Grade C Requiring Antimicrobials

• General qualities of Molar Incisor Perio C requiring antimicrobials ?

  • affects people who otherwise appear health
  • Usually hereditary w history of early tooth loss
  • rapid progression
• Why do we need to distinguish molar incisor perio grade c

  treatment approach is different
• Prevalence of grade C

  molar incisor = less than 1%

  Generalised = 0.13%
• Gender ratio for MI pattern

  1:1
• Gender ratio for generalised grade C

  slightly higher in males
• Grade C perio in ethnicities

  African descent 1-5%African Americans 2.6%North American Hispanics 0.5-1%European Caucasions 0.1-0.5%
• Clinical features of grace c perio req. AM

  • microbial deposits are inconsistent with severe of tissue destruction ie. minimal plaque and calculus
  • Variable inflammation with significant pocketing
• EO features of grade C ?

  • bilateral submandibular lymphadenopathy
  • Submental lymphadenopathy = involvement of lower anteriors
• What do PAs allow

  assessment of bone loss as a % of the root length as well as periapical tissue visualisation
• Aa 4 lines of evidence (aka. how do we know Aa is onvolved in grade C)?

  1. Association studies: Aa isolated in 90% cases and less in health
  2. Demonstration of virulence factors: leukotoxin capable of translocating across ep membranes = tissue invasion
  3. Immune response = more serum antibodies to Aa in MI pattern pts
  4. Clinical studies - Tx success based on reduced levels of subgingival Aa
• How many serotypes of Aa are there and what are they

  5 serotypes

  A, B , C , D and E
• Which serotype is most often assoc. with disease?

  B
• What is the JP2 clone

  a specific clone of serotype B that displays enhance leucotoxin activity
• What pts is JP2 clone common in

  North & West African descent with Periodontitis Grade C requiring antimicrobials - regarded as true pathogen in these locations
• Pg

  an anaerobic grame negative rod:

  
  

  • fimbriae = adhesion
  • Proteinase = invasion of ep cells
  • Inc secretion of IL1 IL6 IL8 and TNFA
• Tx fo perio grade C ?

  • RSD ineffective in controlling Aa Counts due to tissue invasion
  • Prescribe ABs after RSD
  • Referral to specialist
• Who created the guidelines for Tx

  6th European Workshop 2008 Standard Operating Procedure
• When should surgery be considered?

  • Surgical access to clean complex anatomy
  • Consider guided tissue regeneration in bone/furcation defects