Periodontics | Adjunctive Therapy | INBDE, ADAT
TLDRIn this periodontics series video, Ryan discusses adjunctive treatments for periodontal disease, focusing on the strategic use of antibiotics to reduce bacteria in periodontal pockets. He explains that antibiotics are supplementary to mechanical debridement during phase 1 treatment, which includes non-surgical options like plaque control and patient education. The video also covers the use of tetracyclines, specifically doxycycline, for its effectiveness in gingival crevicular fluid. Ryan further explores local antibiotic delivery, host modulation therapy to regulate the host response, and various occlusal corrections to manage traumatic occlusion. He concludes with options for furcation correction to improve oral hygiene and periodontal health.
Takeaways
- 💊 **Antibiotics in Periodontal Disease**: Used to decrease bacteria in periodontal pockets, targeting the initiating factor of periodontal disease.
- 🚫 **Limited Use**: Antibiotics should be used as an adjunct to mechanical debridement and are not suitable for all cases of periodontitis.
- 🔍 **Aggressive Periodontitis**: The aggressive form of periodontitis is where antibiotics are most often employed.
- 💡 **Pharmacology Note**: Tetracyclines, such as doxycycline, are effective due to their concentration in gingival crevicular fluid, requiring only a daily dose.
- 🤝 **Combination Therapy**: The most common effective antibiotic regimen is a combination of amoxicillin and metronidazole for 14 days.
- 🍷 **Alcohol Avoidance**: Alcohol should be avoided with metronidazole due to potential side effects.
- 🏥 **Local Delivery Antibiotics (LDA)**: Used for localized recurrent cases that do not respond to conventional therapies.
- 🛠️ **Host Modulation Therapy**: Aims to down-regulate the destructive host response to bacterial challenges in periodontitis.
- 🧬 **Sub-Antimicrobial Doxycycline**: Used to inhibit MMPs, reducing the destruction of the periodontal ligament, with a dosage of 20 mg twice daily for up to nine months.
- ⚙️ **Occlusal Correction**: Malocclusion can accelerate periodontal disease, and occlusal therapy can help redistribute forces to minimize damage.
- 🦷 **Furcation Correction**: Various techniques like furcation plasty, tunneling, root amputation, and hemisection are used to improve cleanliness and health in areas of furcation involvement.
Q & A
What is the primary role of antibiotics in the treatment of periodontal disease?
-The primary role of antibiotics in the treatment of periodontal disease is to decrease the number of bacteria in the periodontal pocket. They target bacteria, which are part of plaque and the initiating factor in periodontal disease.
When should antibiotics be used in the treatment of periodontal disease?
-Antibiotics should be used as an adjunct to mechanical debridement during phase 1 of treatment, which includes non-surgical options such as plaque control, patient education, scaling, and root planing. They are particularly used in aggressive periodontitis and refractory periodontitis cases.
What are the two types of periodontal disease where antibiotics are most often employed?
-The two types of periodontal disease where antibiotics are most often used are aggressive periodontitis and refractory periodontitis.
Why are bacteriostatic and bactericidal drugs not typically combined?
-Bacteriostatic drugs stop bacterial growth, while bactericidal drugs kill bacteria. Combining the two can be counterproductive because the bactericidal effect can be negated if the bacteria are merely halted in their growth cycle by the bacteriostatic drug.
What is the benefit of tetracyclines in treating periodontal disease?
-Tetracyclines have the benefit of concentrating in the gingival crevicular fluid, which constantly bathes the periodontal pocket where plaque bacteria are found. This concentration allows the antibiotic to work effectively at the site of infection.
What is the typical prescription for periodontal disease using a combination of amoxicillin and metronidazole?
-The typical prescription for periodontal disease using a combination of amoxicillin and metronidazole involves taking 500 milligram tablets of amoxicillin and 250 milligram tablets of metronidazole three times a day for 14 days.
Why is the duration of antibiotic treatment more important than the dose in tackling periodontal disease?
-The duration of antibiotic treatment is more important than the dose because a longer treatment period allows the antibiotics to be more effective in eliminating the bacteria causing periodontal disease. A higher dose for a shorter period may not be as effective.
What are the three common types of locally delivered antibiotics used in periodontal treatment?
-The three common types of locally delivered antibiotics used in periodontal treatment are Arestin (containing minocycline), Atridox (containing doxycycline), and PerioChip (containing chlorhexidine).
What is host modulation therapy and how does it work?
-Host modulation therapy is a newer approach that aims to down-regulate the destructive aspects of the host response to bacterial challenge in periodontal disease. It works by inhibiting the overactive immune response that leads to tissue destruction, rather than targeting the bacteria directly.
Which FDA-approved medication is used in host modulation therapy for periodontal disease?
-The only FDA-approved medication used in host modulation therapy for periodontal disease is sub-antimicrobial dose doxycycline, which inhibits matrix metalloproteinases (MMPs) and helps prevent the destruction of the periodontal ligament.
What is the purpose of occlusal correction in the treatment of periodontal disease?
-Occlusal correction is used to address issues related to malocclusion or a bad bite, which can accelerate and worsen the periodontal condition of the patient. It aims to redistribute occlusal forces to minimize excessive force on individual teeth and improve the overall health of the periodontium.
Outlines
🦷 Antibiotics in Periodontal Treatment
Ryan discusses the use of antibiotics as an adjunctive treatment in periodontal disease, explaining their role in reducing bacterial numbers in the periodontal pocket. He highlights that antibiotics should be used alongside mechanical debridement during Phase 1 therapy, which includes non-surgical treatments like plaque control and scaling. He emphasizes that antibiotics are mainly used for aggressive periodontitis and refractory cases, stressing the importance of combining antibiotics appropriately without mixing bactericidal and bacteriostatic types. Tetracyclines, particularly doxycycline, are noted for their effectiveness due to their concentration in gingival crevicular fluid. The combination of amoxicillin and metronidazole is highlighted as a common and effective regimen, with dosage duration being crucial for effectiveness.
💊 Locally Delivered Antibiotics
Ryan explains the use of locally delivered antibiotics (LDAs) for persistent periodontal pockets. He describes three common LDAs: Arestin (minocycline), Atridox (doxycycline), and PerioChip (chlorhexidine), providing mnemonic aids for remembering their associations. These treatments are used when conventional therapies fail, targeting localized recurrent or residual periodontal pockets with probing depths of 5 mm or more. He highlights the importance of these treatments in specific stubborn areas that do not respond to standard therapies.
🧬 Host Modulation Therapy
Ryan introduces host modulation therapy as a newer approach in periodontics aimed at down-regulating the destructive aspects of the host response to bacterial plaque. This therapy is designed to complement mechanical cleaning during Phase 1, particularly for chronic periodontitis. He details systemic options like NSAIDs, bisphosphonates, and sub-antimicrobial dose doxycycline, emphasizing the latter's effectiveness and approval by the FDA and ADA. Doxycycline inhibits MMPs, preventing the destruction of periodontal ligament collagen, with a prescribed dose of 20 mg twice daily for extended periods.
🔬 Local Host Modulation Agents
Ryan discusses local applications of host modulation agents, such as MD Gain (enamel matrix proteins) and PDGF (growth factor), used in periodontal regeneration. He also introduces occlusal correction as an adjunctive treatment, explaining how malocclusion can exacerbate periodontal conditions. Traumatic occlusion is categorized into primary (excessive forces on healthy periodontium) and secondary (normal forces on a compromised periodontium). Occlusal adjustments, coronal plasty, and splinting are discussed as therapeutic options to improve patient comfort and function.
🦷 Furcation Correction Techniques
Ryan explores four treatment options for furcation involvement in periodontal therapy: furcation plasty, tunneling, root amputation, and hemisection. Each technique is described in detail, focusing on how they improve accessibility and hygiene in challenging areas under the root trunk of molars. Furcation plasty involves smoothing and opening the furcation area, tunneling creates an accessible path through the furcation, root amputation removes a problematic root, and hemisection splits a molar into two functional premolars. Ryan concludes by summarizing the video series and hinting at a final video with a Q&A session.
Mindmap
Keywords
💡Periodontal Disease
💡Adjunctive Treatment
💡Mechanical Debridement
💡Antibiotics
💡Tetracyclines
💡Host Modulation Therapy
💡NSAIDs
💡Bisphosphonates
💡Subantimicrobial Dose Doxycycline
💡Occlusal Correction
💡Furcation Involvement
Highlights
Antibiotics are used as an adjunct to mechanical debridement in treating periodontal disease, targeting bacteria in the periodontal pocket.
Systemic and local antibiotics are included in Phase 1 of treatment, which consists of non-surgical options.
Antibiotics are particularly useful in aggressive periodontitis and refractory periodontitis cases.
Tetracyclines, such as doxycycline, are effective due to their concentration in gingival crevicular fluid.
The common antibiotic regimen for periodontal disease combines amoxicillin and metronidazole.
Duration of antibiotic treatment is more crucial than the dosage for effectiveness against periodontal disease.
Local delivery antibiotics target specific stubborn pockets that do not respond to conventional therapies.
Arestin, Atridox, and PerioChip are common locally delivered antibiotics used in periodontal treatment.
Host modulation therapy aims to down-regulate the destructive host response to bacterial challenges in periodontitis.
Sub-antimicrobial dose doxycycline is used to inhibit MMPs, reducing the destruction of the periodontal ligament.
MD gain and PDGF are local host-modifying agents used in periodontal regeneration.
Occlusal correction addresses the issue of traumatic occlusion, which can worsen periodontal conditions.
Splinting is used to improve patient comfort by immobilizing excessively mobile teeth.
Frenum involvement can be corrected through procedures like frenum plasty, tunneling, root amputation, or hemisection.
Frenum plasty improves access for cleaning by moving the frenum attachment and smoothing the area.
Tunneling involves removing bone and repositioning tissues to create a visible passage for easier cleaning.
Root amputation involves cutting off one root and recontouring the root area for improved hygiene.
Hemisection cuts a molar in half, treating each half as a separate tooth for better hygiene.
Transcripts
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