Its Not Just Perio Anymore Webinar

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Its Not Just Perio Anymore Webinar

  1. 1. Inflammatory Diseases: It’s Not Just Perio Anymore February 5, 2010 MOHC Lory Laughter, RDH, BS
  2. 2. Credentials • Clinical RDH – 16 years experience • Columnist for RDH Magazine – 4 years • Corporate Consultant – 2 years • National Speaker – 3 years
  3. 3. Disclosures • Hygiene Specialist – Orapharma • Dental Relations Manager – Nuvora Inc
  4. 4. Course Disclosure • List of diseases is not complete • Information changes often • Stay current
  5. 5. Inflammation • A localized protective reaction of tissue to irritation, injury, or infection, characterized by pain, redness, swelling, and sometimes loss of function. • Inflammatory disease is one of a number of diseases characterized by inflammation
  6. 6. INFLAMMATORY RESPONSE When bacteria invade tissue WBC are dispatched to destroy the threat. The WBC devour the foreign cells (bacteria) and secrete oxidants and cytokines to signal for more WBC.
  7. 7. Cytokines and your Heart • Proinflammatory cytokines – reduce infection and increase inflammation • Antiinflammatory cytokines – may be increased by Vitamin D. • Suggested link between impaired Vit. D and chronic heart disease. Ray Sahelian, M.D
  8. 8. Inflammatory Response • Systemic response to inflammation • Liver produces C-Reactive Protein • White blood cells • Dilation of blood vessels
  9. 9. C- Reactive Protein • Measured in blood to detect infection • Produced by liver • High levels in blood associated with Cardiovascular events, stroke and diabetes
  10. 10. Sed Rate • Measures how quickly erythrocytes settle in a vial of blood • High levels suggest inflammation • Not site specific and can be elevated by other causes such as fatigue and diarrhea
  11. 11. Systemic Response • Immune response is essentially the same regardless of the location of inflammation. • Often difficult to isolate the cause of inflammation – diagnosis of inflammatory diseases is often complicated. • Inflammatory diseases can/do co-exist
  12. 12. INFLAMMATORY RESPONSE Prolonged high levels of CRP signal a chronic inflammatory state Women's Health Initiative states: increased levels of CRP are linked to cardiovascular diseases
  13. 13. INFLAMMATORY RESPONSE Women with increased CRP 5 times the risk for cardiovascular disease 7 times the risk for Heart Attack
  14. 14. PAD: Peripheral Arterial Disease • Narrowing or blockage of arteries that results in poor blood flow to the arms and legs • Can cause painful cramps when walking or exercising
  15. 15. Possible Causes of PAD • Build up of plaque inside the walls of the arteries – atherosclerosis. • Gradually develops over a lifetime. • High cholesterol, high blood pressure, and smoking contribute to atherosclerosis and peripheral arterial disease.
  16. 16. Possible Causes of PAD • In some cases, peripheral arterial disease can be unrelated to atherosclerosis and caused instead by inflammation of the blood vessels (vasculitis) and old injuries that damaged blood vessels. • Decrease in blood flow ‘starves’ tissues and muscles in the lower body
  17. 17. Risk factors for PAD • High LDL Cholesterol • High Blood Pressure • Smoking • Diabetes • High Homocysteine levels
  18. 18. Symptoms of PAD • Weak or tired legs • Difficulty walking or balancing • Cold/numb feet or toes • Sores that are slow to heal • Foot pain while at rest – advancing disease • Erectile dysfunction • Often NO symptoms until very advanced
  19. 19. Treatment for PAD • Diet to lower cholesterol and BP • Low impact exercise • Angioplasty • Medications
  20. 20. Medications for PAD • Antiplatelets – Plavix or aspirin • Cilostazol – serious side effects • Statins – lower cholesterol • HBP medication
  21. 21. Oral Complications of PAD • Slow healing – Tissue trauma from smoking or biting • HBP Meds – Dry mouth – Tooth decay – Gingival hyperplasia
  22. 22. Dental Treatment Considerations • Periodic position changes • Lesions may heal slower • pH concern from dry mouth • Increased decay rate
  23. 23. Colitis • Inflammation of the large intestine and colon • Bacterial imbalance • Can be spread from person to person
  24. 24. Causes of Colitis • Clostridium difficile • Antibiotic therapy • Infected by another person • Inadequate immune system
  25. 25. Symptoms of Colitis • Diarrhea • Cramping • Fever • Blood in stool • Possible abnormal heart beat
  26. 26. Oral Complications • Periodontal inflammation • Yeast infections • Erosion from nausea and/or vomiting • Will not see during acute disease
  27. 27. Treatment for Colitis • Vancomycin and/or metronidazole • Fluids and electrolytes • Blood transfusion if severe anemia occurs • Possible surgery to remove area of perforations
  28. 28. Dental Treatment Considerations • Repair areas of erosion • Neutralize pH of oral cavity • Treat infections locally and early • May not absorb vitamins/minerals well
  29. 29. Dental Treatment Considerations • Judicious use of systemic medications • Systemic Flouride not recommended • Be aware of complexion • Check with MD during steroid treatments
  30. 30. Rheumatoid Arthritis • Inflammation in the tissue lining the joints • Over time destroys tissue in joints and limits movement • 2 -3 times more common in women • Symptoms often begin at 40 -60
  31. 31. Causes of Rheumatoid Arthritis • Exact cause is not known • Autoimmune disease • Appears to be some genetic tendencies
  32. 32. Symptoms of Rheumatoid Arthritis • Pain, Stiffness and Swelling of joints • Affects both sides of the body • Rarely affects eyes, lungs, heart and nerves
  33. 33. Symmetrical Symptoms Affects small and large joints in symmetry
  34. 34. Risks for Rheumatoid Arthritis • Genetic predisposition • Female • Between age of 40 – 60 • Cracking your knuckles does NOT cause or increase symptoms
  35. 35. Treatment for Rheumatoid Arthritis • Disease-modifying antirheumatic drugs (DMARDs) • Corticosteroids • Weight control / exercise / adequate rest
  36. 36. Other Treatments for RA • Physical Therapy • Biofeedback • Breathing exercises • Acupuncture
  37. 37. Oral Complications of RA • Stiffness of TMJ • Medication side effects – Mouth sores – often wide spread and painful – Dry mouth – Vomiting – erosion of enamel
  38. 38. Dental Treatment Considerations • Bite block and rest periods • Higher decay rate • Warm blanket or pillow around joint • Short appointments not first thing in day • May be slow to heal from tissue trauma
  39. 39. MSRA • methicillin-resistant Staphylococcus aureus • Can cause infection of skin, heart, blood and bones • Can be spread person to person • Can be hospital acquired – esp post surgery
  40. 40. Causes of MSRA • Over population of Staphylococcus • Injudicious use of antibiotics • Unsterile surgical environment • Person to person spread
  41. 41. Symptoms of MSRA • Skin infection that will not heal • High fever • Pain and/or edema • Drainage from wound – not healing • Fainting
  42. 42. Treatment for MSRA • Antibiotics – intravenous common • Debridement of wound • NSAIDs • Long term monitoring – CRP and Sed Rate
  43. 43. Dental Treatment Considerations • Resistant to antibiotics • No treatment when CRP is high • Susceptible to oral inflammation • Dry Mouth/ sores from NSAIDs
  44. 44. Dental Considerations • Clinician/patient should not be in the office if MSRA is active • If outward skin lesions are present, avoid person to person contact • No office personnel in office when lesions are present – not even at desk jobs
  45. 45. Periodontitis • Inflammatory Disease – Infection – Not a disease of calculus • Increased CRP levels • Often undiagnosed in early stages
  46. 46. Causes of Periodontitis • Periodontal disease is a bacterial infection, specifically, red complex bacteria (RCB). • The bacteria associated with periodontal disease reside within biofilms above and below the gingival margin. • Biofilms are dense mixtures of organisms resistant to natural antibodies and proteins that the body uses to fight infection.
  47. 47. INFLAMMATORY RESPONSE • Cytokines in Periodontal Disease most often represented as IL-1 (interleukin 1) • Additional biomarkers in Periodontal Inflammation: ICTP (cross-linked carboxy- terminal telopeptide type 1 collagen)
  48. 48. Treatment for Periodontitis • Mechanical debridement of infected sites – Scaling and Root Planing (non-surgical therapy) • Site specific antibacterial agents – Arestin/Atridox/Periochip – Subgingival Irrigation • Maintenance and monitoring
  49. 49. Treatment for Periodontitis • Systemic anti-inflammatory – Periostat (low dose doxycycline) • Occasionally systemic antibiotics – Stop the inflammatory cascade – Potent and short-term
  50. 50. ARESTIN Distributed by OraPharma Minocycline hydrochloride 1 mg prefilled carpule Adjunct to Scaling and Root Planing Easy application
  51. 51. Treatment for Periodontitis
  52. 52. LAA Facts • The LAA ARESTIN® (minocycline hydrochloride) Microspheres, 1 mg can help eliminate the bacteria that SRP can leave behind including: – P gingivalis – T denticola – T forsythia 2 x as effective as SRP alone in reducing RCB
  53. 53. Bacterial Reduction with LAA In a recent microbiological study of patients with moderate-to-severe periodontitis, ARESTIN® + SRP: significantly reduced the quantity of red complex bacteria VS SRP alone.
  54. 54. Citations • Williams RC, Paquette DW, Offenbacher S, et al. Treatment of periodontitis by local administration of minocycline microspheres: a controlled trial. J Periodontol 2001;72:1535-1544 • American Academy of Periodontology Research, Science, and Therapy Committee. Guidelines for periodontal therapy. J Periodontol 2001;72:1624- 1628.
  55. 55. ATRIDOX Doxycycline hyclate 10% Flexible dosing – treat multiple teeth Gel that flows into pocket May not completely dissolve
  56. 56. ATRIDOX • An important option in the treatment of chronic adult periodontitis. - Flows to the bottom of pocket, readily adapting to root morphology - Controlled release of doxycycline for a period of 7 days - Bioabsorbable- removal may still be needed - Takes only minutes to prepare and administer
  57. 57. ATRIDOX Solidifies to a wax-like substance in minutes - Patient friendly - no anesthesia required Provides dosing flexibility. - Can effectively treat multiple sites with a single syringe. www.atridox.com
  58. 58. PERIO CHIP Chlorhexidine gluconate 2.5 mg in a matrix of hydrolyzed gelatin/glutaraldehyde Broad spectrum anti microbial Single dose chip placed in pocket
  59. 59. Perio Chip at 9 month check • Twice as many patients (30.3%) receiving PerioChip and SRP, had a PD reduction of 2mm or more (vs. control: 13.5%) • Control = SRP alone (or with Placebo chip) vs. SRP & PerioChip. • Chip was placed 1 hour after Scaling and Root Planing, and repeated at 3 and/or 6 months if PD remained 5mm or more.
  60. 60. SUBGINGIVAL IRRIGATION Place antimicrobial solution into pocket - blunt end syringe - endo type syringe - powered irrigation device + allows for pulsating action + cannulas to reach deeper
  61. 61. Inflammatory Diseases and Women • Be an advocate for early detection • Insist on testing for unhealed or slow healing lesions or edema • Encourage the women in your life to be proactive
  62. 62. IBC • Often misdiagnosed as skin infection • Systemic complications from inflammation • Lowest 5 year survival rate • Insist on testing for unhealed skin lesions
  63. 63. Pelvic Inflammatory Disease • Infection of uterus, fallopian tubes and other reproductive organs • Serious complication of some STDs • Inflammation often goes undiagnosed for years – patients don’t seek medical care
  64. 64. PID in the United States • 1million women experience acute PID yearly in the US alone • 100,000 become infertile each year from PID • 150 women die yearly from PID complications
  65. 65. PID • Associated with gonorrhea and chlamydia • Many sexually transmitted bacteria can lead to PID • Number of sex partners associated with PID - both of the woman and her partner
  66. 66. PID Symptoms • Unrecognized by health care professionals 2/3 of the time • Abdominal pain • Discharge • Foul odor • Irregular vaginal bleeding
  67. 67. PID Diagnosis • Ultrasonic evaluation • Bacterial testing – blood and discharge • Laprascopy often required
  68. 68. PID Treatment • At least two antibiotics simultaneously • Woman and her partner both treated • Surgery for abscesses or scarring occurs
  69. 69. PID Consequences • In untreated can lead to – Ectopic pregnancy – Severe Pain – Internal bleeding – DEATH
  70. 70. Inflammatory Diseases • Localized manifestation of systemic condition • Often undiagnosed until later stages • Increased risk for cardiovascular events
  71. 71. Our Role • Health Care Provider • Screenings provide valuable information – BP – Oral Cancer Screening • Recommend further evaluation
  72. 72. Where to Look • PubMed • Web MD • Kaiser – www. kp. org • Amy’s List – AmyRDH.com
  73. 73. Questions

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