Membership Matters - November 2017 - 25

Figure 3. Soft tissue flap of teeth #28-#31,
showing subgingival calculus and
granulation tissue in pocketed areas.

Figure 4. Same site as Figure 3 above, with
calculus and granulation tissue removed.

advanced cases treated for the first time.[1,2] By
attacking infection while it is active, the bacteria
are eliminated aggressively and completely.
This case was treated in the
following manner:
1. Bacterial culture of pathogens.
Cultures were obtained with a paper
point inserted into the pockets.
Culture results showed high levels of
Peptostreptococcus micros and very high
levels of beta-hemolytic Streptococcus.
Because periodontal disease is an infection,
identifying the specific bacteria - such
as Porphyromonas gingivalis, Prevotella
intermedia, and others - allows for accurate
selection of antibiotics that have sensitivity
and specificity for those bacteria.
2. Complete debridement with ultrasonic and
hand instruments of all subgingival calculus
by means of a minimal flap for access to root
surfaces (Figures 3 and 4).

Figure 5. Povidone-iodine application, with
appropriate viscosity to cover all surfaces.

3. Systemic antibiotic therapy as
determined by culture. In this case,
a large number of many different
bacteria required use of amoxicillin and
metronidazole, 250 mg each, 3 times daily
for 8 days. The sensitivity report indicated
that two antibiotics were recommended
because no single agent has action
against every identified bacterium.
4. Local application of povidone-iodine
for 5 minutes and a brief rinse with very
dilute bleach solution at the time of
treatment (Figure 5).
5. Home care regimen, including:
* Use of dilute bleach solution (1:10
dilution of sodium hypochlorite) twice
weekly, applied with a Water-Pik® with
a small Pik Pocket Tip® (Water Pik, Inc.,
Fort Collins, Colorado).
* Use of topical fluoride (0.4% stannous
gel) for application in custom trays.

Want to Learn More?
Dr. Kohner is presenting on Thursday, April 5, and Friday, April 6,
at the 2018 Oregon Dental Conference.

www.oregondental.org

November 2017

25


http://www.oregondental.org

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
Membership Matters - November 2017 - cover4
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