Periodontal Disease

Periodontal Disease

1. Initial therapy: Treats the cause of disease, controls infection and manages aetiological factors

   • Corrective therapy: Comprises therapeutic measures, option for perio surgery and option for adjunctive treatments
     • Supportive therapy: Prevents recurrence, stabilises perio condition and maintains optimum perio health

2. Biofilm formation: 1. Pellicle formation 2. Transport 3. Long-range interactions 4. Short-range interactions 5. Co-aggregation 6. Multiplication 7. Detachment

3. Plaque hypothesis, Specific plaque hypothesis and Ecological plaque hypothesis

4. Stages of development from gingivitis to perio

   • Initial lesion
     • Early gingival lesion
       • Established lesion
         • Advanced lesion

5. Tissue response and healing = reduced pocket depths following...

   • 1. Shrinkage of tissues following reduction of inflammation
     • 2. Formation of a LJE which attaches the gingiva to the clean root surface
       • 3. Tightening of the gingival cuff as gingival collagen fibres reform
         • 4. A small amount of reattachment may occur at the base of the pocket

6. Failure of treatment

   • BOP
   • Redness
   • Swelling
   • Persistent deep pockets
     • Or increasing depths
   • Supparation
   • Increasing mobility
   • Reasons for failure
     • Inadequate patient plaque control due to...
       • Lack of compliance
         • Lack of dexterity
     • Residual deposits remain and harbor plaque due to...
       • Deep pockets
         • Furcation, concavities, root grooves
           • Inexperienced operator

7. Role of antimicrobial therapy in perio

   • Systemic AB's
     • Advantages
       • Perio diseases are bacterial
       • Some have a small number of species
       • AB's are widely available & cheap
       • Can access sites mechanical therapy cannot
       • Fulfils pt's expectations = view as part of their therapy
     • Disadvantages
       • Perio involves many species so they're difficult to identify and target
       • Pathogens are part of the oral flora & found in perio healthy & unhealthy
       • Overuse of AB's = AB resistance
       • Concentrations of microbials in crevicular fluid are low
       • Plaque biofilm affects bacterial response to agent
       • Pt compliance = taking entire course of AB's