When to refere? - PowerPoint Presentation


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When to refere? - PowerPoint Presentation

  1. 1. AAP Classification of Periodontal Diseases and Conditions (1999) <ul><li>Gingival Diseases </li></ul><ul><ul><li>Dental plaque-induced gingival diseases </li></ul></ul><ul><ul><li>Non-plaque induced gingival lesions </li></ul></ul><ul><li>Chronic Periodontitis (Slight: 1-2mm CAL; moderate: 3-4mm CAL; severe: >5mm CAL) </li></ul><ul><ul><li>Localized </li></ul></ul><ul><ul><li>Generalized (>30% of sites are involved) </li></ul></ul><ul><li>Aggressive Periodontitis (Slight: 1-2mm CAL; moderate: 3-4mm CAL; severe: >5mm CAL) </li></ul><ul><ul><li>Localized </li></ul></ul><ul><ul><li>Generalized (>30% of sites are involved) </li></ul></ul><ul><ul><li> </li></ul></ul>
  2. 2. AAP Classification of Periodontal Diseases and Conditions (1999) <ul><li>Periodontitis as a Manifestation of Systemic Diseases </li></ul><ul><ul><li>Associated with hematological disorders </li></ul></ul><ul><ul><li>Associated with genetic disorders </li></ul></ul><ul><ul><li>Not otherwise specified </li></ul></ul><ul><li>Necrotizing Periodontal Diseases </li></ul><ul><ul><li>Necrotizing ulcerative gingivitis </li></ul></ul><ul><ul><li>Necrotizing ulcerative periodontitis </li></ul></ul><ul><li>Abscesses of the Periodontium </li></ul><ul><ul><li>Gingival abscess </li></ul></ul><ul><ul><li>Periodontal abscess </li></ul></ul><ul><ul><li>Pericoronal abscess </li></ul></ul>
  3. 3. AAP Classification of Periodontal Diseases and Conditions (1999) <ul><li>Periodontitis Associated with Endodontic Lesions </li></ul><ul><ul><li>Combined periodontic-endodontic lesions </li></ul></ul><ul><li>Developmental or Acquired Deformities and Conditions </li></ul><ul><ul><li>Localized tooth-related factors that modify or predispose to plaque-induced gingival diseases periodontitis </li></ul></ul><ul><ul><li>Mucogingical deformities and conditions around teeth </li></ul></ul><ul><ul><li>Mucogingival deformities and conditions on edentulous ridges </li></ul></ul><ul><ul><li>Occlusal trauma </li></ul></ul><ul><li>The Periodontal Disease Classification System of the American Academy of Periodontology - An Update, Journal of Canadian Dental Association, 2002; 66:549-7 </li></ul><ul><li>Crystal S. Baik </li></ul>
  4. 4. What is Refractory Periodontal Disease <ul><li>Refractory periodontal disease refers to destructive periodontal diseases in patients who demonstrate continued attachment loss in spite of adequate treatment and proper oral hygiene. </li></ul><ul><li>Contributing factors include:type of therapy provided, furcation involvement, microflora, and smoking history. </li></ul><ul><li>Journal of Canadian Elizabeth Black </li></ul><ul><li>Dental Association, December 2000 </li></ul>
  5. 5. Periodontal Disease and Diabetes <ul><li>The diabetic state is associated with: </li></ul><ul><ul><li>Decreased collagen synthesis </li></ul></ul><ul><ul><li>Increased collagenase activity </li></ul></ul><ul><ul><li>Altered neutrophil function </li></ul></ul><ul><li>Elevated blood sugar levels suppress the host’s immune response and results in: </li></ul><ul><ul><li>Poor wound healing </li></ul></ul><ul><ul><li>Susceptibility to recurrent infections </li></ul></ul><ul><li>Periodontal disease is often considered the 6 th complication of diabetes and may place the individual at risk for future diabetic complications </li></ul>
  6. 6. Periodontal Disease & Diabetes <ul><li>BRITTLE DIABETICS: </li></ul><ul><li>More susceptible to gingivitis, gingival hyperplasias and periodontitis </li></ul><ul><li>More harmful proteins (cytokines) in their gingival tissues </li></ul><ul><li>Decreased beneficial proteins (growth factors)  interferes with the healing response </li></ul><ul><li>Increased levels of serum triglycerides may be related to greater probing depths and attachment loss </li></ul>
  7. 7. Periodontal Disease and Diabetes <ul><li>TREATMENT: </li></ul><ul><li>Closely monitor blood glucose levels </li></ul><ul><li>Maintenance of meticulous oral hygiene and strict recall appointments </li></ul><ul><li>Short appointments in relaxed, non-stressful environment </li></ul><ul><li>Have source of oral glucose available </li></ul><ul><li>Effective treatment of periodontal infection and reduction of periodontal inflammation are associated with a reduction in the level of glycosylated hemoglobin – the marker of diabetic control </li></ul>
  8. 8. Periodontal Treatment and Diabetes - The diabetic patient requires special precautions prior to periodontal treatment -treatment in the uncontrolled diabetic is contraindicated -treatment in the “brittle” diabetic requires prophylactic antibiotics, started 2 days preoperatively (Penicillin VK) and continuing through the immediate post-op period -treatment of the well-controlled diabetic may the same as an ordinary patient
  9. 9. Periodontal Treatment and Diabetes <ul><li>Protocol for Treatment: </li></ul><ul><ul><li>Clinician should make sure that prescribed insulin has been taken, followed by a meal </li></ul></ul><ul><ul><li>Morning appointments are appropriate because of optimal insulin levels </li></ul></ul><ul><ul><li>Monitor vitals, including blood glucose prior to treatment </li></ul></ul><ul><ul><li>Procedures performed may alter the patient’s ability to maintain caloric intake, therefore post-op insulin doses should be altered accordingly </li></ul></ul><ul><ul><li>Tissues should be handled as atraumatically and minimally as possible (less than 2 hrs) </li></ul></ul><ul><ul><li>Epinephrine should not be used in concentration greater than 1:100,000 due to epinephrine effects on insulin </li></ul></ul><ul><ul><li>Diet recommendations should be made to maintain proper glucose balance </li></ul></ul><ul><ul><li>Frequent recall and fastidious home oral care should be stressed </li></ul></ul>
  10. 10. Periodontal Treatment and Diabetes <ul><li>Recent Studies: </li></ul><ul><li>-Effective treatment of periodontal infection and reduction of periodontal inflammation are associated with a reduction in the level of glycated hemoglobin </li></ul><ul><li>-Increased serum triglyceride levels in uncontrolled diabetics have been shown to be related to greater attachment loss and probing depths </li></ul><ul><li>-Therefore…Control of periodontal disease should be an important part of the overall management of the diabetic patient </li></ul><ul><li>Sources: </li></ul><ul><li>Carranza and Newman, Clinical Periodontology, 8 th ed. </li></ul><ul><li>Grossi, et al. Treatment of Periodontal Disease in Diabetics Reduces Glycated Hemoglobin. Journal of Periodontology, Vol. 68, No. 8 </li></ul><ul><li>Chris VanDeven </li></ul>
  11. 11. Smoking and Periodontal Disease <ul><li>Smoking is a major cause of periodontal disease. </li></ul><ul><li>Smokers are 4x as likely to develop periodontitis as non-smokers. </li></ul><ul><li>Smoking may be responsible for more than half of the periodontal disease among adults in the U.S. </li></ul><ul><li>Up to 90% of refractory periodontitis patients are smokers. </li></ul>References: 1) Tomar, S., Asma, S. ; J Periodontol 2000;71:743-751 2) Johnson GK. Slach NA. Impact of tobacco use on periodontal status. [Review] Journal of Dental Education. 65(4):313-21, 2001 Apr. Graham Smith
  12. 12. Smoking and Periodontal Disease <ul><li>Smoking may increase levels of certain periodontal pathogens. </li></ul><ul><li>Smoking has a negative effect on host response, such as neutrophil function and antibody production. </li></ul><ul><li>Smoking has been shown to have a cytotoxic effect on gingival fibroblasts and could slow down wound healing. </li></ul>References: 3) Rota MT.; Tobacco smoke in the development and therapy of periodontal disease: progress and questions. [Review] Bulletin du Groupement International Pour la Recherche Scientifique en Stomatologie et Odontologie. 41(4):116-22, 1999 Oct-Dec. 2) Johnson GK. Slach NA. Impact of tobacco use on periodontal status. [Review] Journal of Dental Education. 65(4):313-21, 2001 Apr. Graham Smith
  13. 13. Smoking and Periodontal Disease <ul><li>Smoking may be one parameter to use in deciding to treat refractory periodontitis in smokers with a systemic antibiotic therapy directed against smoking-associated periodontal bacteria. </li></ul><ul><li>Smoking cessation seems to have a beneficial effect on periodontal health. </li></ul>References: 4) Lie MA. [ Smoking as a risk factor for periodontitis ]. [Review] [Dutch] Nederlands Tijdschrift voor Tandheelkunde. 106(11):419-23, 1999 Nov. 5) van Winkelhoff AJ. Bosch-Tijhof CJ. Winkel EG. van der Reijden WA. Smoking affects the subgingival microflora in periodontitis . Journal of Periodontology. 72(5):666-71, 2001 May. Graham Smith
  14. 14. What is Periostat? <ul><li>Doxycycline Hyclate- inhibits collagenase activity and reduces the collagenase activity in gingival crevicular fluid of patients with adult periodontitis </li></ul><ul><li>Indicated for use as an adjunct to scaling and root planing to promote attachment level gain and to reduce pocket depths </li></ul><ul><li>Periostat is available as a tablet(20mg) to be taken orally two times a day (about an hour before, or two hours after meals). Should be taken with plenty of fluids. </li></ul><ul><li>Typical treatments range from 3months to 12months. </li></ul><ul><li>www.Periostat.com R.Macnowski </li></ul>
  15. 15. What is Periostat? <ul><li>Clinical studies have shown that the use of Periostat, along with SC/RP is more effective at regaining attachment level, than treatment with SC/RP alone </li></ul><ul><li>Periostat is the first and only therapeutic agent designed to modulate the host response and helps to slow the progression of periodontal disease. </li></ul><ul><li>Periostat should be used when traditional SC/RP treatments alone are ineffective, but before surgery is indicated. </li></ul><ul><li>www.Periostat.com R. Macnowski </li></ul>
  16. 16. What is Periostat? <ul><li>Periostat is not an antibiotic- the low dosages of periostat have no detectable effect on bacteria. </li></ul><ul><li>Periostat should not be used with children, expecting mothers, nursing mothers, or anyone with a tetracycline hypersensitivity. </li></ul><ul><li>Periostat may cause hypersensitivity to sunlight </li></ul><ul><li>No reports of tooth staining </li></ul><ul><li>May reduce the effect of BCPs </li></ul><ul><li>www.periostat.com R.Macnowski </li></ul>