current use Abx Flashcards
Philosophy of Treatment via antimicrobials
Periodontitis:
* Is caused by bacteria
* A chronic disease
* Recurs or re-infects
Arrest the disease:
Alter the microflora to prevent reinfection
Maintain the disease in an arrested state
Effective Antimicrobial qualities
Comparative Dosage: Crevicular levels Versus Blood levels
* Cumulative oral dosage can have the problem
of? examples?
* Small dose of local delivery antimicrobial leads
to what crevicular levels?
* An example of a 250 mg tablet of Tetracycline
* Delivered systemically:
* Delivered locally:
- Cumulative oral dosage can have the problem
of side effects: Gastrointestinal problems or tolerance - Small dose of local delivery antimicrobial leads
to high concentration at crevicular level - An example of a 250 mg tablet of Tetracycline
- Delivered systemically: 2ug in peripheral blood level;
16ug in GCF - Delivered locally: 1600 ug in GCF
An antibiotic strength ?? times greater than
the systemic therapeutic dose may be required
to be effective against the bacteria residing in
plaque biofilms.
An antibiotic strength 500 times greater than
the systemic therapeutic dose may be required
to be effective against the bacteria residing in
plaque biofilms.
never use Abx in the absence of? why?
Never use antimicrobial agents in the absence of
mechanical debridement
Disrupt the biofilm physically to allow antibiotic
agents gain access to the periodontal
pathogens and inhibit biofilm formation
Chorhexidine
* %?
* toxicity/hyper sensitivity?
* Active against most?
* microbial resistance?
* Cannot reach?
* Sides effects?
- Chlorhexidine gluconate (CHX)(0.12-0.2%): the most studied and effective rinsing agent for plaque
inhibition and prevention of gingivitis - No systemic toxicity, rare hypersensitivity
- Active against most bacteria and fungi
- No microbial resistance reported
- Cannot reach the site subgingivally
- Sides effects: Taste alteration, tooth discoloration, increased supragingival calculus formation
stains of CHX
- Extrinsic brown discoloration on the teeth from an individual rinsing twice a day for 3 weeks with 0.2% chlorhexidine mouth rinse (Europe). Can be alleviated with 0.12% formulation (US).
- Beverages like tea, coffee and red wine will aggravate this superficial staining.** Can be removed **using prophy paste
CHX mechainsm
charge?
lower concetrations?
higher concentrations?
Chlorhexidine is a positively-charged molecule that binds to the negatively-charged sites on the cell wall; it destabilizes the cell wall and interferes with osmosis.
* Lower concentrations leads to increased permeability and leakage.
* Higher concentrations leads to precipitation of cytoplasmic contents inducing microbial cell death
substanstivity of CHX
- High substantivity
- Adhere to soft and hard tissues and then be released
over time - Slow release over 12 hours
Application of CHX
* As adjunct to regular oral hygiene methods during?
* challenged pts?
* Jaw?
* post surgery?
- As adjunct to regular oral hygiene methods during Phase I therapy (SRP) in high risk individuals (systemically compromised, refractory cases, etc)
- Mentally or physically challenged patients with low manual dexterity
- Jaw fixation, BRONJ
- 1st - 2nd week post surgery
Essential Oils
* Mouth rinse with?
* Antiplaque/ gingivitis index
* Side effects:
- Mouth rinse with eucalyptol, menthol, methyl salicylate, thymol
- Antiplaque effects and significant reduction in gingivitis index
- Side effects: Burning sensation and tooth staining
Side Effects essential oil rinses:
* Most anti-plaque rinses contains?
* Carcinogenic?
* Not recommended in?
- Most anti-plaque rinses contains alcohol as a vehicle to deliver antiseptic ingredients.
- Critical assessment of the literature does NOT support an association of alcohol‐containing mouth rinses and cancer.
- Not recommended in recovering alcoholics (craving for alcohol), in patients taking metronidazole or disulfiram (drug interaction).
essential oil rinse mechanisms?
* Cell wall?
* Inhibition of?
* Extraction of?
* Antiinflammatory action based on?
- Multiple mechanisms proposed
- Cell wall disruption
- Inhibition of bacterial enzymes
- Extraction of endotoxins derived from lipopolysaccharide (LPS) of Gram-negative bacteria
- Antiinflammatory action based on antioxidant activity
Hydrogen Peroxide
* Beneficial effects were seen with H2O2 levels above?
* Prolonged use of H2O2 decreased?
* Conflicting results was shown on the effectiveness of?
* Therapeutic delivery of H2O2 to prevent periodontal disease required?
- Beneficial effects were seen with H2O2 levels above 1%.
- Prolonged use of H2O2 decreased plaque and gingivitis indices.
- Conflicting results was shown on the effectiveness of 1.5% H2O 2 rinse.
- Therapeutic delivery of H2O2 to prevent periodontal disease required mechanical access to subgingival pockets. **Never use antimicrobial agents in the absence of mechanical debridement
**
Side Effects H2O2
* 3% H2O2 or less used daily showed?
* carcinogenic?
* ADA and FDA have concerns regarding?
* Possible?
- 3% H2O2 or less used daily showed occasional irritant effects: In small number of subjects with preexisting ulceration and When combined with high levels of salt solutions.
- In animal model, 30% H 2O2 was referred to as a co-carcinogen; 3% or less, no co-carcinogenic activity/adverse effects were observed.
- ADA and FDA have concerns regarding long-term use
- Possible co-carcinogen and impaired wound healing
Subgingival Irrigation
* when used as a monotherapy?
* Tissue invasive organisms?
- Significantly reduced monitored bacteria when
used as mono therapy, but not eliminated: Microbiota rebound to baseline within 1 to 8 weeks after short-term subgingival irrigation - Tissue invasive organisms doesn’t respond well.
- After 6 months of irrigation every 2 weeks with 3% hydrogen peroxide, limited success was achieved in reducing high concentrations of Actinobacillus actinomycetemcomitans
Properties of sub g irrigation
* Reaches the site with?
* Achieved ?% penetration in pockets of less than 6mm when tip was place ?mm apical to the margin.
* ?% penetration in deeper pockets when canula was placed ?mm apical to the margin.
Properties
* Reaches the site with a sufficient concentration
* Achieved 90% penetration in pockets of less than 6mm when
tip was place 1mm apical to the margin.
* 70-80% penetration in deeper pockets when canula was placed
3mm apical to the margin.
substantivity of sub g irrigation:
* Blood and proteins?
* retained to have an effect?
* 50% of a fluorescein labeled hydroxypropylcellulose gel injectedsubgingivally was washed out of pockets within?
* The gingival crevicular fluid is replaced in a 5 mm pocket how many times per hour?
* The half life of an antimicrobial irrigation concentration is ?
- Lack of substantivity
- Blood and protein can deactivate the drug
- The medicament may not be retained long enough to have an efficacious effect.
- 50% of a fluorescein labeled hydroxypropylcellulose gel injectedsubgingivally was washed out of pockets within 12.5 minutes
- The gingival crevicular fluid is replaced in a 5 mm pocket 40 times over an hour period
- The half life of an antimicrobial irrigation concentration is 1 minute.
subg CHX irrigation
- Single use to reduce the bacterial load; adjunctive use to gain the antiseptic effect
- A syringe and a jet irrigator with a cannula were equally effective.
- Low irrigation forces were effective
Betadine® subg irrigation
contents?
* Can be used how?
* Do not use when there is history of?
* Use with caution in ?
Betadine® (10% povidone-iodine and 1% free iodine)
* Can be used diluted as an irrigant
* Do not use when there is history of iodine sensitivity
* Use with caution in pregnancy and lactation to prevent inducing transient hypothyroidism in newborn
Local Antimicrobial Delivery
- LAD is the medicament placed in a periodontal pocket with a delivery system and released in a controlled manner, allowing minimum inhibitory concentration for 7 days.
LAD forms
- Chip/Slab/Strip/Film
- Injectable gel
- Fiber
- Microsphere
Ideal Properties LAD
* Effective against?
* Low risk of?
* systemic absorption?
* Biodegradable?
* Easy?
* Enhances?
- Effective against periodontal pathogens: Kill the pathogens effectively and Reach the site really well
- Low risk of bacterial resistance
- Low systemic absorption: Good concentration and substantivity
- Biodegradable
- Easy to use
- Enhances scaling and root planing
Indications for LAD
* When local sites with inflammation have not
responded to? example situations?
Always use as?
- When local sites with inflammation have not
responded to periodontal or maintenance therapy.
Examples: - Residual isolated pockets ≥5mm, not responding favorably to initial SRP with BOP at re-evaluation.
- Residual pockets after periodontal surgery.
- Recurrent isolated pockets ≥5mm with BOP at maintenance.
Always as adjunct therapy, never use alone.
laser interactions with tissue
msot important is absorption
Antibiotic Regiment
In acute periodontal abscess cases
heart conditons for Abx prophylaxis
Only patients at the highest risk of infective endocarditis
