Ideal properties of antibiotics

Question 1

IDEAL ANTIBIOTIC

Answer 1

Specific for periodontal pathogens
Allogenic
Non toxic
Substantive
Not in general use for treatment of other diseases
Inexpensive

Question 2

GUIDELINES

Answer 2

Clinical diagnosis…adjunctive therapy to control active disease
Continuing disease activity
Medical status and current medications
Microbiological sampling
Plaque Sampling
Periodontal surgery

Question 3

Microorganisms associated with periodontal disease

Answer 3

Aggregatibacter actinomycetemcomitans
Porphrymonas gingivalis
Tanerella Forsythus (Bacteroides intermedius)
Prevotella intermedia
Campylobacter rectus
Peptostreptococcus spp
Fusobacterium spp
Eubacterium spp
Treponema spp

Question 4

ANTIMICROBIAL MECHANISM

Answer 4

Antimetabolic— Sulphonamides, trimethoprim

Cell wall inhibitor—Penicillins, cephalosporins, vancomycin

Bacterial protein synthesis inhibitor—Tetracyclines, clindamycin, aminoglycosides

DNA gyrase inhibitor—Nalidixic acid, ciprofloxacin, ofloxacin

Question 5

COMBINATION THERAPY

Answer 5

No single antibiotic effective against all putative pathogens

Metronidazole and amoxicillin produce excellent effects in aggressive periodontitis (synergy)

Systemic antibiotic therapy combined with mechanical debridement effective in localised periodontitis

Penicillins inactivate tetracyclines therefore don’t use in combination
May also have increase adverse reactions with some combinations

Question 6

Who to prescribe antibiotics to:

Answer 6

Aggressive Periodontitis
Necrotizing ulcerative Gingivitis
Necrotizing ulcerative Periodontitis
Underlying uncontrolled systemic conditions (e.g immunocompromised pts)
Abscesses of the periodontium (if severe)

Question 7

OTHER CHEMOTHERAPEUTIC ADJUNCTS

Answer 7

Chlorhexidine gluconate
Effective as an antiplaque rinse to reduce
gingivitis but not as
a subgingival irrigant to reduce periodontal
pocketing

Povodine-Iodine (Betadine)
May be effective when used directly into
periodontal pocket
Used with caution in pregnancy , lactation and
iodine sensitive
patients

Question 8

Management

Answer 8

Diagnosis
(If you notice that the patient has severe pain, prescribe antibiotics first with a mouth rinse with analgesics)

Mechanical removal of plaque and calculus (Scaling and polishing)

Antibiotics and Mouth rinse (if necessary with analgesics)

Root planning (If necessary)

Recall

Corrective treatment

Maintenance phase