Treatments 1

You are more likely to find periodontitis in elderly patients.. does this make it an "inevitable" disorder?

no

What is worse, prognosis-wise: 20% bone loss at 20 years old or 70 years old?

at 20 years old

much more common/'ok' for a 70 year old... even though still, obviously, bad in general

Staging tells you ___

severity

Grading tells you ___

progression

When you eliminate all confounding factors, does aging correlate with being more likely to develop periodontitis?

no!

So why is prevalence of periodontitis higher in older people?

they are more likely to have predispositions that lead to development of periodontitis

What are some of these confounding factors?

smoking

medications that affect immunity

possible medical treatments (ex: heart transfers)

diabetes

antibiotics/anti-inflammation medicine usage

oral hygiene capacity

Apical migration of the junctional epithelium = ___

gingival recession

Is gingival recession an inevitable physiologic process of aging?

no

but it is common in elderly

The PDLs of elderly patients tend to have ___ numbers of fibroblasts and a more ___ shape

decreased

irregular

Elderly patients tend to have an ___ in cemental width

increase

this is not surprising, since deposition continues over time after tooth erupts

T/F: the healing rate of bone in extraction sockets is affected by increasing age

false

not affected!

There is typically a greater ___ response in older individuals when oral hygiene is discontinued

inflammatory

Is there a difference in response to periodontal surgical/nonsurgical treatments based upon aging?

nope

Nonsurgical Treatments

SRP

prophy

Surgical treatments are usually reserved for ___

5/6+ mm deep pockets

___ is the most common chronic metabolic bone disease

Osteoporosis

___ therapy has been used to treat osteoporosis

Bisphosphonate

How do bisphosphonates work?

they decrease osteoclastic activity

___ is also used to treat osteoporosis, and may even be preferred over bis, since it has a MUCH shorter half life

Denosumab

Well... it actually wouldn't be preferred over bis... why?

Denosumab has a higher chance of leading to MRONJ than bis

MRONJ

medication related osteonecrosis of the jaw

extreme adverse effect of certain drugs

Bisphosphonates are mainly given ___, but may also be given ___.... The latter has a small, but more likely (relatively), chance of leading to MRONJ

orally

IV

Osteonecrosis is more likely in the ___ than the ___

mandible

maxilla

Why?

the maxilla receives a lot more blood than the mandible

Bisphosphonates end in "___"

-nate

___ are frequently recommended for bisphosphonates, such as ___, which has a half life of 10 years

Drug holidays

Alendronate

Drug Holiday

temporary cessation of medication to reduce side effects

you only take this drug once every few months

5-8% of people over the age of 60 have ___

dementia

___ (dental symptom) in both older men and women has been related to an increased risk of developing dementia and cognitive decline

Tooth loss

Dementia is often linked to ___

periodontitis

Why?

there will likely be a reduction in the patient'a personal hygiene and dental care

Puberty

the period of sexual maturation, during which a person becomes capable of reproducing

lots of sex hormone production

Which hormones do females produce?

estrogen

progesterone

In females going through puberty, the prevalence of ___ increases without an increase in the amount of plaque

gingivitis

Gram ___ ___, especially ___, have been associated with puberty gingivitis

-

anaerobes

Prevotella intermedia

During puberty, periodontal tissues can have an exaggerated response to ___, such as food debris, materia alba, plaque, calculus, etc.

local factors

During puberty, it is especially important to access ___

preventive care

Gingival inflammations seems to be aggravated by an ___ or ___ in sex hormones

imbalance

increase

Gingival tissues have been reported to be more edematous during, and more erythematous before, the onset of ___ in some women

menses

An increase of ___ has been observed during the menstrual period and is sometimes associated with a minor increase in ___

gingival exudate

tooth mobility

Let's move on to pregnancy, where periodontal disease is associated with an increased risk for ___

preterm low-birth-weight (PLBW) infants

___ is also extremely common in pregnant women

Pregnancy gingivitis

Will periodontal therapy during the second trimester (or later) of gestation improve pregnancy outcomes — making the child less underweight?

no, probably not

kid will still, likely, be born with low weight

Does association = causation?

nope

Pregnancy medications are split into 5 categories, based upon their usefulness/harm:

A

B

C

D

X

Which is the best? Which is the most commonly used category? Which can you not use, unless in an emergency scenario? Which can you never use?

A: tested on human women

B: not many A's around

D: no better med for the issue

X: NO!!!!

Give some examples of B dental drugs:

Lidocaine

Articaine

What can you not use Articaine for, though, in pregnancy?

even though you can use Articaine on pregnant patients, you should not use it in blocking fashion

Why?

has a higher chance of causing paresthesias, in this manner of usage, than Lidocaine

very low chance!! but why not use the safest drug, with virtually zero chance of paresthesias, especially since both have very similar effectiveness

Which analgesic medication is B until you get to third trimester, when it becomes D?

Ibuprofen

Hydrocodone and Oxycodone are both B... but you'd probably be better off just taking ___, which is the gold standard (and also B) for pregnancy pain relief

acetaminophen

Why is Tetracycline a D drug?

causes gray-brown tooth discoloration in baby

How do you treat this?

with a crown... veneers may be too thin to work

probably full mouth work...

Why is Clarithromycin a D drug?

teratogenic effects have been reported via research

Taking oral contraceptives for a long time may lead to ___

exaggerated response of gingival tissues to local irritants

Let's pivot to Halitosis, which is ___

bad breath (malodor)

Pseudohalitosis

condition in which a person feels as though they have halitosis, but the odor is neither offensive or noticeable to others

Halitophobia

fear of having bad breath

(clinically diagnosable)

The vast majority of halitosis cases are caused by (intraoral/extraoral) factors

intraoral

—originating from oral cavity

What is the predominant cause of oral malodor?

tongue coating

What are 2nd/3rd place, interchangeable?

gingivitis

periodontitis

What are some extraoral factors that can cause halitosis?

ear, nose, and throat (ENT) disorders, systemic

diseases (e.g., diabetes), metabolic or hormonal changes, hepatic or renal insufficiency, bronchial and pulmonary diseases, or gastroenterologic disorders

Bacteria associated with gingivitis and periodontitis are able to produce ___ that contribute to bad breath

volatile sulfur compounds

VSCs

What diseases/conditions that we learned about before also commonly have halitosis associations?

pericoronitis

major recurrent oral ulcerations

herpetic gingivitis

NUG/NUP

How can you treat malodor?

tongue cleaning

chlorhexidine application + SRP

Listerine

Halita

What is more effective: 0.05% chlorhexidine with 0.14% zinc lactate, or 0.20% chlorhexidine?

the former, as there is a synergistic effect to combat VSC-producing-bacteria levels

You can also short-term mask the malodor using ___ and ___

rinses

lozenges