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Perio > Antimicrobials > Flashcards

Antimicrobials Flashcards

0
Q

What are the advantages of systemic Antimicrobials?

A

Simeple
Cheap
Multiple sites
Eradiation of other sites eg tongue

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1
Q

Where can bacteria be located?

A 
Root surface
Pocket lumen
Root dentine
Soft tissues
Oral reservoirs
EO resevoirs
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2
Q

What are the disadvantages of systemic ?

A 
Safety
Emergence of bacteria resistance
Allergy (1/10 pencillin)
Superinfection with opputunistcs
Toxic side effect
Interaction with other drugs 
Compliance
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3
Q

What are the RF to syestmic antimicrobialsm?

A 
Poor oh
Smoking
Systemic disease
Drug interactions 
Side effects
Compliance
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4
Q

What are the indications to systemic antimicrobials?

A

Aggressive perio
Necrotising perio
Perio abscess

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5
Q

What will happen if you prescribe systemic antibiotics without RSD?

A

Multiple abscess

Topoll et al 1990

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6
Q

Which Antimicrobials do we use in perio?

A

Tetracyclines
Metron
Penciillins

(Spitsmycin, vancomycin, kanamycin)

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7
Q

What are the properties of tetracyclines?

A 
Bacteriostatic 
Anticollagenase
Anti inflam
Inhibits bone resorption
Promote fibroblast attachment to root surface
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8
Q

Which bactera are very susceptible to tetracyclines?

A

Aa

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9
Q

What dose is tetracycline given at?

A

250mg qds three weeks

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10
Q

What must you combine when using tetracyclines?

A

OHI

RSD

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11
Q

What is the diasadvantage with tetracycline?

A

Staining
EM

Re activation of disease in 25% of aggressive! chronic
Aa still found in 56% of aggressive

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12
Q

What is metron used for?

A

Gram neg anaerobes eg P Gingivalis, P intermedia

NOT AA

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13
Q

What is the perio pill?

A

250mg tds 7 days amox
200mg tds 7 days metron

If allergic then ciproflucloxillin 250mg bd 7 days

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14
Q

T/F perio pill works against Aa?

A

T

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15
Q

Which host modulating drugs are there?

A

Anti collagenases: perio stat
Anti inflam:
Anti oxidants stimulate phagocytic cels and immunity

16
Q

What is perio stat?

A

Anti collagenases

Low sub lethal dose of doxycycline 20mg bd 3months -1 year
Reduces collagenases in GCF and gingiva
Doc concentrates in the GCF, wide spectrum and substantive to dentine and cementum
Reduces BOP and PD in chronic perio

NO EFFECT ON BACTERIA

17
Q

How effective is perio stat?

A

Preshaw et al 2004

Reduction in pocket depths seen as early as three months an maintain for 9 months

18
Q

Which local antibiotics are there?

A

Controlled release devices eg hollow fibres, acrylic, monolithic fibres, ethyl cellulose

19
Q

What are the advantages of local Antimicrobials therapy?

A 
High local concentration 
Site specific
Not dependant on compliance
Penetrates biofilm and endotoxins 
Low toxicity 
Less unwanted side effects
20
Q

What are the disadvantages to local Antimicrobials?

A 
Time
Hypersensitivity
Bacterial resistance
Placement and retention 
Bacterial eradication 
Multiple sites
Compatibilty of delivery vehicle system with periodontal tissues
21
Q

Which local agents are there?

A

Dentomycine: 2% minocycline
Elyzol: 25% metron
Actisite: 25% tetracycline fibres
Arestin: 1mg minocycline hydrochloride microspheres
Periochip : biodegradable CHX chip for pickets more than 5mm

22
Q

What is dentoycine?

A

Lipid based gel
Used as an adjunct

Not as good a actisite

23
Q

What is elyzol?

A

25% metron

As effective as Subginginval scaling on PPD and BOP
But sticky and lost easily

24
Q

What is actisite?

A

25% tetracycline fibres

Good adjunct for reduction in BOP and PPD
Used in pockets of 6-10 mm
BEST than all others along side RSD

High initial delivery and then slow after over 10 days

25
Q

What is arrestin?

A

Minocycline hydrochloride 1mg

Deep pockets
Difficult patients

26
Q

How effective is atridox?

A

Similar effect to RSD alone

27
Q

What is the perio chip?

A

Reduced PPD compared to RSD alone

improved CAL

28
Q

How much CHX is retained after rinsing?

A

30%

Perio (6 decks)

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