Pharmacologic adjuncts to conventional periodontal therapy

Osmosis from Elsevier
25 Aug 202112:45
EducationalLearning
32 Likes 10 Comments

TLDRThe video script provides a comprehensive overview of periodontal disease treatment, emphasizing the importance of preserving natural teeth and preventing disease recurrence. It outlines the primary mechanical therapies, including scaling and root planing, and the use of pharmacological agents as adjuncts. The summary highlights three generations of antiplaque agents delivered through mouthwashes, with second-generation agents like chlorhexidine gluconate being most effective. It also covers local delivery methods, such as oral irrigation and sustained release products like PerioChip, Atridox, and Arestin. Systemic therapies, including antibiotics and host modulation therapy with doxycycline hyclate, are discussed, noting their limited use due to potential resistance. The script concludes with the role of NSAIDs, statins, and bisphosphonates in offering periodontal benefits, though not specifically prescribed for periodontitis.

Takeaways
  • 🦷 The primary goal of periodontal therapy is to preserve natural teeth and prevent the recurrence of periodontal disease.
  • 🔍 Gingivitis is the mildest form of periodontal disease, which can progress to periodontitis if untreated.
  • 🛠 Conventional treatment involves mechanical therapy such as scaling and root planing, but not all patients respond well to this approach.
  • 💊 Pharmacological agents can be used as an adjunct to conventional therapy for patients who do not respond well to mechanical treatment.
  • 🌿 Topical medications, like mouthwashes with antiplaque agents, are categorized into three generations based on their antimicrobial and antiplaque effects.
  • 🚿 Oral irrigation uses a stream of water or solutions to disrupt dental biofilm and decrease inflammation, with methods for both supragingival and subgingival areas.
  • 💧 Subgingival irrigants like sodium hypochlorite and povidone-iodine have rapid bactericidal action but can cause taste issues and other side effects.
  • 🍃 Local sustained release medications, such as PerioChip, Atridox, and Arestin, provide a gradual release of antimicrobials to the periodontal pocket.
  • 💊 Systemic delivery includes antibiotics and host modulation therapy, used for aggressive or refractory periodontitis, but not for most cases to avoid bacterial resistance.
  • 🧬 Host modulation therapy aims to resolve immune-mediated destruction in the periodontium, with Periostat being an approved drug for this purpose.
  • 📚 Other medications like NSAIDs, statins, and bisphosphonates may offer periodontal benefits but are not specifically prescribed for treating periodontitis.
Q & A

  • What is periodontal disease?

    -Periodontal disease refers to a group of inflammatory conditions that affect the tissues around the teeth, with gingivitis being the mildest form and periodontitis being a more advanced stage.

  • What is the primary goal of periodontal therapy?

    -The primary goal of periodontal therapy is to save the natural dentition and periodontium and to prevent the recurrence of periodontal disease.

  • What are the conventional treatments for periodontal disease?

    -Conventional treatments for periodontal disease are based on mechanical therapy, such as scaling and root planing with curettes, or surgical procedures.

  • Why might pharmacological agents be used in periodontal treatment?

    -Pharmacological agents can be a useful adjunct in periodontal treatment for cases where patients do not respond well to conventional therapy.

  • How are medications for periodontitis categorized based on delivery type?

    -Medications for periodontitis are categorized into topical, local, and systemic medications based on their type of delivery.

  • What is the difference between supragingival and subgingival irrigation?

    -Supragingival irrigation uses a tip placed above the gingival margin to remove bacterial biofilm along the gingival margin, while subgingival irrigation places the tip beneath the gingival margin to target bacteria in the periodontal pockets.

  • What are the main disadvantages of using sodium hypochlorite as an antimicrobial irrigant?

    -The main disadvantages of sodium hypochlorite include an unpleasant taste and possible irritation of the oropharyngeal mucosa.

  • How does PerioChip work as a local sustained release medication?

    -PerioChip is a biodegradable chip that contains chlorhexidine gluconate. It releases approximately 40% of the chlorhexidine gluconate within the first 24 hours and linearly releases the rest over 7 to 10 days, maintaining an effective concentration in the gingival crevicular fluid.

  • What is the role of systemic antibiotics in treating periodontitis?

    -Systemic antibiotics can be used in individuals with aggressive or refractory forms of periodontitis, acute infections, diabetes, and dental implants. However, they are not indicated for most periodontitis cases due to the risk of increasing bacterial resistance.

  • What is host modulation therapy and how is it used in periodontal treatment?

    -Host modulation therapy aims to decrease or resolve the immune-mediated destruction of the periodontium by targeting the host's immune response. The only agent approved to treat periodontitis in this manner is a sub-antimicrobial dose of doxycycline hyclate, which has anti-collagenase and anti-matrix metalloproteinase activity.

  • What are some other medications that can provide periodontal benefits but are not prescribed specifically for periodontitis?

    -Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), statins, and bisphosphonates can provide periodontal benefits but are typically prescribed for other health issues and not specifically for treating periodontitis.

Outlines
00:00
🦷 Periodontal Disease and Treatment Overview

This paragraph introduces periodontal disease as a group of inflammatory conditions affecting the tissues around the teeth, with gingivitis being the mildest form that can progress to periodontitis if untreated. The primary goal of therapy is to preserve natural teeth and prevent disease recurrence. Conventional treatments include mechanical methods like scaling with curettes and surgical procedures. However, when conventional methods fail, pharmacological agents can be used as an adjunct. Medications are categorized into topical, local, and systemic, with the most common topical agents being antiplaque mouthwashes. These are further divided into three generations based on their antimicrobial and antiplaque effects. Local delivery includes oral irrigation and sustained release systems, while systemic delivery involves antibiotics and host modulation therapy.

05:01
💊 Advanced Local and Systemic Medication Delivery

The second paragraph delves into the specifics of local and systemic medication delivery for periodontitis. It discusses oral irrigation, which targets dental biofilm and reduces gingival inflammation, and is categorized into supragingival and subgingival irrigation. Antimicrobial irrigants like sodium hypochlorite and povidone-iodine are used, each with their advantages and disadvantages. Local sustained release products such as PerioChip, Atridox, and Arestin are also described, highlighting their composition and release mechanisms. Systemic delivery is reserved for severe cases and includes antibiotics and host modulation therapy, with doxycycline hyclate (Periostat) being the only approved agent for periodontitis treatment. Other medications like NSAIDs, statins, and bisphosphonates may offer periodontal benefits but are not prescribed specifically for periodontitis.

10:03
📚 Summary of Periodontal Therapy Approaches

The final paragraph recaps the primary goal of periodontal therapy, which is to preserve the natural dentition and prevent disease recurrence. It outlines the mechanical approach to treating periodontitis, involving scaling and planing, re-evaluation, possible surgery, and a maintenance program. Pharmacological agents are used as adjuncts to this mechanical approach. The paragraph also summarizes the types of medications used, including their delivery methods and the rationale behind their use. It concludes by emphasizing that while host modulation therapy holds promise, the challenge lies in validating these therapies' risks and benefits in clinical settings.

Mindmap
Keywords
💡Periodontal disease
Periodontal disease is a collective term for infections that affect the tissues surrounding the teeth, including the gums, periodontal ligament, and alveolar bone. It is a central theme of the video, as it discusses the progression from gingivitis to periodontitis and the various treatment options available. The video emphasizes the importance of treating periodontal disease to save natural teeth and prevent recurrence.
💡Gingivitis
Gingivitis is the initial and mildest form of periodontal disease characterized by inflammation of the gums. It is significant because it can progress to periodontitis if left untreated, as mentioned in the video. It is a warning sign that requires attention and proper dental hygiene to prevent further deterioration of oral health.
💡Periodontitis
Periodontitis is a more severe form of periodontal disease that involves not only the gums but also the structures that support the teeth, such as the periodontal ligament and alveolar bone. The video discusses periodontitis in the context of its treatment, emphasizing the need for therapy to halt the disease's progression and save the natural dentition.
💡Mechanical therapy
Mechanical therapy refers to the conventional treatment methods for periodontal disease that involve physical removal of dental plaque and calculus. The video mentions the use of curettes for scaling and root planing as examples of mechanical therapy. This approach is fundamental in disrupting the biofilm and removing harmful bacteria from the teeth surface.
💡Pharmacological agents
Pharmacological agents are medications used as an adjunct to conventional mechanical therapy for periodontal disease. The video discusses their utility in cases where patients do not respond well to mechanical therapy alone. These agents can include mouthwashes with antiplaque agents or locally delivered antibiotics, which are used to enhance the effectiveness of treatment.
💡Topical medications
Topical medications are those applied directly to the affected area, in this case, the mouth. The video outlines that these are often in the form of mouthwashes containing antiplaque agents. These agents are categorized into generations based on their antimicrobial and antiplaque effects, with chlorhexidine gluconate from the second generation being highlighted for its prolonged antibacterial activity.
💡Local delivery medications
Local delivery medications are treatments that are applied directly to the site of infection, such as within the periodontal pockets. The video describes oral irrigation and local sustained release systems like PerioChip, Atridox, and Arestin. These methods are used to target bacteria in the subgingival region and provide a sustained release of medication to improve clinical outcomes.
💡Systemic delivery
Systemic delivery refers to the administration of medications throughout the body, typically via oral or intravenous routes. The video notes that systemic antibiotics and host modulation therapy fall under this category. It is important to highlight that systemic antibiotics are not indicated for most cases of periodontitis due to the risk of increasing bacterial resistance.
💡Host modulation therapy
Host modulation therapy aims to alter the host's immune response to reduce the damage caused by periodontal disease. The video explains that this therapy is used when conventional treatments are not effective. An example given is the use of a subantimicrobial dose of doxycycline hyclate, branded as Periostat, which has anti-collagenase and anti-matrix metalloproteinase activity to decrease the breakdown of periodontal structures.
💡PerioChip
PerioChip is a biodegradable chip that contains chlorhexidine gluconate, an antiseptic agent. As detailed in the video, it is used in local sustained release therapy. Once placed into a periodontal pocket, it biodegrades and releases chlorhexidine gluconate over 7 to 10 days, maintaining an effective concentration against oral bacteria and serving as an adjunct to mechanical periodontal treatments.
💡Arestin
Arestin is a locally-delivered antibiotic that utilizes biodegradable microsphere technology for ease of use. The video mentions that it contains minocycline hydrochloride within a bioadhesive and bioabsorbable polymer called PGLA. Arestin is administered into subgingival spaces and has a low MIC90, indicating its potency in treating periodontal disease with minimal bacteria required to be inhibited.
Highlights

Periodontal disease is a group of inflammatory conditions affecting the tissues around the teeth.

The primary goal of periodontal therapy is to save the natural dentition and prevent recurrence of the disease.

Conventional treatment includes mechanical therapy like scaling and root planing or surgical procedures.

Pharmacological agents can be a useful adjunct for patients not responding well to conventional therapy.

Medications for periodontitis are categorized into topical, local, and systemic based on delivery type.

First-generation antiplaque agents include fluoride, oxygenating agents, phenolic compounds, and quaternary ammonium compounds.

Second-generation agents like chlorhexidine gluconate have prolonged antibacterial activity.

Third-generation agents interfere with bacteria's ability to attach to teeth, with delmopinol hydrochloride as a main example.

Oral irrigation disrupts dental biofilm and decreases gingival inflammation.

Subgingival irrigation targets bacteria in around 70% of the subgingival region.

Sodium hypochlorite and povidone-iodine are common subgingival antimicrobial irrigants.

Local sustained release medications like PerioChip, Atridox, and Arestin improve clinical attachment levels.

PerioChip releases chlorhexidine gluconate linearly over 7-10 days.

Atridox contains doxycycline hyclate for a first-order release with a lower MIC90 than PerioChip.

Arestin uses minocycline hydrochloride in a bioadhesive polymer for local antibiotic delivery.

Systemic antibiotics are used in aggressive/refractory periodontitis, acute infections, diabetes, and dental implants.

Host modulation therapy aims to resolve immune-mediated destruction of periodontium.

Sub-antimicrobial dose doxycycline hyclate (Periostat) is approved to treat periodontitis.

NSAIDs, statins, and bisphosphonates may provide periodontal benefits but are not prescribed specifically for periodontitis.

The most effective topical agents are second-generation ones like chlorhexidine gluconate.

Pharmacologic agents can be used as adjuncts to conventional mechanical periodontal therapy.

Transcripts

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Related Tags
Periodontal TherapyGingivitisPeriodontitisPharmacological AgentsAntiplaque AgentsOral HygieneDental HealthAntimicrobial TreatmentSurgical ProceduresHost ModulationDental InflammationOral IrrigationAntibiotic TherapyDental BiofilmChlorhexidinePerioChipAtridoxArestinSystemic AntibioticsDoxycyclineNSAIDsStatinsBisphosphonatesDental AbscessPeriodontal PocketsTherapeutic ApproachesOral Health Care