Download Incorporating Periodontal Medicine into Clinical Practice Maria

Periodontal Disease: Therapeutic Strategies
•
Elimination of bacterial infection
• Modulation of host response
– mechanical removal of infectious
– systemic delivery of hostagent
modulating drugs
– Triclosan toothpaste
• NSAIDS
– Antiseptic rinse/irrigation
• Periostat® (SDD)
– surgical reduction of periodontal
• Bisphosphonates
pockets
– local delivery of host modulating
– topical antimicrobials
• Actisite®
Modulation of risk factors drugs
• Emdogain
• Periochip
–smoking cessation
• Growth Factors
• Atridox®
–diabetic control
• Arestin
• BMPs
–improved oral hygiene
– systemic antimicrobials
–corrective dentistry
–improved nutrition
–stress reduction
–weight loss
These Strategies are Complementary
Colgate Total
• Only toothpaste to contain triclosan, an
antibacterial ingredient
– Adheres to oral mucosa (soft and hard tissues)
for up to 12 hours
• Only toothpaste approved by FDA and Accepted
by ADA for treatment of gingivitis, plaque, caries,
calculus and oral malodor.
Colgate Total
Placebo controlled studies in smokers (Kerdvongbundit and
Wikesjo, J Clin Periodontol. 2003;30(12):1024-30) and
subjects with recurrent periodontitis (Furuichi et al., J Clin
Periodontol. 1999;26(2):63-6) suggest that an oral hygiene
regimen including a triclosan/copolymer dentrifice may
sustain the short-term effect of non-surgical therapy in
smokers and improve on healing after non-surgical
treatment of recurrent periodontitis as measured by
improvements in gingival inflammation, probing depth
reductions and probing attachment levels.
Colgate Total
Triclosan in vitro has anti-inflammatory effects
inhibiting cytokine (IL-1b and TNF-a) stimulated
production of prostanoinds (PGE2) from monocytes
and reducing the activity of an enzyme responsible for
the production of prostanoids (COX-2) in culture, as
well as inhibiting bone resorption in a parathyroidhormone-induced release of calcium from bone
cultures.
Intervention
• Can periodontal therapy affect glycemic control in people
with diabetes?
• The first case series to demonstrate this was published in
1960 where type 1 diabetics with periodontitis had a
reduction in required insulin doses following:
–
–
–
–
Scaling and root planing
Localized gingivectomy
Selected tooth extraction
Combined with penicillin and streptomycin
Williams and Mahan, JAMA, 1960
Preliminary Intervention Trials
Meta-analysis of 10 intervention trials included 456 patients
• The decrease in absolute HbA1c values was ~0.4%
• The addition of systemic antibiotics resulted in an average
absolute reduction of 0.7%
• Numerous deficiencies
– Small sample sizes
– Mixing type 1 and 2 diabetics
– Confounding effects of smoking, BMI, medications, etc.
• Additional studies are needed to determine whether
periodontal therapy provides a significant benefit on
glycemic control
Janket S-J et al., J Dent Res, 2005
Raising The Bar
• Glycated Hemoglobin
– Lower and lower to prevent diabetic complications
• Oral Care
– Optimal to reduce insulin resistance and to allow for
metabolic control
– Improved to prevent long term complications
– What is complete treatment, who is well controlled?
• Is a 5 mm probing depth too much disease?
• Is gingivitis too much disease?