Grade C Perio requiring Antimicrobials

• When might we consider antimicrobials for MI Perio grade C?

  • pt who otherwise appear healthy
  • family history of early tooth loss
  • rapid rate of disease progression
• Prevelance of Grade C Perio:

  • MI pattern <1%
  • Generalised 0.13%
• Clinical Features?

  • amount of microbial deposite inconsistent with severity of perio tissue destruction
  • minimal plaque and calculus
  • variable inflammation with significant pocketing
• probing in children?

  • measure UR6, UL1, UL6, UR6, LL1, LL6
  • age 7-11 use BPE 0, 1, 2
  • age 12-17 use full BPE codes
• Extra-oral features?

  • bilateral submandibular lymphadenopathy
  • submental lymphadenopathy

  as lymphatic system carries lymph which has removed inflammatory excudate and antigens
• what should be visable in appropriate radiographs?

  crestal bone levels

  to allow bone level assessment
• in grade c req antimicrobials amount of bone loss is inconsistent with local risk factors
• Perio Grade C - MI Pattern:

  • commences around puberty
  • minimal microbial deposit
  • gingiva appear healthy until probed
  • perio destruction localised to first perm molar and incisor
  • main pathogen - Aggregatibacter actinomycetemcomitans
  • neutrophil function abnormalities
  • robust serum antibody response to infecting agent
• Perio Grade C generalised:

  • usually people under 30
  • minimal microbial deposits
  • generalised pocketing and widespread bone loss
  • attachment loss is episodic
  • Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis
  • neutrophil function abnormalities
  • poor serum antibody response to infecting agents
• A.Actinomycetemcomitans: colonises the gingival crevice, possesses at least 10 virulence factors causing great perio destruction
• Porphyromonas Gingivalis: anaerobic gram -ve rod, fimbriae act as adhesive mechanism, proteinase virulence factor enables invasion of epithelial cells
• Treatment:

  • PMPR and RSD ineffective
  • Referral to Specialist Periodontist
  • Intensive OHI, sub and sup PMPR & RSD >4mm
  • within 2 weeks total mouth disinfection CHX
  • last tx visit prescribe

  (Amoxicillin 500mg TDS + Metronidazole 400mg TDS for 7 days) or (Doxycycline 200mg loading dose then 100mg OD for 21 days) or (Azithromycin 500mg OD for 3 days)
• What surgical procedures might be considered?

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