Refractory periodontal disease is characterized by low plaque scores and low responsiveness to periodontal therapy. Low biofilm lysine content in refractory chronic periodontitis. On a clinical basis, when a patient presents for periodontal evaluation after the completion of initial periodontal therapy, including scaling and root planing. Detection of enterococcus faecalis in subgingival biofilm.
Fortunately it is relatively rare but still remains a significant clinical challenge. The clinical and radiographic findings in these 4 cases involve patients with a refractory form of generalized chronic periodontitis. Refractory periodontitis or recurrence of disease wiley online library. Clinical features the primary feature of refractory periodontitis is the occurrence of additional clinical attachment loss after repeated attempts to control the infection with conventional periodontal therapy. Chronic periapical periodontitis also known as chronic. Evidence has been accumulating for the past 30 years which indicates that almost all forms of periodontal disease are chronic but specific bacterial infections due to the overgrowth in the dental plaque of a finite number of mostly anaerobic species such as porphyromonas gingivalis, bacteroides forsythus, and treponema.
Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. Cases of chronic periodontitis that do not respond to periodontal treatment is defined as refractory chronic periodontitis. A hyperactive neutrophil phenotype in patients with refractory periodontitis andrea m. The bodys immune system fights the bacteria as the plaque spreads and grows below the gum line. Relationship between human immunodeficiency virus hiv1. Refractory neutrophil activation in type 2 diabetics with. Its diagnostic protocol includes a dental medical history, a clinical periodontal examination and a radiological examination. Recently, studies suggest that these patients have elevated lysine decarboxylase activity in the sulcular microbiota. Hufriedy, bop, and gingival recession on the buccal and lingual as pects. Chronic periodontitis is controlled without antibiotics by scaling and root planing srp to remove. Treatment of severe periodontitis may improve clinical. Apical periodontitis is an inflammatory lesion in the periodontal tissues that is caused mostly by bacterial elements derived from the infected root canal system of teeth core concept 7. Pds by using a manual periodontal probe with 1 millimeter markings mich igan 60.
Case series report of 66 refractory maintenance patients evaluating the effectiveness of topical oxidizing agents r. In this chapter, the terms are used interchangeably except when the term chronic periodontitis is used to differentiate one disease entity from another specific disease. Request pdf low biofilm lysine content in refractory chronic periodontitis background. Management of periodontal disease with doxycycline. Atridox is a doxycycline gel that conforms to the gum surface and then. Overview in response to increasing concerns on the part of health care providers, thirdparty payers, and consumers about the quality, cost, and access to dental.
Chronic periodontitis affects about 750 million people or about 10. Chronic periodontitis is one of the seven categories of periodontitis as defined by the american academy of periodontology 1999 classification system. As a sole treatment for refractory chronic, aggressive or advanced periodontal diseases localized delivery of antimicrobial agents localized delivery of antimicrobial agents is indicated in cases of refractory periodontal disease andor residual periodontal disease with probing depths greater than or equal to 5 millimeters with inflammation. Detection of enterococcus faecalis in subgingival biofilm of patients with chronic refractory periodontitis esrafil balaeigajan 1, adileh shirmohammadi 2, rahib abashov 3, mohammad agazadeh 4, masoumeh faramarzie 5 1 dentist, department of community dentistry, tabriz dental faculty. The patients often have a history of antibiotic therapy and therefore have a high incidence of resistance in the. Chronic periodontitis is controlled without antibiotics by scaling and root planing srp to remove dental biofilm. The administration of antibiotics for the treatment of chronic and refractory periodontitis should follow accepted pharmacological principles including, when appropriate, identification of pathogenic organisms and antibiotic sensitivity testing. Because of its slow rate of progression, however, chronic periodontitis usually becomes clinically significant when a patient reaches his or her mid30s or later. A hyperactive neutrophil phenotype in patients with.
Rp is characterized by progressive breakdown of the periodontal supporting tissues despite ongoing sanativedebridement, surgical, andor pharmacological treatments i. Current studies show that, even in the era of antiretroviral therapies, hiv1 infection is associated with more severe and frequent refractory chronic periodontitis. Chronic apical periodontitis with calculuslike mineral. Initial colonizer for juvenile and progressive periodontitis. Treating a patient with chronic periodontitis discussion this case illustrates the periodontal treatment of a patient with chronic periodontitis using scaling and root planing and subsequent surgical interventions aimed at reducing residual pockets, with adjunctive use of a mouthrinse containing 0. Biofilm cf is associated with periodontitis severity pretherapy and extent of therapeutic response post. This chapter describes forms of periodontitis, the periodontal diseases of the supporting tissues. Consequently, a new classification was developed at the international workshop for a classification of periodontal diseases and conditions in 1999. Until 1977, periodontitis was divided into two classes juvenile and chronic marginal periodontitis, that have become four in 1986 the first class has been split into subclasses, prepubertal, localized and generalized, the other classes including adult, necrotizing ulcerative gingivo periodontitis, and refractory periodontitis. Apr 22, 2016 clinical and microbiological features of refractory periodontitis subjects colombo et al. In its early stage, called gingivitis, the gums become swollen, red, and may bleed. Managing refractory periodontal disease using the periodontal. It has been previously reported that the epithelial barrier to bacterial proinflammatory products is impaired when biofilm lysine falls below the. Periodontal disease as a specific, albeit chronic, infection.
The onset of chronic periodontitis can occur at any time, and the first signs may be detected during adolescence in the presence of chronic plaque and calculus accumulation. Moderate chronic periodontitis case type iv advanced periodontitis case type v refractory periodontitis. When most clinicians say periodontitis or periodontal disease, they are referring to chronic periodontitis. This study aimed to identify characteristic representative genes through a comparative analysis of gene expression profiles in the blood and saliva of chronic periodontitis cp and refractory periodontitis rp patients to provide new treatment strategies that may be helpful in the treatment of different forms of periodontitis. This study aimed to identify characteristic representative genes through a comparative analysis of gene expression profiles in the blood and saliva of chronic periodontitis cp and refractory periodontitis rp. These cases appear resistant to treatment and as such, these patients are deemed to exhibit refractory periodontitis. Clinical and microbiological features of refractory periodontitis subjects colombo et al. Periodontal diseases comprise a wide range of inflammatory conditions that affect the supporting structures of the teeth the gingiva, bone and periodontal ligament, which could lead to tooth. In nontreated teeth apical periodontitis represents a defensive response to a primary infection in a necrotic pulp. We previously reported that the epithelial barrier to bacterial proinflammatory products is impaired when biofilm lysine falls below the.
The aim of the present study was to assess the efficiency of photodynamic therapy pdt in treating patients diagnosed with refractory periodontitis and compare the clinical and biological outcomes of conventional periodontal treatment with or without adjunctive pdt in these. A timely diagnosis of chronic periodontitis at its earliest stage is essential to. Successful treatment of generalized refractory chronic. Neutrophils pmns are critical components of the innate immune system and help to maintain oral health in the face of a constant bacterial challenge. The diagnosis of refractory periodontitis should only be made in. Refractory periodontitis periodontal disease click to. Recurrences of the diseasenew signs and symptoms destructive periodontal disease, which occur after periodontal treatment, because the disease was not adequate treatment andor the patient was not the practice of proper care. Subgingival microbial profiles in refractory periodontal disease socransky et al.
The prognosis for periodontal disease for most patients is good providing the preceding followup recommendations are met, based upon the individual case. Comparative analysis of blood and saliva expression profiles. Refractory periodontitis periodontal disease is a chronic infectious disease of the supporting tissue of the teeth nowadays, a large majority of patients with periodontitis respond well to conventional therapies however, a small percentage of patients respond poorly of treatment refractory. The use of systemic antibiotics in the treatment of refractory. Periodontitis is very common, and is widely regarded as the second most common dental disease worldwide, after dental decay, and in the united states has a prevalence of 3050% of the population, but only about 10% have severe forms. This covered in much more detail the full range of periodontal diseases. Periodontal disease is perhaps the most common chronic infection in adults. Despite the best therapeutic efforts by dental professionals to treat periodontal disease, some patients do not respond as well as expected. Chronic periodontitis is a common disease of the oral cavity consisting of chronic inflammation of the periodontal tissues that is caused by the accumulation of profuse amounts of dental plaque. Detection of enterococcus faecalis in subgingival biofilm of. Apical periodontitis may also develop due to a secondary infection subsequent to. Refractory periodontitis is not a distinct entity, and all cases of refractory periodontitis can fall into some ot the other categories of periodontitis. Apr 22, 2016 refractory periodontitis periodontal disease is a chronic infectious disease of the supporting tissue of the teeth nowadays, a large majority of patients with periodontitis respond well to conventional therapies however, a small percentage of patients respond poorly of treatment refractory periodontitis 3.
Case series report of 66 refractory maintenance patients. Chapter 15 chronic peridontitis flashcards quizlet. The above features are in contrast to adult chronic periodontal disease and recurrence of disease. Recently, studies suggest that these patients have elevated lysine decarboxylase. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out. Refractory responses requiring antibiotic therapy result from smoking andor microbial infections that starve the biofilm and epithelial attachment of lysine.
Cap is characterized by the formation of the destruction of alveolar bone and inflammatory granulation tissues. To date, no novel treatment approach is available for optimum outcomes regarding refractory periodontitis. The periodontal disease classification system of the american academy of periodontology an update colin b. Learn vocabulary, terms, and more with flashcards, games, and other study tools. About 1015% of us adults are refractory to therapy for chronic periodontitis. Chronic periodontitis predominantly affects adults, but aggressive periodontitis may occasionally occur in children. Treatment with directed antibiotic therapy as an adjunct to scaling and root planing retards the. Abscesses are lanced, and antibiotics are used to treat pronounced general symptoms. Common elements among the patients were being well educated in dental health, minimal plaque, clinically significant marginal gingival inflammation, and a. Periodontitis is a chronic inflammatory disease, destroying tooth. Treatment usually includes improving oral hygiene, dental scaling and root planing, as well as systemic and local antibiotic therapy.
Refractory chronic periodontitis of 16 patients was treated by root planing and adjunctive tetracycline hydrochloride therapy. Chronic periodontitis can lead to the formation of a cyst of the jaw, and both forms of periodontitis can sensitize the body to streptococci. The innate and adaptive arms of the immune system become activated in patients with metabolic disorders, particularly type 2 diabetes mellitus t2dm patients. Common elements among the patients were being well educated in dental health, minimal plaque, clinically significant marginal gingival inflammation, and a reported history of atopy. Refractory periodontitis or recurrence of disease, journal. Thus, rather than a single disease entity, rp describes destructive periodontal diseasesinitially diagnosed as chronic, aggressive, or other types of periodontitis. Case report characterization of patients presenting for treatment to a university refractory periodontal diseases unit. Adult periodontitis was reclassified chronic periodontitis and earlyonset periodontitis to aggressive periodontitis. A diagnosis of refractory periodontitis requires the gathering of baseline data and a subsequent evaluation. Chronic periodontitis is the most common form of periodontal disease. Initial colonizer for aggressive and chronic periodontitis, periimplantitis, and recurrence. Until 1977, periodontitis was divided into two classes juvenile and chronic marginal periodontitis, that have become four in 1986 the first class has been split into subclasses, prepubertal, localized and generalized, the other classes including adult, necrotizing ulcerative gingivoperiodontitis, and refractory. The subgingival microflora of refractory disease may be either predominantly grampositive with elevated levels of streptococcus intermedius or may be gram. This low dose doxycycline, part of the tetracycline family does not create bacterial resistance40.
Antibodybased diagnostic for refractory periodontitis. Refractory periodontitis pdf approved by the board of trustees, american academy of. Of the many forms of periodontal disease, refractory periodontal diseases are the least characterized. Although refractory periodontitis is not a currently accepted diagnosis see haptcr 4, many patients fail to respond to conventional therapy, and their management will be discussed. The periodontal disease classification system of the american. The periodontal disease classification system of the. Like other investigators we attempt to trace levels of detected periodontal pathogens with severity of periodontal destruction, measured with the loss of both attachment and bone. Aggressive periodontitis is a type of periodontal disease with rapid insertion and alveolar bone loss, which is characterized by familial aggregation and affecting healthy individuals, except periodontitis 3. It usually affects young people, but it can appear at any age, although this is less frequent3,4. I have been seeing a lot of enquiries about cats with refractory chronic oral inflammatory disease following extraction of all premolars and molars. Treatment of plaqueinduced gingivitis, chronic periodontitis aapd. Periodontal disease is an inclusive term describing any disease of the tissues surrounding the teeth, including gingival diseases and diseases of the supporting structures. Treatment of severe periodontitis may improve clinical disease activity in otherwise treatment refractory rheumatoid arthritis patients. Until recently, the accepted standard for the classification of periodontal diseases was the one agreed upon at the 1989 world workshop in clinical periodontics.
Clinical features the primary feature of refractory periodontitis is the occurrence of additional clinical attachment loss after repeated attempts to control the infection with. Successful treatment of generalized refractory chronic periodontitis. Refractory periodontitis or recurrence of disease refractory periodontitis or recurrence of disease magnusson, ingvar. Refractory periodontitis refers to continued attachment loss in spite of adequate treatment and proper oral hygiene. Aggressive periodontitis is a type of periodontal disease with rapid insertion and alveolar bone loss, which is characterized by familial aggregation and affecting healthy individuals, except periodontitis3. Comparative analysis of blood and saliva expression. Refractory periodontitis or recurrence of disease magnusson. Refractory periodontitis rp is the most enigmatic and difficult to treat. Clinical and biological effects of adjunctive photodynamic. Diagnosis of refractory periodontitis periodontal disease. The disease formerly known as lymphocyticplasmacytic. Treatment of periodontitis is usually conservative, consisting of filling the root canals. Prognosis for pets with severe or refractory periodontitis is guardedmany pets resist home care because of chronic. In periodontitis, gums pull away from the teeth and form spaces called pockets that become infected.
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