Periodontitis
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Introduction
- An inflammatory condition of the periodontium: periodontal ligament, cementum, alveolar bone, gingivae
Classification
- Acute periodontitis
- Chronic periodontitis
- Juvenile periodontitis
- Other sub-classifications
Acute periodontitis
- Relatively uncommon, of short duration; may be due to trauma, abscess or ulceration
- Characterized by pain, may be associated with bleeding, fever, swelling and redness of the mucosa, unpleasant taste in the mouth
Chronic periodontitis
- This is inflammation within the supporting tissues of the teeth with bone loss
- The most frequently occurring form of periodontitis
- Characterized by pocket formation and/or recession of the gingiva
- Prevalent in adults, but can occur at any age
- A sequala to untreated gingivitis
Clinical features
- May be asymptomatic initially, with a low grade inflammation of the periodontium and gingiva
- As it progresses, and following attachment, lost gums become red, slightly swollen and bleed on slight touch
- Associated teeth show different degrees of mobility
Risk factors
- Diabetes mellitus
- Smoking
- Certain periodontal bacteria
- Aging
- Gender
- Genetic predisposition
- Immunosuppression
- Stress
- Nutrition
- Pregnancy
- HIV infection
- Substance abuse
- Medications
- Eliminate, alter, or control above risk factors which may contribute to chronic
- Consultation with the patient’s physician may be indicated
Non-drug treatment
- Instruction, reinforcement, and evaluation of the patient’s plaque control should be performed
- Supra- and sub-gingival scaling and root planning to remove microbial plaque and calculi
Drug treatment
- Analgesics
- Paracetamol
- Adult: 1 g orally every 8 hours for 3 - 5 days
- Child:
- 1 - 5 years: 125 - 250 mg;
- 6-12 years: 250 - 500 mg orally every 8 hours
- Antibiotics
- Amoxicillin
- Adult: 250 mg orally every 8 hours for 5 days
- Child:
- 1 month - 1 year: 5 mg orally every 8 hours for 5 days; dose doubled in severe infections
- 1 - 5 years: 125 mg every 8 hours for 5 days
- 5 - 12 years: 250 mg 8 hourly for 5 days
- 12 - 18 years 500 mg 8 hourly for 5 days; all doses doubled in severe infections
- Metronidazole
- Adult: 200 mg orally every 8 hours for 5 days
- Child:
- 1 - 3 years: 50 mg orally every 8 hours for 5 days;
- 3 - 7 years: 100 mg every 12 hours for 5 days;
- 7 - 10 years: 100 mg every 8 hours for 5 days
- Antiseptic mouthwashes
- 2% Chlorhexidine gluconate (alcohol free) Rinse mouth with 10 mLs for about 1 minute twice daily for 1 - 2 weeks
- Hexetidine mouthwashes to alternate with warm saline mouthwashes
Notable adverse drug reactions, caution
- Metronidazole: nausea, vomiting and metallic taste
- Metronidazole is contraindicated in pregnancy
- Avoid alcohol during treatment with metronidazole, and for at least 48 hours after treatment
Prevention
- Oral health education
- Scaling and polishing every six months