10.11 Systemic Antibiotics in Periodontal therapy

Question 1

what is best to control plaque and gingivitis?

Answer 1

mechanical oral hygiene methods

Question 2

what is the only prescription agent approved by the FDA?

Answer 2

Chlorhexidine

Question 3

by ADA (they control advertising) regulation, for a company to make “gingivitis claims,” what is required?

Answer 3

two 6 month clinical trials

Question 4

what are the only OTC mouthwash and tooth pastes that have ADA approval?

Answer 4

• Listerine

- Colgate total and Stannous Fluoride

Question 5

bactericidal, definition and antibiotic examples

Answer 5

directly kill bacteria, reduction in viable counts.

ex: penicillins, cephalosporings, metronidazole

Question 6

bacteriostatic, def and antibiotic examples

Answer 6

inhibit growth of bacteria, no change in viable counts

ex: erythromycin, clindamycin tetracyclines (doxycycline)

Question 7

which antibiotics penetrate will into the gingival crevicular fluid (GCF)?

Answer 7

tetracycline (doxycycline) and metronidazole

Question 8

which antibiotic can retain good antibacterial activity in a low pH?

Answer 8

Metronidazole

Question 9

antibiotic tissue concentration must be equal to or greater than the _____

Answer 9

MIC (minimal inhibitory concentration)

Question 10

in his diagram thing it basically says that attachment levels for systemic antibiotics are “better for ____ PD than for ____ PD”

Answer 10

better for aggressive PD than Chronic PD, but it’s not ineffective for chronic

Question 11

tetracycline

• examples
• bacteriocidal?,

Answer 11

-Tetracycline-HCl, minocycline, doxycycline
-Inhibit most putative periodontal pathogens
-Bacteriostatic, broad-spectrum, generally more effective against Gram (+) bacteria than Gram (-)
-Concentration in gingival crevice (4 – 8 mg/ml)
is 2- 10 times that in serum – effective against many periodontal pathogens (>MICs)

Question 12

doxycycline, why used more than tetracycline?

Answer 12

• Closely related to tetracycline; concentration in GCF (1.2 - 8.1 mg/ml)
• Little side effects compared to tetracycline-HCl
• Safe with renal dysfunction, GI disturbances
• Lesser chance of developing resistant organisms

Question 13

low dose doxycycline (LDD) what is the trade name?, and general info

Answer 13

-Periostat
Non-microbial action of low dose (subantimicrobial dose) tetracyclines discovered (Golub et al. 1983)
-Mechanism of action
-To modulate host-derived enzymes, blocking
MMPs (matrix metalloproteases)
-Anti-collagenase activity
-Shown to effectively reduce collagenase activity in the GCF and gingival inflammation
-have to take it forever(?)

Question 14

which abx has anti-collagenase activity?

Answer 14

LDD (periostat)

Question 15

which abx is effective against spirochetes? and when are spirochetes seen?

Answer 15

Metronidazole

• originally used as amebicide/trichomonacide for treating urinary tract infection
• adequate serum and GCF concentration > MICs for most periodontal pathogens
• effective agains spirochetes (ANUG lesion), G(-) anaerobic rods

Question 16

which abx inhibits beta-lactamase? and when is it used?

Answer 16

amoxicillin/clavulanate (augmentin)

-in refractory periodontitis

Question 17

what is used for an acute infection

Answer 17

amoxicillin

-effective mainly against G (+)

Question 18

what antibiotics are often used together in combination therapy?
-and what bacteria is it effective against?

Answer 18

met (250 mg) + amoxicillin (500 mg) combined with SRP for 7 days
-effective in suppressing A.a.

Question 19

in what types of perio disease is systemic abx shown to be most effective? (in conjunction with SRP)

Answer 19

aggressive pd

Question 20

evidence supports the use of what antibiotics?

Answer 20

Metronidazole and tetracycline (or doxycycline),

Question 21

inclusive datat suggest that _____(which antibiotics) are also effective?

Answer 21

augmentin (amoxicillin/clavulanate), doxycycline and amoxicillin + metronidazole

Question 22

evidence for LLD (low dose doxycycline) use

Answer 22

it is not clear whether LLD is as effective as antibiotics