasty: to open up the furcation area and smooth it out for better access.
2. Tunneling: to remove bone and move the tissues apically to create a Gleckman Class IV, which allows for easier cleaning.
3. Root amputation or resection: to cut off one of the roots to facilitate cleaning.
4. Hemisection: to cut the tooth in half and retain it as two separate teeth.

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Description

Learn about the role of antibiotics in treating periodontal disease, including their effect on bacteria and plaque. Understand how they should be used in conjunction with mechanical debridement.