Membership Matters - November 2017 - 24

P E R I O D O N TA L
DISEASE

Antimicrobial Treatment for
Advanced Periodontal Disease
Reprinted with permission from Medscape
Case Presentation
A 42-year-old healthy black man was
referred from his general dentist. Following
a period of 20 years with no dental care, the
patient presented with a chief complaint of
"bad breath." He reported a history of a very
unpleasant dental experience as a youth,
which resulted in avoiding dental visits since
that time. Now, the patient reports that he is
willing to undergo dental therapy.

By James S. Kohner,
DDS
Originally published
December 15, 2011
Editor's Note: This author's
case report is based on
the work of Jorgen Slots,
DDS, DMD, PhD, MBA.
See Anti-Infective Agents in
Periodontal Treatment on
Medscape for an overview.

Medical History and Dental
Examination
History. The patient's medical history was
unremarkable, with no history of smoking.
He is a former college athlete who exercises
regularly and is in good physical shape other
than his lack of dental care.
Dental examination. Clinical examination
reveals excessive calculus, deep periodontal
pockets, and generalized suppurative
discharge. His existing dental restorations
are unremarkable, with both occlusion and
mobility of teeth within normal limits (FigureĀ 1).
Radiographs. Full mouth radiographs were
taken. Subgingival calculus and generalized
bone loss associated with periodontal
disease were evident from radiographs in all
quadrants (Figure 2).

Diagnosis
This patient had advanced periodontitis,
with significant pocketing of 5-10 mm,

Figure 1. Preoperative view of mandibular
right lingual tissues.
24

Membership Matters

complicated by potential compliance issues
and fear from previous dental experiences.

Treatment Plan
The conventional approach to managing
periodontal disease includes debridement
followed by instructions for plaque removal
at home. Because of the length of time
since the patient's last dental treatment,
and his active oral infection, antimicrobial
disinfection was selected as the best
method to reduce the number of periodontal
pathogens. Initial debridement alone would
have allowed for some repair, slowing
down not just the disease but the repair
potential as well. This case illustrates how
adding chemotherapeutic agents targeting
the specific periodontal microbiota will
facilitate maximum repair and successful
management of even very advanced cases
such as this one.
By aggressively and accurately targeting
pathogens, results will be improved over
traditional scaling and surgical methods.[1,2]
These traditional combined methods may
not kill all bacteria at diseased sites.
Antimicrobial cleansing is an innovative
method that combines in-office procedures
with specific antimicrobial procedures to
be performed at home, providing optimal
healing. These processes have yielded
predictable clinical results for cases that did
not respond to initial treatment as well as for

Figure 2. Radiograph of same area showing
subgingival calculus.
Oregon Dental Association



Table of Contents for the Digital Edition of Membership Matters - November 2017

Guest Editorial
New Members, Dental Community, Board of Trustees
Events and Education
Molar Movement
Insider Results
ODA Member Benefit of the Month
Compliance Corner
Dopac and the 2018 Election Season
Through the Loupes
Collaborative Care and Guided Implant Surgery
Antimicrobial Treatment for Advanced Periodontal Disease
Society Updates
Dental Foundation of Oregon
Index of Advertisers
Membership Matters - November 2017 - Intro
Membership Matters - November 2017 - cover1
Membership Matters - November 2017 - cover2
Membership Matters - November 2017 - 3
Membership Matters - November 2017 - Guest Editorial
Membership Matters - November 2017 - 5
Membership Matters - November 2017 - New Members, Dental Community, Board of Trustees
Membership Matters - November 2017 - 7
Membership Matters - November 2017 - 8
Membership Matters - November 2017 - Events and Education
Membership Matters - November 2017 - 10
Membership Matters - November 2017 - Molar Movement
Membership Matters - November 2017 - 12
Membership Matters - November 2017 - Insider Results
Membership Matters - November 2017 - 14
Membership Matters - November 2017 - ODA Member Benefit of the Month
Membership Matters - November 2017 - Compliance Corner
Membership Matters - November 2017 - Dopac and the 2018 Election Season
Membership Matters - November 2017 - Through the Loupes
Membership Matters - November 2017 - 19
Membership Matters - November 2017 - Collaborative Care and Guided Implant Surgery
Membership Matters - November 2017 - 21
Membership Matters - November 2017 - 22
Membership Matters - November 2017 - 23
Membership Matters - November 2017 - Antimicrobial Treatment for Advanced Periodontal Disease
Membership Matters - November 2017 - 25
Membership Matters - November 2017 - 26
Membership Matters - November 2017 - 27
Membership Matters - November 2017 - Society Updates
Membership Matters - November 2017 - 29
Membership Matters - November 2017 - 30
Membership Matters - November 2017 - 31
Membership Matters - November 2017 - Dental Foundation of Oregon
Membership Matters - November 2017 - 33
Membership Matters - November 2017 - Index of Advertisers
Membership Matters - November 2017 - cover3
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