Comprehensive Treatment of Gingivitis and Periodontitis - Part II

  • Recommendations for Antibiotics in Periodontology

    • The routine prescribing of antibiotics in immunocompetent patients with periodontopathy is not recommended.

    • The standard treatment for periodontal disease is scaling and root planing (SRP).

    • Antibiotics should only be considered for patients with refractory periodontitis (no response to standard treatment) with confirmed presence of A. actinomycetemcomitans and/or P. gingivalis in Stage IV periodontitis.

    • Patients requiring antibiotic treatment should follow a combination therapy regimen:

    • Empirical treatment includes:

      • Amoxicillin (without clavulanic acid) and Metronidazole (both for 7 days):

      • Amoxicillin:

        • Adults and children > 40 kg: 500 mg 3 times a day (every 8 hours)

        • Children < 40 kg: 40 mg/kg in 3 divided doses (3 times a day)

      • Metronidazole:

        • Adults and children > 12 years: 500 mg 3 times a day

        • Children < 12 years: 7.5 mg/kg 3 times a day

      • If allergic to amoxicillin, prescribe Metronidazole only.

  • Endocarditis Prophylaxis Recommendations

    • Based on the 2017 American Heart Association and American College of Cardiology guidelines, reaffirmed by the ADA.

    • Dosage regimen:

    • Single Dose 30 to 60 min before Procedure for children:

      • Oral Amoxicillin:

        • Adults: 2 g

        • Children: 50 mg/kg

      • Unable to take oral medication:

        • Ampicillin / Cefazolin or Ceftriaxone:

        • adults: 2 g IM or IV / 1 g IM or IV

        • children; 50 mg/kg IM or IV

      • Allergic to ampicillin/ penicillin: oral

        • Cephalexin : A: 2g; C:50 mg/kg

        • Clindamycin : A: 600 mg; C:20 mg/kg

        • Azithromycin or Clarithromycin: A: 500 mg; C: 15 mg/kg

      • Unable to take oral medication and allergic to penicillins/ampicillin:

      • Alternative regimens as stated, considering:

        • Cefazolin or Ceftriaxone: A: 1g IM or IV; C:50 mg/kg IM or IV

        • Clindamycin: A: 600mg IM or IV; C:20 mg/kg IM or IV

    • Prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of the teeth, or perforation of the oral mucosa.

  • Vertical Bone Loss vs. Horizontal Bone Loss

    • Horizontal Bone Loss:

    • Results in bone levels that are approximately at the same height on adjacent tooth roots.

    • On a radiograph, an imaginary line drawn between the CEJs (cementoenamel junctions) of adjacent teeth is approximately parallel.

    • Vertical Bone Loss:

    • Results in an uneven reduction in bone height on adjacent tooth roots, leading to a trench-like area of missing bone next to a root.

    • Radiographically, if the line between the CEJs is not parallel, this indicates vertical bone loss.

  • epulis inflammatoria is due to external root resoprtion

  • Periotest Application

    • Periotest is a dental measuring instrument used for:

    • Assessment of osseointegration of dental implants.

    • Diagnosis and assessment of periodontopathies in natural teeth.

    • Monitoring treatment progress and assessment of occlusal load.

    • The Periotest scale ranges from -8 to +50; lower values indicate greater stability/damping effect of the measured implant or tooth.

    • Degree of clinical loosening:

    • Periotest value range:

      • -8 to +9 : 0 Very stable

      • +10 to +19 : I Stable

      • +20 to +29 : II Moderately stable

      • +30 to +50 : III Loosening detected.