L THERAPY
Consists of:
•PHASE I
• PHASE II
• PHASE III
• PHASE IV
E&D TREATMENT TREATMENT
PLANNING
OHE BEHAVIOR
SURGICAL
AL CHANGE
PROCEDU
RES
PROPHYLA DEBRIDEME RECONSTRUC
XIS NT TIVE
PROCEDURES
OTHER
DENTAL
TREATMENT
SUPPORTIVE PERIODONTAL
CARE
Phase I therapy is referred to by many
names;
•Initial / first line therapy
•Nonsurgical periodontal therapy
•Cause-related therapy
•Etiotropic phase of therapy
PHASE 1
PHASE 1
AIM of Therapy;
Rationale;
Pathogenic organisms that were not
accessible to mechanical removal by
hand/power driven instruments can be
reduced/eliminated.
PHASE 1
Treatment Sessions
- The following conditions must considered to plan
Phase 1 treatment sessions needed;
CHEMICAL
PERIODONTAL
THERAPY
CHEMICAL PERIODONTAL
THERAPY
GOAL –
Miscellaneous agents;
- Matrix protein
- Growth factor
- Hydrogen peroxide
CHEMICAL PERIODONTAL
THERAPY
ANTISEPTIC AGENTS
• Tetracycline
- 250 mg tetracycline for 14 days
- Doxycycline 100 mg once a day for 14 days (double dose for first
day because half of it will bind to plasma & another half will be in
blood).
CHEMICAL PERIODONTAL
THERAPY
ANTIBIOTIC – Systemic Uses
(ANUG/P)
• In case of ANUG/P, Metronidazole may be needed
for 3 – 4 days only.
- 200 mg Metronidazole tds for 3 – 4 days.
- Analgesic may be prescribed to patient diagnosed
with ANUG/P due to pain.
- Since the ANUG/P lesions being very painful to
mechanical plaque control, chlorhexidine may be
given.
CHEMICAL PERIODONTAL
THERAPY
ANTIBIOTIC – Systemic Uses
• For post-surgical systemic antibiotic,
Metronidazole may be needed for 1 – 7 days.
- 400 mg Metronidazole tds for 1 day.
- Analgesic may also prescribed.
- Chlorhexidine mouthwashes must be given
since the wound may be painful to
mechanical plaque removal.
CHEMICAL PERIODONTAL
THERAPY
ANTIBIOTIC – Systemic Uses
• Periostat® is available as a
- 20 mg doxycycline taken twice daily about
an hour before or 2 hours after meals.
- Adjunct to scaling & root planning.
- Act as collagenase inhibitor (degrade
collagen at periodontal ligament/gingiva but
not to controlled the bacteria) at low
concentration.
- Danger to develop bacterial resistance.
- Take about a month.
CHEMICAL PERIODONTAL
THERAPY
INDICATION:
• Antibiotic prophylactic agents in which the risks of
bacterimia & infective endocarditis is high.
• Systemic antibiotics prescribed are directed against
specific microorganisms as an adjunct to mechanical
instrumentation in aggressive periodontitis & ANUG/P.
• The used of systemic antibiotic without cautions can
lead to development of bacterial resistance.
• Certain individual may suffered from immediate
hypersensitivity which can be fatal.
General terms for a chemical substances
provides a clinical therapeutic benefit.
CHEMOTHERAPEU
TIC AGENTS
COMMON ANTIBIOTIC REGIMENS TO TREAT
PERIODONTAL DISEASES
Regimen Dosage/Duration
Single Agent
Amoxicillin 500 mg tds for 8 days
Azithromycin 500 mg Once daily for 4 – 7 days
Combination Therapy
Metronidazole + 250 mg of each tds for 8 days
amoxicillin
Metrinidazole
Data from + 500
Jorgensen MG, Slots mg of each
J: Compend Twice
Contin Educ daily
Dent for 82000
21:111, days
ciprofloxacin
CHEMOTHERAPEUTIC
AGENTS
Monocycline Doxycycline
• Effective against broad • Same spectrum of
spectrum of activity as minocycline
microorganisms.
& may be equally
• Suppresses spirochetes &
effective.
motile rods as effectively
scaling & root
debridement.
• Less phototoxicity & renal
toxicity than tetracycline
but may cause reversed
vertigo.
CHEMOTHERAPEUTIC
AGENTS
Metronidazole Clindamycin
• Bactericidal to anaerobic • Effective against
organisms & is believed to anaerobic bacteria.
disrupt bacterial DNA
synthesis in conditions • Effective in situations
with a low reduction in patient is allergic to
potential. penicillin.
• Effective against • Shown efficacy in
Porphyromonas gingivalis
& provetella intermedia. patient with
• Used in ANUG, chronic refractory
periodontitis & aggressive periodontitis.
periodontitis
CHEMOTHERAPEUTIC
AGENTS
Ciprofloxacin Amoxicillin
• Quinolone active • Semisynthetic penicillin with
extended antiinfective
against gram-negative spectrum that includes gram-
rods, including all positive & gram-negative
bacteria.
facultative & some
• Used in management of
anaerobic putative aggressive periodontitis in both
periodontal localized & generalized forms.
pathogens. • Susceptible to penicillinase.
• Minimal effect on
Streptococcus species.
• To fight AA.
CHEMOTHERAPEUTIC
AGENTS
Amoxicillin – Clavulanate potassium
• = Augmentin
• Useful in managing patient
with localized aggressive
periodontitis or refractory
periodontitis.
• This antiinfective agent is
resistant to penicillinase
enzymes produced by
some bacteria.
Guidelines for use of antimicrobial therapy
Clinical diagnosis
PHASE 2
PERIODONTAL RISK
ASSESSMENT
DEFINITION:
• Risk –
probability that an event will occur in the future/ probability that
an individual develops a given disease.
Can divide into:
- Risk factor
- Risk indicator (determinant)
- Risk predictor
• Risk Assessment –
it is a process which qualitative / quantitative assessment are
made of likelihood for adverse effect to occur as a result of
exposure to specified health hazards, so it can be reduced,
avoided / managed.
PERIODONTAL RISK
ASSESSMENT
IMPORTANCE OF PRA
• Periodontal disease is an imbalance of bacterial plaque & host
susceptibility.
• Role of the bacteria as initiator to periodontal disease & 1o etiology
of periodontal disease.
• Host – related factors (influence the presentation & progression of
periodontal disease).
• All people are not equally susceptible to periodontal disease. (in
longitudinal study of Sri Lankan tea plantation)
• All people are not equally response to periodontal therapy.(in
longitudinal study of well maintained 600 patients were followed
for 22 years)
• Successful of periodontal therapy.
- Early & corrective diagnosis
- Risk management
- Effective treatment
PERIODONTAL RISK
ASSESSMENT
PURPOSE OF PRA
• Identify disease severity
• Identify the patient likelihood of
developing the disease
• Understand future disease
progression
• For When
comprehensive
To Perform: treatment
planning.
1. To all new periodontal patient.
2. After active treatment before Supportive
Periodontal Therapy
PERIODONTAL RISK
ASSESSMENT
RISK TO LOOK FOR:
RISK FACTOR RISK INDICATOR RISK PREDICTOR
Biological plausible as a Biological plausible as a No current biological
causative agent for causative agent for plausible as a causative
disease. disease. agent.