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Perio 1 > Current Use of Antimicrobials > Flashcards

Current Use of Antimicrobials Flashcards

1
Q

G O A L S O F _______ T H E R A P Y
Arrest the disease
Alter the microflora to prevent reinfection
Maintain the disease in an arrested state

A

Antimicrobial

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2
Q 
An effective \_\_\_\_\_ does the following things:
• kills or inhibits target microflora 
• reaches the site 
• has an adequate concentration 
• has a sufficient duration 
• does not harm
A

Antimicrobial

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3
Q

Crevicular concentration is high using ______ delivery with a very
small dose of antimicrobial

A

Local delivery

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4
Q

T/F; Antimicrobial agents are never used in the absence of mechanical
debridement

A

True

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5
Q

Is it effective to give ABX to a perio pt without mechanically debriding?

A

Not effective: Debride then prescribe

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6
Q

I N D I C A T I O N S F O R _______
Applications :
✓Localized & Generalized aggressive periodontitis (old classification) / Grade C
✓Necrotizing gingivitis and periodontitis
✓Periodontitis associated with or aggravated by systemic disease (e.g. poorly
controlled diabetes)
✓Diffuse periodontal abscess with fever, malaise, etc
✓Patients in whom periodontal surgery is contraindicated

A

A D J U N C T I V E
A N T I M I C R O B I A L T H E R A P I E S D U R I N G
P H A S E I ( N O N - S U R G I C A L ) T R E A T M E N T
(ABX prescription with phase 1 debridement)

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7
Q

: the most studied and most 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
Taste and tooth discoloration side effects
Cannot reach the site subgingivally

A

Chlorhexidine gluconate (CHX) (0.12-0.2%)

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8
Q

Extrinsic _______ of the teeth of an individual rinsing
twice a day for 3 weeks with a 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.

A

brown discoloration

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9
Q

Which conc of CHX can be used to decrease the amount of extrinsic staining? Can the stains be removed with prophy paste?

A

.12%; Can be removed with prophy paste

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10
Q

_____ mechanism of action
Cationic, binds to negatively charged bacterial cell membranes
that, at lower concentrations leads to increased permeability and leakage, at higher
concentrations this membrane leakage leads to cytoplasmic entry and precipitation
of cytoplasmic contents inducing microbial cell death.
Cationic nature contributes to high substantivity once it binds to salivary pellicle: slow
release from tooth surfaces over 12 hours!

A

CHX MOA

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11
Q

W H E N D O W E
P R E S C R I B E ______?
• As adjunct to regular oral hygiene methods during Phase I therapy (SRP)
only in high risk individuals (systemically compromised, refractory
cases, etc)
• Mentally or physically challenged patients with low manual dexterity
• Jaw fixation
• 1st - 2nd week post surgery

A

C H X

R I N S E ?

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12
Q

Studies have shown conflicting results
1.5% effective as rinse (Boyd, 89)
oral ulcerations with 3% rinse (Rees, 86)
3% and 30% used as twice weekly rinse had issues
long term use can lead to pre-neoplastic lesions (Weitzman, 86)
ADA and FDA have concerns regarding long term use
possible co-carcinogen and impaired wound healing

A

Hydrogen peroxide

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13
Q

reaches the site with a sufficient concentration has a poor duration of action

A

Antimicrobial irrigation

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14
Q

What 2 things are used in antimicrobial irrigation?

A

CHX .12%

Betadine

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15
Q 
kills the pathogens effectively 
reaches the site very well 
has a very good concentration 
has a very good duration of action
Ideal properties: 
effective against periodontal pathogens 
low systemic absorption 
low risk of bacterial resistance 
biodegradable 
easily to use 
enhances scaling and root planing
A

Local delivery of antimicrbials

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16
Q 
Systemic or local drug delivery?
Site specific therapy 
 Better control of concentration, local effective dose 
 Limited or no systemic adverse effects 
 In office delivery, ensures compliance
A

Local delivery

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17
Q

: 10% povidone-iodine and 1% free iodine and can be used diluted as an irrigant.
do not use if any history of iodine sensitivity
use with caution in pregnancy and lactation because of the possibility of inducing
transient hypothyroidism in newborns

A

Betadine®

18
Q

What is the most popular direct delivery antimicrobial?

A

Arestin

19
Q

______ is (minocycline hydrochloride) in microspheres
(bioresorbable polymer of Poly(glycolide-co-dl-lactide)
or PGLA
available in 1 mg unit doses of dry powder
bacteriostatic, broad spectrum, inhibits protein synthesis

A

Arestin®

20
Q

When do we use _______?
Always as adjunct to SRP, never stand alone therapy
Residual isolated pockets ≥5mm, not responding favorably to
initial SRP, especially if BOP is present at re-evaluation.
Residual pockets after phase II (periodontal surgery)

Used at time of reevaluation
Used during maintenance
Used to treat a periodontal abscess
Used before regenerative therapy

A

local antimicrobial

drug delivery

21
Q

Is local drug delivery effective around implants?

A

Not effective

22
Q

T/F: T H E “ I D E A L ” A N T I B I O T I C F O R P E R I O D O N T I T I S
D O E S N O T E X I S T

A

True

23
Q 
Broad spectrum bacteriostatic 
High concentration in GCF 
(2-10 fold>serum). Highly 
e f f e c t i v e a g a i n s t A . 
actinomycetemcomitans, but 
re s i s t a n t s t r a i n s a re n o w 
c o m m o n . I n a d d i t i o n t o 
antimicrobial they also have 
anti-collagenolytic effects: 
i n h i b i t c o n n e c t i v e t i s s u e 
d e s t r u c t i o n a n d p ro m o t e 
repair 
Photosensitivity: severe skin 
burns
A

Tetracyclines

24
Q 
Broad spectrum bactericidal 
Used in combination with 
metronidazole 
Up  to  10%  of  humans  are 
allergic  to  penicillins   (can 
substitute  with  ciprofloxacin, 
clindamycin or erythromycin)
A

Penicillins
(Amoxicillin and
Augmentin)

25
Q 
Particularly  effective  against 
anaerobic b a c t e r i a a n d 
spirochetes, bactericidal 
Never  used  as  monotherapy 
in  periodontal  diseases  but 
a s c o m b i n a t i o n w i t h 
penicillins or ciprofloxacin 
Adverse reaction (nausea, 
vomiting, cramping) when 
taken with alcohol. 
Not to be combined with 
anticoagulants or lithium
A

Metronidazole

26
Q

Compliance is better with DCN
because it can be given qd or bid,
but photosensitivity is a problem
C o m m o n l y p re s c r i b e d i s a l s o
metronidazole in combination with
amoxicillin or cipro.
Clinical results of systemic therapy
are similar to local delivery

A

Doxycycline (DCN)

27
Q 
Target prostaglandins and inflammation 
Selective COX-1 vs COX-2 inhibitors 
E.g: Indomethacin, flurbiprofen and 
naproxen long term daily use (up to 3 
years) can lead to slower disease 
progression 
Serious side effects (renal, hepatic, GI 
tract). They are not used as adjuncts in 
periodontal therapy
A

NSAIDs

28
Q

Disrupt osteoclast activity
Can improve alveolar bone density but
their role in disease progression in humans
is unclear
Serious side effects with IV agents
(osteonecrosis of the jaw after oral surgery)
There is currently no approved application
in periodontal therapy

A

Bisphosphonates

29
Q

Of most tetracyclines ______ has best anti-

collagenolytic activity and better GI absorption

A

Doxycycline (DCN)

30
Q

• Monochromatic light
• Consists of a single wavelength of light and three principal parts:
-an energy source,
-an active lasing medium
-two or more mirrors that form an optical cavity or resonator
• The wavelength and other properties are determined primarily by the composition
of an active medium (it can be a gas, a crystal, or a solid-state semiconductor)
4 different interactions with a target tissue:
Reflection
Transmission
Scattering
Absorption

A

Lasers

31
Q

How do most lasers interact with target tissue?

A

Absorption

32
Q

When absorbed, it elevates the temperature and produces photochemical effects depending on
the water content of the tissues.
When a temperature of 100°C is reached, vaporization of the water within the tissue occurs
(ablation)
At temperatures below 100°C, but above approximately 60°C, proteins begin to denature,
without vaporization of the underlying tissue.
Conversely, at temperatures above 200°C, the tissue is dehydrated and then burned, resulting in
an undesirable effect called carbonization.
Absorption requires an absorber of light, termed chromophores, which have a certain affinity
for specific wavelengths of light.
The primary chromophores in the intraoral soft tissue are Melanin, Hemoglobin, and
Water, and in dental hard tissues, Water and Hydroxyapatite.
Different laser wavelengths have different absorption coefficients with respect to these
primary tissue components, making the laser selection procedure-dependent

A

Absorption of lasers

33
Q

___ lasers
• Used soft tissue treatments
• Despite their bactericidal efficacy, they are not effective for calculus removal
• May be helpful as an adjunct to SRP due to having bactericidal and detoxing
effects.5
• Low-level laser has also been recommended for pain reduction and enhancing
wound healing due to its anti-inflammatory effects.
- Basic, cheapest
- Hemoglobin and melanin used as chromophores: not used on hard tissue

A

Diode lasers

34
Q

____ lasers
• PDT (Photodynamic Therapy): Low-level laser irradiation in conjunction with the use
of a photosensitizer modality of bacterial reduction
• Free Radicals

A

PDT & NON- PDT

35
Q

____ lasers
Highly absorbed by the pigmented tissue
Effective surgical laser for cutting and coagulating dental soft tissues
Good hemostasis. In addition to its surgical applications
Used for nonsurgical sulcular debridement in periodontal disease control and the Laser Assisted
New Attachment Procedure (LANAP).

A

Nd:YAG lasers

36
Q

______ lasers
The erbium wavelengths have a high affinity for hydroxyapatite
highest absorption of water in any dental laser wavelengths
laser of choice for treatment of dental hard tissues
Can also be used for soft tissue ablation ( because they contains a high percentage of
water)

A

Erbium lasers

37
Q

When do we prescribe prophylactic antimicrobials?

A

Sub actue bacterial endocarditis

38
Q

The following are indications for ______:
‣Prosthetic cardiac valves, including bio-prosthetic and homograft valves (from
a cadaver)
‣Previous bacterial endocarditis
‣Congenital heart disease
‣Complex cyanotic congenital heart disease
‣Repaired congenital defects corrected with prosthetic material or device
for six months
‣Repaired congenital defect with prosthetic material or device with partial
defect
‣Cardiac transplant patients with cardiac valvulopathy

A

Prophy ABX

39
Q

Does total joint replacement require abx prophy?

A

Not routinely

40
Q

Consider _____ weeks of antibiotic

after use of bone grafting

A

1 week

41
Q

Do you want to do abx prophy before or after implant placement without bone grafting?

A

Only before

Perio 1 (12 decks)

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