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Perio Q4 heat
Terms in this set (49)
1. oral bacteria (pathogenic)
2. environmental factors (smoking, diabetes etc.)
3. genetic factor
when these 3 things intermingle that determines the developing and severity of perio disease:
something new that they are trying to develop to understand perio disease?
perio is complex disease- presence of microbial pathogens is necessary but not solely sufficient to cause disease
single nucleotide polymorphism
What does SNP stand for?
variation at a specific location found in more than 1% of the population
-common genetic variants that able to cause alterations in genetic code as in base pair substitutions
What is SNP?
heritable environmental influences on genetic expression
(a mechanism for regulating gene activity independent of DNA sequence that determines which genes are turned on or off)
what is epigenetics?
methylation- addition of a methyl group, which changes how genetic code is expressed
epigenetics most common modification which generally causes gene silencing is?
epigenetic patterns to most conditions that lead to disease
evidence suggests that lifestyle of smoking, food intake, lack of exercise and drug use strongly influence?
1. certain orange and red complex bacteria can cause epigenetic changes in cells and tissues
Ex: orange- C. rectus <---- especially this one
2. up/down regulation of transcription factors for genes involved in inflammation
epigenetic in perio?
- vitamin D receptor
- Interleukin 1b (IL-1b)
- tumor necrosis factor (TNF)- alpha
- estrogen receptor- alpha
what are some candidate genes for perio?
or asked: 2 polymorphisms that could be associated with aggressive perio?
- affects both bone metabolism and immunity
- important for calcium resorption in bone which is needed for osteoid to become calcified
Vitamin D receptor importance?
can down- regulate or inhibit production or function of the inflammatory mediators released by the host-bacterial interaction
host modulation (HMT)
Golub and Williams
found that when the diabetic rats, with lots of collangease activity, were given an antibiotic, they had improved gingival health due to it inhibiting the host's collagenase (which breaks down collagen)
fathers of HMT and their findings?
-continued breakdown and inflammation despite conventional therapy
HMT is useful in patients with?
periostat- has doxycycline 20mg
name a HMT and what's the drug in it?
-downregulates MMP-> which inhibits collagenase activity to stop tissue destruction
how does periostat (doxycycline 20mg) work?
-refractory periodontitis: low plaque score & low response to perio therapy
-cases of residual pockets in b/t SRP session or in areas where surgery has not completely reduced uncleansible pockets
indications from adjunctive therapies and when they are appropriate for patient
LDAs - local delivery antimicrobial agents
- used to put into perio pockets in order to reduce sub gingival bacterial flora
- work best if site 5-7mm
- 8mm or greater the effectiveness decreases
what are available for use as adjuncts to scaling and root planing (SRP)?
Arestin- 1mg minocycline
periochip- 2.5mg chlorhexidine
atridox- 10% doxycycline
Local antibiotics (3 of them)
- used when you feel traditional therapy may not be successful
a treatment modality used in addition to traditional perio therapy
-systemic and localized antibiotics: they can't penetrate biofilm alone
- host modulation
- occlusal therapies
adjunctive therapies include
peri-implant mucositis= inflammation but NO bone loss
peri-implantitis= inflammation & bone loss
diagnosis for perio implant diseases & describe characteristics
1) Amoxicillin 500mg/metronidazole 250-500mg TID 7-14 days
1) clindamycin 300mg TID 7-10 days
2) metronidazole/ Ciprofloxacin both 500mg BID 8 days
3) Doxycycline 100-200mg qd for 21 days
what antibiotics could you prescribe for aggressive periodontitis?
issues with implants:
- non mobile with SOME bone loss & pocketing
- clinically stable
- non mobile with MORE bone loss/ pocketing
- refractory to therapy & continuing to worsen
- circumferential peri-implant radiolucency, totally refractory to treatment
- deep intrabony pockets
- narrow defect
- more walls (3>2>1)
what are 3 factors for regenerative surgery?
injury resulting in tissue changes from EXCESSIVE occlusal forces applied to a tooth or teeth with NORMAL support
occurs in presence of:
--normal bone levels
--normal attachment levels
--excessive occlusal forces
primary occlusal trauma
injury resulting in tissue changes from excessive OR normal occlusal forces applied to a tooth/teeth with REDUCED perio support
occurs in presence of:
-- attachment loss
-- normal/excessive forces
secondary occlusal trauma
widening of PDL space on radiograph
chipped enamel or crown/root fractures
some clinical features of occlusal trauma?
removable or fixed appliances
extraction of selected teeth
treatment considerations for chronic perio with occlusal trauma?
excessive occlusal forces on reduced periodontium result in increased?
when probing around implant how much pressure do you use?
pressure for normal tooth?
- they can't move
- NO PDL or cementum
- reduced tactile sensitivity and reflex function
- reduced blood supply
difference between normal teeth and implants?
Inflamed tissues- probe will go to bone level
what are probing depths for healthy implants?
bumblebee plastic perio probe
titanium cavitron scalers
gold perio problem
titanium perio probes
name 2 special instruments used for diagnosis and maintenance of implants?
diagnosis for implants? 3
what kind of entry you put into epic to record your patient care?
2 things that could cause perio abscess
2 ways to determine amount of bone around an implant?
biological width on implant tend to be longer as in ______ mm
biological width on normal tooth is ____ and its has perpendicular CT fibers unlike implants
most common type of restorable splinting
periodontal attachment loss
what is most common cause of diagnosed & charted mobility?
this tissue type is important for well being and esthetics of implant
Have to have radiograph to diagnose implants?
1st year after restoration perform recall every ____ months?
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