• Most common ALL: Pre – B-cell type
• L-asparaginase: Used in ALL
• CNS prophylaxis: Intrathecal methotrexate

Periodontal Medicaments

Periodontal diseases often require adjunctive therapies to traditional mechanical treatments such as scaling and root planing. Various medicaments have been developed to enhance the healing process and control infection in periodontal tissues.

1. Elyzol

• Composition:
  • Elyzol is an oil-based gel containing 25% metronidazole. It is formulated with glyceryl mono-oleate and sesame oil.
• Clinical Use:
  • Elyzol has been found to be equivalent to scaling and root planing in terms of effectiveness for treating periodontal disease.
  • However, no adjunctive effects beyond those achieved with mechanical debridement have been demonstrated.

2. Actisite

• Composition:

  • Actisite consists of tetracycline-containing fibers.
  • Each fiber has a diameter of 0.5 mm and contains 12.7 mg of tetracycline per 9 inches of fiber.

• Clinical Use:

  • The fibers are placed directly into periodontal pockets, where they release tetracycline over time, helping to reduce bacterial load and promote healing.

3. Arestin

• Composition:

  • Arestin contains minocycline, which is delivered as a biodegradable powder in a syringe.

• Clinical Use:

  • Arestin is indicated for the treatment of periodontal disease and is applied directly into periodontal pockets, where it provides localized antibiotic therapy.

4. Atridox

• Composition:

  • Atridox contains 10% doxycycline in a syringeable gel system that is biodegradable.

• Clinical Use:

  • The gel is injected into periodontal pockets, where it solidifies and releases doxycycline over time, aiding in the management of periodontal disease.

5. Dentamycin and Periocline

• Composition:

  • Both Dentamycin and Periocline contain 2% minocycline hydrochloride.

• Clinical Use:

  • These products are used similarly to other local delivery systems, providing localized antibiotic therapy to reduce bacterial infection in periodontal pockets.

6. Periochip

• Composition:

  • Periochip is a biodegradable chip that contains chlorhexidine.

• Clinical Use:

  • The chip is placed in the gingival crevice, where it releases chlorhexidine over time, providing antimicrobial action and helping to control periodontal disease.

PERIOTEST Device in Periodontal Assessment

The PERIOTEST device is a valuable tool used in dentistry to assess the mobility of teeth and the reaction of the periodontium to applied forces. This lecture covers the principles of the PERIOTEST device, its measurement scale, and its clinical significance in evaluating periodontal health.

Function: The PERIOTEST device measures the reaction of the periodontium to a defined percussion force applied to the tooth. This is done using a tapping instrument that delivers a controlled force to the tooth.

Contact Time: The contact time between the tapping head and the tooth varies between 0.3 and 2 milliseconds. This duration is typically shorter for stable teeth compared to mobile teeth, allowing for a quick assessment of tooth stability.

PERIOTEST Scale

The PERIOTEST scale ranges from -8 to +50, with specific ranges indicating different levels of tooth mobility:

Clinical Significance

Assessment of Tooth Mobility:
The PERIOTEST device provides a quantitative measure of tooth mobility, which is essential for diagnosing periodontal disease and assessing the stability of teeth.

Correlation with Other Measurements:
The PERIOTEST values correlate well with:

• Tooth Mobility Assessed with a Metric System: This allows for a standardized approach to measuring mobility, enhancing the reliability of assessments.

• Degree of Periodontal Disease and Alveolar Bone Loss: Higher mobility readings often indicate more severe periodontal disease and greater loss of supporting bone, making the PERIOTEST a useful tool in monitoring disease progression.

Treatment Planning:
Understanding the mobility of teeth can aid in treatment planning, including decisions regarding periodontal therapy, splinting of mobile teeth, or extraction in cases of severe mobility.

Dental Calculus

Dental calculus, also known as tartar, is a hard deposit that forms on teeth due to the mineralization of dental plaque. Understanding the composition and crystal forms of calculus is essential for dental professionals in diagnosing and managing periodontal disease.

Crystal Forms in Dental Calculus

1. Common Crystal Forms:

   • Dental calculus typically contains two or more crystal forms. The most frequently detected forms include:
     • Hydroxyapatite:
       • This is the primary mineral component of both enamel and calculus, constituting a significant portion of the calculus sample.
       • Hydroxyapatite is a crystalline structure that provides strength and stability to the calculus.
     • Octacalcium Phosphate:
       • Detected in a high percentage of supragingival calculus samples (97% to 100%).
       • This form is also a significant contributor to the bulk of calculus.

2. Other Crystal Forms:

   • Brushite:
     • More commonly found in the mandibular anterior region of the mouth.
     • Brushite is a less stable form of calcium phosphate and may indicate a younger calculus deposit.
   • Magnesium Whitlockite:
     • Typically found in the posterior areas of the mouth.
     • This form may be associated with older calculus deposits and can indicate changes in the mineral composition over time.

3. Variation with Age:

   • The incidence and types of crystal forms present in calculus can vary with the age of the deposit.
   • Younger calculus deposits may have a higher proportion of brushite, while older deposits may show a predominance of hydroxyapatite and magnesium whitlockite.

Clinical Significance

1. Understanding Calculus Formation:

   • Knowledge of the crystal forms in calculus can help dental professionals understand the mineralization process and the conditions under which calculus forms.

2. Implications for Treatment:

   • The composition of calculus can influence treatment strategies. For example, older calculus deposits may be more difficult to remove due to their hardness and mineral content.

3. Assessment of Periodontal Health:

   • The presence and type of calculus can provide insights into a patient’s oral hygiene practices and periodontal health. Regular monitoring and removal of calculus are essential for preventing periodontal disease.

4. Research and Development:

   • Understanding the mineral composition of calculus can aid in the development of new dental materials and treatments aimed at preventing calculus formation and promoting oral health.

Changes in Plaque pH After Sucrose Rinse

The pH of dental plaque is a critical factor in the development of dental caries and periodontal disease. Key findings from various studies that investigated the changes in plaque pH following carbohydrate rinses, particularly focusing on sucrose and glucose.

Key Findings from Studies

1. Monitoring Plaque pH Changes:

   • A study reported that changes in plaque pH after a sucrose rinse were monitored using plaque sampling, antimony and glass electrodes, and telemetry.
   • Results:
     • The minimum pH at approximal sites (areas between teeth) was approximately 0.7 pH units lower than that on buccal surfaces (outer surfaces of the teeth).
     • The pH at the approximal site remained below resting levels for over 120 minutes.
     • The area under the pH response curves from approximal sites was five times greater than that from buccal surfaces, indicating a more significant and prolonged acidogenic response in interproximal areas.

2. Stephan's Early Studies (1935):

   • Method: Colorimetric measurement of plaque pH suspended in water.
   • Findings:
     • The pH of 211 plaque samples ranged from 4.6 to 7.0.
     • The mean pH value was found to be 5.9, indicating a generally acidic environment in dental plaque.

3. Stephan's Follow-Up Studies (1940):

   • Method: Use of an antimony electrode to measure in situ plaque pH after rinsing with sugar solutions.
   • Findings:
     • A 10% solution of glucose or sucrose caused a rapid drop in plaque pH by about 2 units within 2 to 5 minutes, reaching values between 4.5 and 5.0.
     • A 1% lactose solution lowered the pH by 0.3 units, while a 1% glucose solution caused a drop of 1.5 units.
     • A 1% boiled starch solution resulted in a reduction of 1.5 pH units over 51 minutes.
     • In all cases, the pH tended to return to initial values within approximately 2 hours.

4. Investigation of Proximal Cavities:

   • Studies of actual proximal cavities opened mechanically showed that the lowest pH values ranged from 4.6 to 4.1.
   • After rinsing with a 10% glucose or sucrose solution, the pH in the plaque dropped to between 4.5 and 5.0 within 2 to 5 minutes and gradually returned to baseline levels within 1 to 2 hours.

Implications

• The studies highlight the significant impact of carbohydrate exposure, particularly sucrose and glucose, on the pH of dental plaque.
• The rapid drop in pH following carbohydrate rinses indicates an acidogenic response from plaque microorganisms, which can contribute to enamel demineralization and caries development.
• The prolonged acidic environment in approximal sites suggests that these areas may be more susceptible to caries due to the slower recovery of pH levels.