CURRENT USE OF ANTIMICROBIALS/ANTIBIOTICS Flashcards
Never use antimicrobial agents in the absence of…
important
mechanical debridement
What is the mechanism behind chlorhexidine?
important
- 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
Chlorhexidine has a unique feature that allows it to…
important
- Adhere to soft and hard tissues and then be released over time
- Slow release over 12 hours
- High substantivity
What is the highly desireable property of chlorhexidine?
important
High substantivity
Generalized 5-6 mm pockets at a reeval. Plaque score is at 20%. What should you do next…
- local antimicrobial delivery (LAD)
- refer to periodontist
important
- refer to periodontist
LAD is better for localized pockets not generalized
What are the indications for local antimicrobial delivery (LAD)?
important
- When local sites with inflammation have not responded to periodontal or maintenance therapy
- 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.
Can you use local antimicrobial delivery (LAD) alone?
important
NO
- Always as adjunct therapy, never use alone.
What are the common products for local antimicrobial delivery (LAD)?
important
- PerioChip - Chlorhexidine gluconate
- Atridox - Doxycycline hyclate
- Arestin - Minocycline hydrochloride
- Acisite - Tetracycline hydrochloride
What is the active ingredient in periochip?
important
Chlorhexidine
How do you use periochip?
- Inserted in the pocket ≥ 5mm
- Release takes 7days
- Dissolves within 7-10 days, does not require removal
- Significant improvement in CAL when used with SRP
What is the active ingredient in atridox?
important
doxycycline hyclate
What is the active ingredient in arestine?
important
minocycline hydrochloride
How do you use arestin?
important
- Bacteriostatic by inhibiting protein synthesis
- Broad spectrum
- Significantly reduced red-complex bacteria in smokers.
- greater improvement in PD, CAL regardless of smoking status.
What is the active ingredient in actisite?
important
tetracycline hydrochloride
How do you use actisite?
important
- Currently unavailable
- Slow release over 10 days
- Packed into the pocket and left in place for 7-12 days, need removal
- Improve PD, BOP, and CAL when combined use with SRP in 6 months but no difference after 5 years
What are diode lasers?
important
- Used in soft tissue treatment
- Not effective for calculus removal
- Low-level laser has been recommended for pain reduction and enhancing wound healing due to its anti-inflammatory effects
What are Nd:YAG lasers?
important
- Highly absorbed by the pigmented tissue
- Effective in cutting and coagulating dental soft tissues
- Used for nonsurgical sulcular debridement in periodontal disease control (Laser Assisted New Attachment Procedure (LANAP)
Which of the lasers is effective for Laser Assisted New Attachment Procedure (LANAP)?
important
Nd:YAG
What is the main feature of tetracycline systemic antibiotics?
important
- Anti-collagenolytic effects: inhibit connective tissue destruction and promote repair
What are the features of subantimicrobial dose doxycycline (SDD) for perio host modulation?
important
- 20 mg doxycycline twice daily or 40mg once daily, for 6-9 months
- Among tetracyclines, Doxycycline has the best anticollagenolytic activity and better GI absorption
Sub-antimicrobial Dose Doxycycline (SDD)
What is periostat?
important
- is a host-modulating agent. It inhibits host
collagen-degrading enzymes - FDA-approved host modifier as an
adjunct to SRP - DO NOT USE AS STAND-ALONE THERAPY
- Clinical significance?
— 0.2-0.4mm difference in attachment gain
Maintain good oral health and regular dental care are much more important to prevent endocarditis than…
antibiotic prophylaxis for a dental procedure
