chemotherapeutics Flashcards
chx moa
is a broad spectrum cationic surfactant that facilitates plaque disposal
1) positively charged cationic bisbiguanide adsorbs to different negatively charged sites eg mucous membranes, EPS
2) binds to cell wall to interfere with membrane transport
3) disrupts osmotic barrier to cause cytoplasmic leakage
4) binding allows a substantivity effect where CHX binds to salivary proteins released over 8-12 hours
- bacteriostatic in low concs, bactericidal in high concs
moa of listerine
- ruptures cell walls of microorganisms
- inhibits enzymatic activity
- extracts endotoxins from gram neg bacteria
- penetrate biofilm to exert a bactericidal effect
- slows down bacterial multiplication
moa of triclosan
- lipid soluble compound that penetrates bacterial membranes
- disrupts cytoplasmic membrane of bacteria (antibacterial effect)
- suppresses microbial pathogen recognition pathway and acute/chronic mediators of inflammation (anti inflammatory effect)
limitations of systemic antibiotics as a chemotherapeutic
- inability to achieve high GCF concentration
- risk of adverse reactions
- bacterial resistance
dosing regimen for acute periodontal abscess
1) amoxicillin
- loading dose of 1g, maintenance dose of 500mg/tid for 3 days
2) azithromycin
- loading dose of 1g on day 1 then 500mg on day 2 and 3
3) clindamycin
- loading dose of 600g on day 1, then 300mg/qid for 3 days
what is periostat, properties, dosage
is doxycycline hyclate
- a type of systemic AB administered in tablet form (20mg)
properties:
- anti collagenase
- inhibit MMP activity
- decrease CT breakdown
dosage: 20mg BD for 3 months
shown to cause CAL gain and PD reductions when used as an adjunct to scrd
types of locally delivered antibiotics
1) doxycycline gel (atridox)
2) minocycline microspheres (arestin/periocline)
- has a long acting bacteriostatic effect
- most lipid soluble, ensuring bacterial cell membrane penetration
3) metronidazole gel
- targets anaerobic bacteria and protozoa
- moa is that it forms unstable molecules with bacterial DNA
4) chx chip (periochip)
- serves as a controlled delivery device slowly releasing its CHX while simultaneously biodegrading which maintains a 7-10 day sustained release
indications for chemotherapeutics
- patients with dexterity issues
- patients with very severe periodontitis with isolated pockets
- patients with moderate disease that have not responded to scrd alone
- patients on compromised maintenance (disease recurrence)
- patients who need ab prophylaxis prior to treatment
contraindications for chemotherapeutics
- before mechanical debridement, should be used as an adjunctive
- when the use of LDA has failed to control periodontitis
