Dental Tribune United Kingdom Edition

15Perio TribuneSeptember 10-16, 2012United Kingdom Edition Periodontal Disease How do you measure success? Dentomycin abridged prescribing information. Please refer to the Summary of Product Characteristics before using Dentomycin 2% w/w Periodontal Gel (minocycline as hydrochloride dihydrate). Presentation: a light yellow coloured gel containing minocycline as hydrochloride dihydrate equivalent to minocycline 2% w/w. Each disposable application contains minocycline HCI equivalent to 10mg minocycline in each 0.5g of gel. Uses: Moderate to severe chronic adult periodontitis as an adjunct to scaling and root planing in pockets of 5mm depth or greater. Dosage: Adults – Following scaling and root planing to pockets of at least 5mm depth. Gel should fill each pocket to overflow. Applications should be every 14 days for 3-4 applications (e.g. 0,2,4 and 6 weeks). This should not normally be repeated within 6 months of initial therapy. Use only one applicator per patient per visit which should be wiped with 70% ethanol between applications to each tooth. Avoid tooth brushing, flossing, mouth washing, eating or drinking for 2 hours after treatment. Elderly – As adults, caution in hepatic dysfunction or severe renal impairment. Children – contraindicated in children < 12 years. Not recommended in children > 12 years. Contraindications: Hypersensitivity to tetracyclines, complete renal failure, children under 12 years. Precautions: Closely observe treatment area. If swelling, papules, rubefaction etc. occur, discontinue therapy. Safety in pregnancy and lactation not established. Side-effects: Incidences are low and include local irritation and very rarely diarrhoea, upset stomach, mild dysphoria and hypersensitivity reactions. Storage: 2°-8°C. Legal category: POM. Presentation and cost: Disposable applicator in an aluminium foil pouch. Each carton contains 5 pouches. Carton £103.02+VAT. Licence No: PL 27880/0001 PA1321/1/1. Product Licence Holder: Henry Schein UK Holdings Limited, Medcare House, Centurion Close, Gillingham Business Park, Gillingham, Kent, ME8 0SB. Telephone 020 7224 1457 Fax 020 7224 1694 Distributed by: Blackwell Supplies a division of Henry Schein UK Holdings Ltd, Medcare House, Gillingham Business Park, Gillingham, Kent ME8 0SB Tel 020 7224 1457 Fax 020 7224 1694 Date of preparation: February 2011 *Registered Trademark BLA/DEN 18 Dentomycin offers: • 42% reduction in pocket depth after 12 weeks1 • broader spectrum of antibacterial action2 with greater all round activity than metronidazole or tetracycline • conditioning of the root surface3 and enhanced connective tissue attachment4 • improved healing through inhibition of degradative collagenases5 • effective treatment of chronic periodontitis which has been associated with cardiovascular diseases6-9 1. van Steenberghe D, Bercy P, Kohl J, et al. Subgingival minocycline hydrochloride ointment in moderate to severe chronic adult periodontitis: a randomized, double-blind, vehicle-controlled, multicenter study. J Periodontol 1993;64:637-44 2. Slots J and Rams TE. Antibiotics in periodontal therapy: advantages and disadvantages. J Clin Periodontol 1990;17:479-93 3. Rompen EH, Kohl J, Nusgens B, Lapiere CM, Kinetic aspects of gingival and periodontal ligament fibroblast attachment to surface-conditioned dentin. J Dent Res 1993;72:607-12 4. Rifkin BR, Vernillo AT, Golub LM. Blocking periodontal disease progression by inhibiting tissue-destructive enzymes: a potential therapeutic role for tetracyclines and their chemically-modified analogs. J Periodontol 1993;64:819-27 5. Somerman MJ, Foster RA, Vorsteg GM, et al. Effects of minocycline on fibroblast attachment and spreading. J Periodontal Res 1988;23:154-9 6. DeStefano F, Anda RF, Kahn HS, et al. Dental disease and risk of coronary heart disease and mortality. BMJ 1993;306:688-91 7. Joshipura KJ, Rimm EB, Douglass CW, et al. Poor oral health and coronary heart disease. J Dent Res 1996;75:1631-6 8. Mattila KJ. Dental infections as a risk factor for acute myocardial infarction. Eur Heart J 1993;14 Suppl K:51-3 9. Morrison HI, Ellison LF, Taylor GW. Periodontal disease and risk of fatal coronary heart and cerebrovascular diseases. J Cardiovasc Risk 1999;6:7-11 Information about adverse event reporting can be found at www.yellowcard.gov.uk Adverse events should also be reported to Blackwell Supplies,Medcare House, Gillingham, Kent ME8 0SB or by telephone: 01634 877525 BPE Inertpretation 0 No need for periodontal treatment - but lots of praise is good! 1 Oral hygiene instruction (OHI) 2 OHI, removal of plaque re- tentive factors, including all supra- and subgingival calcu- lus 3 OHI, root surface debride- ment (RSD) 4 OHI, RSD. Assess the need for more complex treatment; referral to a specialist may be indicated. * OHI, RSD. Assess the need for more complex treatment; referral to a specialist may be indicated. When to refer If a specialist is at hand, there can be a temptation to refer on to them quickly. In some cas- es this is entirely appropriate. In others it can send a mixed message to the patient about the work they have had with either the GDP or hygienist/ hygienist therapist. It is impor- tant that the patient is aware of the importance of their role in stabilising any disease and has ownership of their condi- tion before referring on. They should also value the clinician who will be carrying out their maintenance regime as that is the person who will support them in ensuring they keep themselves at a high level of oral health. My lovely Professor Barry Ely, sadly no longer with us, used to say three strikes then refer. So, have three goes at RSD with OHE and if there is still no improvement then refer on. This would be done within a three - four month period and will not be detri- mental to the patient in almost all cases. Of course, if you see rapid deterioration, then you would refer on and seek ad- vice at the soonest possible opportunity. Other things that could be put in your protocol: • A guide to an oral health ed- ucation session • Recall interval guide The list I have developed here is just a general exam- ple for you and could form the template for debate with- in your team and provide the bones for your final structure to ensure quality, consistency and best practice. DT ‘It is important that the patient is aware of the impor- tance of their role in stabilising any disease and has ownership of their condition before referring on’ About the author Mhari Coxon has 20 years experi- ence in dentistry, working as a nurse, receptionist, oral health advi- sor and ultimately hygienist in a va- riety of practice environments. She is passionate about her profession. At present, she works as Senior Profes- sional Relations Manager for Philips Oral Healthcare and clinically as a hygienist in central London. From Chairing the London BSDHT for 3 years, and working as an MD; Mhari excels at motivating and co-ordinat- ing a team and utilising skills, decen- tralising leadership and developing self efficacy in members. Throughout her career Mhari has developed hy- giene protocols and plans in practices which have continued to be used with great success. Mhari is Clinical Di- rector for CPDforDCP Ltd, a training company offering motivational and interactive development courses to the dental team. A keen writer, Mhari is on the Publications Committee of Dental Health, the British Society of Hygienists and Therapists (BSDHT) Journal, has a conversational col- umn in Dental Tribune and writes articles for many other publications and online sites. As a speaker Mhari has presented regionally, nationally and internationally for many groups including Talking Points in Dentistry, the British Orthodontic Society Spe- cialist group, the BSDHT, the BDA, the International Symposium of Dental Hygiene, the dentistry show and many others. In 2006 she was the Probe Awards hygienist of the year, and was highly commended in 2010. 2011 saw her placed 15 in the Dentistry Top 50 most influential people in the UK.