host modulation


×
Rating : Rate It:
 
Post a comment
    Post Comment on Twitter
Comments:  



  Notes
 
 
1 : HostModulation. Submited to :- Dept. of periodontics. Kiranbir Sandhu.
2 : The concept of host modulation was first introduced to dentistry by Williams and Golub et al Host….. “The organism from which the parasite obtains its nourishment.” OR In transplantation of tissue,“the individual who recieves the graft.” Modulation… The alteration of function or status of something in response to a stimulus or an altered chemical or physical environment.
3 : In addition to bacterial control, modulation of host immunoinflamatory response is also capable of controlling periodontitis.
4 : Pathogenesis of periodontitis…
5 : …Periodontal balance…
6 : RISK FACTORS FOR PERIODONTAL DISEASE HERIDITARY : family history. SMOKING : frequency; current history; past history. SYSTEMIC DISEASES: #Diabetes; # HIV; #Neutropenia # Osteoporosis STRESS : reported by patient. MEDICATION : #Ca-channel blockers ; # drugs known to cause dry mouth or xerostomia. NUTRITION POOR ORAL HYGIENE : plaque and calculus. FAULTY DENTISTRY: overhangs. HORMONAL VARIATIONS : # during pregnancy #menopause. CONNECTIVE TISSUE DISEASES.
7 : RISK ASSESSMENT RISK ASSESSMENT
8 : HOST MODULATORY THERAPY( HMT ) HMT means treating the host side of the host -bacteria interaction. Decrese the tissue destruction & stabilise or regenerate the peridontium by modifying the destructive aspects of the host response & upregulating protective responses. ...AIM...
9 :
10 : Host modulation agents… Systemically Administered Agents :- NSAIDs Bisphosphonates Subantimicrobial-Dose Doxycycline Locally administered Agents :- Topical NSAIDs Enamel matrix proteins Growth factors Bone morphogenetic proteins
11 : NSAIDs Mechanism:- Gram neg bacteria LPS ACTIVATES # Neutrophils # Macrophage PGE2 Osteoclast # Fibroblast cells cells # Gingival epi. Cells BONE RESORPTION cont.
12 :
13 : NSAIDs Inhibit PGs dec in tissue inflammation. Used to treat pain , acute inflammation and variety of chronic inflammation. Side effects *GIT prob. * Hemorrage. *Renal & hepatic impairment. *Rebound effect Because of above side effects long term use of NSAIDs as an adjunctive treatment for periodontitis has never developed beyond research studies.
14 : BISPHOSPHONATES Inhibits bone resorption by disrupting the osteocalst activity. Mechanism of action is unclear. But it is believed that it interferes with osteoblast metabolism & secretion of lysosomal enzymes. Possess anticollagenase properties.
15 : Side effects:- * inhibits bone calcifications, * Induce changes in the W.B.C count, *avascular necrosis of jaw. NO BISPHOSPHONATE DRUGS ARE APPROVED FOR TREATMENT OF PERIODONTAL DISEASES.
16 : MECHANISM OF BISPHOSPHONATES
17 : SUBANTIMICROBIAL-DOSE DOXYCYLINE ( SDD ) Taken twice daily for 3 mths. Upto period of 9 mths. Of continuous dosing. 20 mg dose of doxycyline ( periostat ) is approved as an adjunct to SRP in treatment of chronic periodontitis.
18 : Exerts therapeutic effect by enzymes, cytokine & osteoclast inhibition rather than antimicrobial action Approved by FDA and ADA
19 : LOCALLY ADMINISTERED AGENTS Topical NSAIDs Beneficial for treatment of periodontitis Ketorolac mouth rinse reported that gingival crevicular fluid levels of PGE2 were reduced by approx. half over 6 mths. And bone loss was minimised. Not approved.
20 : Enamel matrix proteins , growth factors, bone morphogenic proteins these can be used as adjuncts to surgical procedures because * improves wound healing * regeneration of lost bone, PDL, cementum. cont.
21 : These include :- Enamel matrix proteins :- Embdogain Bone morphogenetic proteins :- # BMP-2 # BMP-7 Growth factors :- ~ PDGF ~ Insulin-like growth factor. Tetracyclins * Only local modulating agent that is approved by FDA for adjuctive use during dentistry is EMBDOGAIN
22 :
23 : EFFECTS OF HMT THAT ARE PRODUCED AT DIFFERENT LEVEL
24 : Complementary treatment strategies in periodontics
25 : SUBANTIMICROBIAL-DOSE DOXYCYCLINE( SDD ) SDD is only FDA approved systemically administered agent. Not used as monotherapy. Earlier it was called LLD ( low dose doxycyline) Member of tetracycline family.
26 : MECHANISM OF ACTION OF SSD Besides of antibiotic properties doxycyline has ability to downregulate # MMPs # family of zinc dependent enzymes that are capable of degrading extracellular matrix molecules.
27 : MMPs Level play major role in inflammation. of MMP is prop.to degradation of collagen. PMNs MMP-8 & MMP-9 Degradation of type1collagen Decreases osteoclast activity and increases osteoblast activity. By producing Inhibitors of reactive oxygen species
28 : SIDE EFFECTS OF SDD Doxycycline at antibiotic doses( >100mg) produce following adverse effects:- Photosenstivity Hypersenstivity reactions Nausea Vomiting Oesophageal irritation. IN CLINICAL TRIAL SDD (20mg ) IS USED AS AN ADJUNCTIVE TO SRP
29 :
30 : EMERGING HOST MODULATORY THERAPIES:- CHEMICALLY MODIFIED TETRACYCLINS (CMTs) non-antibiotic tetracyclins analouge That is devoid of all antibiotic activity. With host modulatory and anticollagenolytic activity. they are more potent inhibitors of proinflammatory mediators & increases the level of antinflammatory mediators (IL-10) cont.
31 : CMT-3 AND CMT-8 INHIBIT OSTEOCLASTIC BONE RESORPTION. PROMOTES BONE FORMATION. ENHANCES WOUND HEALING. INHIBITS PROTEINASES PRODUCED BY PERIODONTAL PATHOGENS.
32 : REFRENCES CARRANZA’S CLINICAL PERIODONTOLOGY
33 : ..THANK YOU..

 

Add as Friend By : Kiranbir
Added On : 1 Years ago.
host modulation
Views 797 | Favourite 0 | Total Upload :2

Embed Code:

Flag as inappropriate


Related  Most Viewed



Free Powerpoint Templates



 



Medical PowerPoint Templates | Powerpoint Templates | Tags | Contact | About Us | Privacy | FAQ | Blog

© Slideworld