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26 KONTROVERSEN IN DER PARODONTOLOGIE Konsequenzen für die Praxis Samstag, 19. 11. 2005 • 16.30 – 17.45 Uhr Priv. Doz. Dr. Michael Christgau Kontroverse Meinungen und Standpunkte – Diskussionsleitung 1991 Promotion 2000 Habilitation, Lehrbefugnis für ZMK-Heilkunde 2001 Spezialist für Parodontologie (DGP) 1990-2002 Poliklinik für Zahnerhaltung und Parodontologie, Universität Regensburg 2000-2002 Oberarzt 1997-1999 DFG-Forschungsaufenthalt an der University of Texas at Houston, USA seit 2002 Partner in Gemeinschaftspraxis in Düsseldorf; externer Oberarzt, Poliklinik für Zahnerhaltung und Parodontologie, Universität Regensburg 2004 Tätigkeitsschwerpunkt Implantologie Schwerpunkte: Parodontologie, Implantologie, Knochenaugmentationen, festsitzende Prothetik DH/ZMF-SEMINAR-PROGRAMM Freitag, 18. 11. 2005 • 9.00 – 10.30 Uhr DH/ZMF-Seminar – Saal 6 Prof. Dr. Andrea Mombelli (CV siehe S. 17) Möglichkeiten und Grenzen der konservativen Parodontalbehandlung Erfolg in der Parodontaltherapie ist an zwei essenzielle Bedingungen gebunden: 1. Die Ursache der Parodontitis – die subgingivale Plaque – muss vollständig entfernt werden. 2. Eine massive Wiederbesiedlung des behandelten Bereichs muss wirkungsvoll unterdrückt werden. Für den Langzeiterfolg müssen beide Bedingungen erfüllt sein: Weder kann eine aufwändige, rigorose Therapie, oder die zusätzliche Verabreichung von Medikamenten, einen Mangel bei der Mundhygiene wettmachen, noch kann eine perfekte Mundhygiene den Erfolg garantieren, wenn die Therapie nie vollständig zuende geführt worden ist. Gerade dieser zweite Punkt kann für Dentalhygienikerinnen und ZMFs problematisch sein, da ihre Tätigkeit gewisse Grenzen hat und sie daher bei fortgeschrittenen Fällen nicht immer alles, was für die Gesundung der Gewebe notwendig wäre, selbst durchführen können. Bei solchen Patienten besteht die Gefahr, dass die Behandlungsphase nie offiziell beendet wird. Endlose, frustrierende Therapie, statt echtes Recall, ist die Folge, wobei Attachment und Hartgewebe trotz aller Bemühungen weiter verloren gehen. In solchen Fällen ist eine detaillierte Re-Evaluation unumgänglich, damit die notwendigen Zusatzbehandlungen geplant und durchgeführt werden können.
KONTROVERSEN IN DER PARODONTOLOGIE Konsequenzen für die Praxis One-stage, Full-mouth Disinfection Freitag, 18. 11. 2005 • 11.15 – 13.00 Uhr DH/ZMF-Seminar – Saal 6 Prof. Dr. Marc Quirynen (CV siehe S. 24) The existence of an "intra-oral” transmission of bacteria (from one niche to another, also called translocation or cross-infection) has recently been thoroughly investigated. In order to reduce the chance for an intra-oral transmission (also called cross-contamination), the "one-stage, fullmouth disinfection" has been introduced. This strategy attempts to eradicate, or at least suppress, periodontopathogens in a short time span, and this not only from the periodontal pockets but from all their intra-oral habitats (mucous membranes, tongue, and saliva). The one-stage fullmouth disinfection concept consists of a combination of following therapeutic efforts: a full mouth scaling and root planing within 24 to reduce the number of subgingival pathogenic organisms, a subgingival irrigation of all pockets with a 1% chlorhexidine gel in order to kill remaining bacteria, tongue brushing with an antiseptic to suppress the bacteria in this niche, mouth rinsing with an antiseptic to reduce the bacteria in the saliva and on the tonsils. Several comparative studies between the one-stage, full-mouth approach and the standard therapy (root planing per quadrant with 2 week intervals), clearly illustrated the benefits of such a fullmouth approach in relation to gain in attachment, pocket depth reduction, microbiological shifts (for review see Quirynen et al. (2001)). A similar approach also resulted in significant additional improvements during guided tissue regeneration and/or the application of local antibiotics. My presentations will give a general overview on the scientific background of the intra-oral bacterial transmission, as well as of most recent clinical observations with the full-mouth strategies, including additional improvements of the concept. Chemotherapeutic Control of Malodour Breath malodour is a considerable social problem, the incidence of which remains poorly documented in most countries. Several studies in industrialized countries reported incidences up to 50%, with a variety degree of intensity. From large scale inventories in multidisciplinary breath odour outpatient clinics it appears that in the vast majority (85 %) the cause originates from the oral cavity. Gingivitis, periodontitis and tongue coating are the predominant factors. Since more than 90% of the population suffers from gingivitis and/or periodontitis, there is however the risk that such plaque-related inflammatory condition is too easily considered the cause, while in fact more important pathologies are being overlooked. Indeed, for a minority of patients extra-oral causes can be identified including: ENT pathology, systemic diseases (e.g. diabetes, metabolic or hormonal problems, hepatic or renal insufficiency, a bronchial carcinoma or a gastro-enterologic pathology). A category of subjects imagine they have breath malodour. This is called imaginary breath odour or halitophobia. The unpleasant smell of breath mainly originates from volatile sulphide compounds (VSCs). However, other compounds in mouth air may also be offensive, such as: diamines (e.g. putrescine and cadaverine), indole, skatole, and butyric or propionic acid. Most of these compounds result from the proteolytic degradation by oral microorganisms of peptides (sulphide or non-sulphide containing amino acids) present in saliva, shed epithelium, food debris, gingival crevicular fluid, interdental plaque, postnasal drip, and blood. Especially gram-negative, anaerobic bacteria possess such proteolytic activity. When hormonal, gastro-intestinal, renal or metabolic pathologies are the cause, additional malodorous molecules can be produced which circulate in the blood and are expressed through the expired air or the crevicular fluid. Strong antiseptics (e.g. mouth rinses) can reduce oral malodour by killing the bacteria, but of course have no impact on a bad breath from a non-oral origin. The removal of the substrata for bacteria (e.g. tongue coating) forms another important treatment strategy, and should not be forgotten. Dieser Vortrag wird von der Firma GlaxoSmithKline Consumer Healthcare unterstützt. 27
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