Chchemotherapeutic

Question 1

Chemotherapeutic Agents (Drugs) in the
Treatment of Periodontal Diseases

Answer 1

 Chemical substance that provides a clinical therapeutic benefit and can
be administered:
 Systemically Used- Antibiotics & Analgesics
 Dentin desensitizing agents – discussed
 Chemical Plaque Control- As mouth wash & Antiseptic
 Delivered locally into PD tissue
 Drug used for autoimmune disease

Question 2

Locally Delivered, Controlled-Release Antimicrobials Developed
and FDA Approved for Dental Use. Product Antimicrobial Agent

Answer 2

Actisite - Tetracycline (No longer commercially available in the Us
PerioChip - Chlorhexidine
Arestin - Minocycline
Atridox - Doxycycline
Elyzol- Metronidazole

Question 3

Locally delivered antibiotics used

Answer 3

Used as an adjunct to PD therapy, maintenance therapy or to delay or
postponed the surgical procedure

Question 4

Advantages of local delivered antibiotics

Answer 4

 High drug concentration at infected side
 Maintenance of concentration
 Lower drug dose (12.7 mg tetracycline fiber)
 Ease & retention after placement
 Time period for intended pharmacological effect
 Fewer systemic side effect, low/no serum drug level
 Reduce risk for developing drug resistant microbial population at non oral sites
 Reduction of patient compliance problem

Question 5

Advantages of systemic antibiotic

Answer 5

 Less expensive
 Choice for selection of other antibiotics
 Reservoir in other area of mouth
 Multiple sites can be treated simultaneously

Question 6

Clinically all locally delivered drugs reduce

Answer 6

probing depth, bleeding on
probing and periodontal Pathogens and gains in clinical attachment level with
or without scaling and root planing

Question 7

Precaution of local drug

Answer 7

Abscessed Pocket
Dental floss
Pregnant woman and children

Question 8

Side effect of local antibiotics

Answer 8

Headache and URTI
Localized discomfort

Question 9

Actisite- containing

Answer 9

Actisite- containing 12.7 mg tetracycline fiber

Question 10

Conc required To inhibit growth of bacteria

Answer 10

32 to 64 mg/ml
required to inhibit the growth of pockets pathogens)

Question 11

Systemicaly used tetracycline have concentration of

Answer 11

4 to 8 mg/ml in GCF

Question 12

Disadvantages of the fiber;

Answer 12

o Length of time required for placement (10 minutes or more per tooth)
o Patient appointment 10 days after placement for removal of the fiber
o Oral candidiasis in a few cases

Question 13

resorbable delivery system of chlorhexidine gluconate

Answer 13

resorbable delivery system of chlorhexidine gluconate (Periochip 4.0 x
5.0 x 0.35 mm)
Releases chlorhexidine and maintains drug concentrations in the gingival
CF greater than 100 mg/ml for at least 7 days

Question 14

Adverse effects of chlorhexidine

Answer 14

minimal, slight pain and swelling

Question 15

Metronidazole %

Answer 15

Metronidazole 25% dental gel applications at a 1-week
interval have shown effect like scaling and RP but no
adjunctive benefits in conjunction with scaling and root planing over the 6
month period

Question 16

The only systemically administered sub-antimirobial
agent indicated for the treatment of chronic/ aggressive periodontitis,
approved by FDA & ADA

Answer 16

Doxycycline (Periostat 20-mg dose, twice daily for 3 months,
up to a maximum of 9 months of continuous dosing as an adjunct to SRP
in the treatment of chronic/aggressive periodontitis

Question 17

Doxycycline Therapeutic effect; by

Answer 17

enzyme, cytokine, and osteoclast inhibition
rather than by any antibiotic effect

Question 18

Possible associations between periodontitis and systemic disorders

Answer 18

(diabetes, cardiovascular & lung diseases, stroke, osteoporosis and
rheumatoid arthritis

Question 19

Disease cytokines

Answer 19

1l-1 1l-6 pge 2 tnf alpha mmps

Question 20

Risk Factors for Periodontal Disease & Risk Reduction Strategies

Answer 20

 Poor oral hygiene: Improved oral hygiene, HMT chemotherapeutics
 Faulty dentistry: Corrective dentistry
 Hormonal variations: Consultation with a physician, HMT
chemotherapeutics
 Immunocompromise: Consultation with a physician, HMT
chemotherapeutics
 Connective tissue diseases: Consultation with a physician, HMT
chemotherapeutics

Heredity: Host modulatory therapy (HMT) chemotherapeutics
 Smoking: Cessation, HMT chemotherapeutics
 Diabetes: Improved control, work with physician, HMT
chemotherapeutics
 Obesity: Weight loss
 Stress: Mmanagement, HMT chemotherapeutics
 Medications: Work with physician; HMT chemotherapy
 Nutrition: Supplement

Question 21

Host Modulatory Therapy (HMT)
 Can be used this as

Answer 21

Host Modulatory Therapy (HMT)
 Can be used to interrupt the positive-feedback loops and ultimately reduce
the excessive levels of cytokines, prostanoids, and enzymes that result in
tissue destruction
 Matrix metalloproteinases (MMPs) break down collagen fibers, disrupting
the normal anatomy of the gingival tissues, ultimately resulting in
destruction of the periodontal ligament
 The inflammation extends apically and osteoclasts are stimulated to resorb
alveolar bone by the high levels of prostaglandins, interleukins, and TNF-α
in the tissues Drugs can be administered to down-regulate osteoclastic activity and
ultimately to inhibit bone resorption by these cells
 Elevations in the proinflammatory or destructive mediators in response to
bacterial challenge are counterbalanced by elevations in antiinflammatory
or protective mediators such as the cytokines IL-4, IL-10, other mediators
such as IL-1ra (receptor antagonist) and tissue inhibitors of
metalloproteinases (TIMPs)
 Under conditions of health, the antiinflammatory or protective mediators
control tissue destruction

Question 22

Systemically Administered Pharmacologic agents:

Answer 22

 Nonsteroidal Antiinflammatory Drugs Salicylates (aspirin),
Indomethacin, Propionic acid derivatives (ibuprofen, flurbiprofen &
naproxen)
 Bisphosphonates
 Sub-Antimicrobial-Dose Doxycycline
At present NSAIDs and bisphosphonate drugs are Not approved and
indicated for the treatment of periodontal diseases

Question 23

Non Steroidal Anti inflammatory Drugs NSAIDs;
 Used to treat

Answer 23

treat pain, acute inflammation and variety of chronic
inflammatory conditions
 Inhibit prostaglandins- Reduce tissue inflammation
 Inhibit osteoclast activity in the PD tissues by blocking PGE2 and
interfere with arachidonic acid metabolism
 Reduces vascular permeability, platelet aggregation, inhibit PMN
migration and alveolar bone loss

Question 24

Nsaids side effects

Answer 24

Gastrointestinal problems, decreased platelet aggregation, renal
& hepatic impairment

Question 25

Bisphosphonates – Mechanism

Answer 25

 Interfere with osteoblast metabolism & secretion of lysosomal enzymes
 Possess anticollagenase activity, enhance alveolar bone density
 Inhibit bone resorption by disrupting osteoclast activity
Unwanted effects;
Inhibit bone calcification, inducing changes in white blood cell counts,
avascular necrosis of the jaws (risk of bone necrosis following dental
extractions)