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Dr. Ignacio Yañez Polo
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GUMS DISEASES PREVENTION AND THERAPY
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1.- ORAL INSTRUCCTIONS IN THE PUBLIC HEALTH SERVICE
This combined procedure's primary purpose is to educate and train the patient with a hands-on approach in order to develop excellent oral hygiene skills for a better controlling the cause of periodontal disease (bacterial plaque). A prophylaxis (regular dental cleaning and polishing) is done simultaneously to remove deposits of plaque, calculus, stain from the surfaces of the teeth that are above the gum to facilitate development of better home care techniques.
How to brush ?
1. For thorough but gentle cleansing, use a soft toothbrush 4. Inside back teeth. Use short, angled brush strokes.
2. Hold your brush at a 45° angel. Begin by brushing the outside of the front teeth. Use a gentle back-and-forth motion. 5. Inside front teeth. Tilt the brush vertically; use an up-and-down motion.
3. Next, brush the outside back teeth, starting along the gumline. 6. Chewing surfaces. Hold the brush flat. Use a gentle scrubbing motion.
7. Replace your old toothbrush
at least every 1-2 months
2. TERAPIA PERIODONTAL
Periodontal Scaling and Root Planing is a conservative cleaning procedure meant to remove contamination and infection from beneath the gum. Scaling removes deposits of bacterial plaque, calculus, food debris, and pus that have accumulated in the infect pocket due to periodontitis.
Root planing smoothes and cleans the root of the tooth so that the gum tissue may heal next to the tooth. Scaling and root planing is usually performed in one section of the mouth at a time using local anesthesia for your comfort. This non-surgical treatment is often effective in allowing complete healing of early stages of periodontitis and may reduce the extent of surgical treatment needed when performed in more advanced stages of gum disease.
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3. What Role do Systemic Antibiotics Play in the Treatment of Periodontal DiseaseA
Numerous Periodontists have evaluated the ADJUNCTIVE use of systemic antibiotics (by mouth) to halt the progression of gum (Periodontal) disease. Some benefit has been demonstrated when these medications are incorporated into the treatment protocol (used during such conservative procedures such as scaling and root therapy.
Current data to suggest that the use of systemic adjunctive antibiotic therapy to reduce the need for periodontal surgery are limited and require further study for valication.
However, given the potential side effects of these drugs, including the development of resistent bacterial strains or increased growth of opportunistic organisms (yeast infections), incorporation of systemic antibiotic therapy into the routine management for the majority of adult periodontitis cases cannot be justified at this time.
Systemic antibiotic therapy should be reserved for patients with continuing periodontal breakdown despite meticulous scaling and root planing and oral hygiene care. In addition, patients at high risk for periodontal breakdown, such as juvenile periodontitis (genetic-predisposed) and patients with other early-onset forms of periodontitis, may be treated with antibiotcs in CONJUNCTION with conventional forms of treatment, as scaling and root planing.
Just What Antibiotics are Used in Treating Periodontal Disease:
AUGMENTIN
Usual doseage: 500 Mg. taken twice per day for atleast 8 days
Dangerous side effect: Severe Diarhea or Collitis!
AMOXICILLIN
Usual doseage: 500 Mg. taken twice per day for atleast 8 days
METRONIDAZOLE (also known as FLAGYL)
Usual doseage: 500 Mg. taken twice per day for atleast 8 days
Dangerous side effects: Dizziness and Blurry Vision, along with Headache
CLINDAMYCIN- Usually used if a patient is allergic to "penicillin"
Usual doseage: 300 Mg. taken twice per day, but only for 5-6 days
Dangerous side effect: Severe Diarhea or Collitis!
CIPROFLOXACIN
Usual doseage: 500 Mg. taken twice per day for atleast 8 days
TETRACYCLINE OR DOXYCYCLINE
Usual doseage for Tetracycline: 500 Mg. taken four times per day for atleast 14 days
Usual doseage for Doxycline: 100 Mg. taken twice per day for atleast 14 days
Dangerous side effects:
Severe sunburn if exposure to bright sunshine
Severe stomach cramps and nausea
Combination of Antibiotics for Better Results:
AUGMENTIN and METRONIDAZOLE
CIPROFLOXACIN and METRONIDAZOLE
How to take combination pills:
Usually you take TWO tablets of EACH per DAY or 4 Pills altogether:
Start off with Augmentin or Cipro before breakfast
Take Metronidazole before lunch
Take Augmentin (or Cipro) again before dinner
Lastly, take Metronidazole before bedtime
Please follow the instructions for taking antibiotics carefully. There can be very serious side effects that if not heeded can make you very sick. If you have any problems, discontinue them right away and call Dr. Mao.
One way to prevent diarhea is to take YOGURT ("live culture"-plain).
WHEN TO START TAKING THE ANTIBIOTICS?
Usually, START the Morning of the FIRST VISIT for Scaling and Root Planing or Surgery
4. LOCAL ANTIOBIOTiC
Artridox ( Doxiciclina) is now available as a conservative, non-surgical mode of periodontal therapy. It is mostly used when or if conventional periodontal therapy, whether it be surgical or non-surgical (scaling and root planing), does not appear to be working.
Atridox is basically an antibiotic, namely doxycycline which many people have taken atleast once in their lives. But, this new mode of delivery is much more effective than taking the antibiotic in pill form (by mouth).
Atridox is placed directly into the pocket (see photo on left) and allowed to convert into gel-form. It is thru this gel-type form of delivery into the pocket that allows the antibiotic to become time-released over a one to two week period. In addition, the antibiotic can penetrate deep into the pocket and reach even those bacteria (which are susceptible) that are located within the gum tissue itself. It reaches beyond where dental instruments can reach in many cases. Click here if you would like to learn much more about the Atridox
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5.- -Professional Statement on Atridox™ 8.5% doxycycline in the Atrigel® Delivery System
The Atridox™ product (8.5% doxycycline in the Atrigel® Delivery System) combines a biodegradable polymer with doxycycline, an antibiotic that kills bacteria associated with periodontal diseases. It is a site-specific anti-microbial delivery system intended for use in the non-surgical treatment of chronic adult periodontitis.
The treatment is applied to an infected periodontal pocket as a fluid, where it solidifies, releasing the drug for a period of about seven days. Gain of attachment and reduction of pocket depths are the primary clinical parameters used to assess outcomes after periodontal therapy.
Analysis of clinical trial with Atridox revealed:
Atridox was statistically superior to placebo.
Atridox was clinically equivalent to scaling and root planing.
Both Atridox and scaling and root planing were statistically superior to oral hygiene alone.
It should be noted that mean probing depth reduction (1.3 mm) and gain of clinical attachment (0.8mm) are considered limited alterations in patients with advanced periodontitis. Therefore, the magnitude of expected results need to be considered by each practitioner in light of the severity of the defects being treated.
Concern has been expressed in the medical/dental community regarding the development of resistance to commonly used antibiotics. Accordingly, the use of antibiotics is often reserved for sites that are non-responsive to conventional therapy. At present, the Academy is not aware of any data available regarding the need for further surgical or non-surgical treatment of sites after treatment with Atridox.
In addition, the Academy is not aware of any studies that have addressed the use of Atridox in diseases other than adult periodontitis (i.e., localized juvenile periodontitis, rapidly progressive periodontitis). Likewise, the Academy is not aware of any investigations that have addressed the utility of Atridox in specific types of defects, such as furcations, intrabony lesions. Long-term (>1 year) data regarding the stability of treatment outcomes are also not available.
Each practitioner must determine the usefulness of Atridox in light of the available data and the needs of the individual patient. Thus, further studies are warranted to determine the long-term benefits for use of Atridox as an adjunct to root planing and scaling.
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6.-Professional Statement on PerioChip chlorhexidine containing resorbable polymer
The PerioChip is designed to be placed in a periodontal pocket > 5 mm after scaling and root planing. This device releases chlorhexidine as the polymer is resorbed.
Published studies have indicated that subgingival administration of chlorhexidine in a controlled release device reduces subgingival bacteria and improves gingival health. Randomized controlled clinical trials that compared the efficacy of scaling and root planing alone to scaling and root planing plus PerioChip revealed statistically significant benefits of adjunctive chip use with regard to reducing probing depths (0.65 mm versus 0.95 mm) and gain of clinical attachment (0.58 mm versus 0.78 mm).
However, the magnitude of these changes was small (0.3 mm). Furthermore, it should be noted that these are considered limited alterations in patients with advanced periodontitis. Therefore, the magnitude of the results needs to be considered by each practitioner in light of the defects being treated. Additional research needs to clarify potential uses of this local delivery system.
At present, the Academy is aware of no data regarding the need for further surgical or non-surgical treatment of sites after treatment with PerioChip. Furthermore, the Academy is not aware of any studies that have addressed the use of PerioChip in diseases other than adult periodontitis (i.e., localized juvenile periodontitis, rapid progressive periodontitis). Similarly, the Academy is not aware of any investigations that have addressed the utility of PerioChip in specific types of defects (i.e., furcations, intrabony lesions). Long-term (>1 year) data of stability of treatment outcomes are also not available.
Each practitioner must, of course, determine the usefulness of PerioChip in light of the available data and the needs of the individual patient.
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7.- Periostat®
Is antibiotic available as a 20 mg capsule of doxycycline hyclate ( also know to many people as a form of Tetracycline) for oral administration and is indicated as an adjunct to scaling and root planing (SRP) a procedure done by your Periodontist to promote the reduction of pockets around the teeth. Periostat works by attacking the enzymes (collagenases) that are produced by the cells within the pockets and inside the gum tissue itself. These enzymes are produced in response to a bacterial invasion of the gum and pockets with adult periodontitis (gum disease). The Periostat® is available by prescription only and has been available in pharmacies since Thanksgiving 1998.
Periostat® is the only treatment that suppresses the pathologically elevated levels of tissue-destroying enzymes that may lead to tooth loss in adult periodontitis. And as a systemic therapy, Periostat® treats all periodontal pockets throughout the mouth simultaneously. Click here if you would like to learn much more about the Atridox
QUESTIONS AND ANSWERS FOR USE OF PERIOSTAT
Q: How does Periostat work?
A: Periostat works by suppressing the enzymes that destroy the gum tissues and bone.
Q: Why should I take Periostat?
A: Recent research suggests that periodontitis is best treated by a two-pronged approach: one is reduction of bacterial load in the periodontal pocket and the other is enzyme suppression. Periostat® is the only treatment that suppresses the pathologically elevated levels of tissue-destroying enzymes that may lead to tooth loss in adult periodontitis. And as a systemic therapy, Periostat® treats all periodontal pockets throughout the mouth simultaneously.
Q: When should I take Periostat?
A: Periostat should be take twice daily, one capsule in the morning and one in the evening, about an hour before meals.
Q: How Long should I take Periostat?
A: Your Periodontist will provide specific instructions on the length of your therapy. Periostat can be take for a period of 3 to 9 months. The length usually will depend on how bad your perio problems are and your tolerance to the antibiotic.
Q: What if I forget to take a capsule?
A: Just resume taking the next sheduled dosage. Do Not double up to make up for missed capsules.
Q: Are there any people who should not take Periostat?
A: Any one who has shown hypersensitivity to any of the tetracyclines or in infants or children under 8 yrs of age. PREGNANT or NURSING mothers should NOT take Periostat. If you are on birth control pills, Periostat may render oral contraceptives less effective.
Q: What are some ADVERSE REACTIONS?
A: If you are exposed to direct sunlight or ultraviolet light, the use of Periostat may cause an exaggerated sunburn.
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8.- Periodontal Maintenance Procedures
Is follow active Periodontal therapy. Afterward, an interval is established for periodic ongoing care. This care is under the supervision of the periodontist and includes an update of the medical history, an evaluation of the periodontal status, removal of bacterial plaque from crevicular and pocket areas, scaling and root planing where indicated, polishing, and review of the patient's plaque control efficiency. The time of the interval will vary, depending on the clinical judgment of Dentist.
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