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Periodontology > Local and systemic antimicrobials in the management of inflammatory perio disease > Flashcards

Local and systemic antimicrobials in the management of inflammatory perio disease Flashcards

1
Q

What are the principles of treatment of periodontal disease?

A 
Mechanical plaque control:
Patient preformed 
Non-surgical root surface cleaning
Surgical root surface cleaning
Role of other factors: smoking/stress/systemic medication and disease
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2
Q

What are the choice of antimicrobials for systemic use?

A

Tetracyclines
Metronidazole
Combination of metronidazole and amoxicillin
Azithromycin

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3
Q

What is the choice of treatment with antimicrobials for aggressive periodontitis?

A

Metronidazole 400mg and amoxicillin 500mg both TDS 7days

Azithromycin 500mg for 3 days

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4
Q

What was the former treatment for aggressive periodontitis?

A

Tetracycline 500mg TDS 3 weeks
or Doxycycline 100mg daily 100mg daily 3 weeks
or Tetracycline 250mg QDS 2 to 3 weeks

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5
Q

What is the treatment for periodontal abscess?

A 
As an adjunct to mechanical treatment 
Metronidazole 
Amoxicillin/clavulanic acid 
Azithromycin
Tetracycline
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6
Q

What warning is there about azithromycin?

A

Prolong the QTC interval - increasing the risk of abnormal heart rhythm
Interactions include statins
Must check BNF/check with pharmacist or GP

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7
Q

What do you ideally want in a study evaluating systemic antibiotics

A

Prospective
Randomicsed placebo-controlled,
double-blind trial

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8
Q

When is the role of systemic antimicrobials used as an adjunt to mechanical treatment used?

A 
Aggressive perio
NUG/NUP
Periodontal abscess
Deep periodontal pockets not responding to RSD
Progressive or active disease 
Guided tissue regeneration 
NOT in chronic adult periodontitis
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9
Q

What are the problems with evaluating systemic antibiotics?

A

Majority of older adults fall short

Evidence base emerging following recent studies

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10
Q

Systemic antimicrobials, evidence base 1

Herrera et. al 2002 systemic review

A

Additional benefit (CAL/PPD) - deep pockets
Reduced risk of further progressive or active disease
Aggressive disease might have adjuctive benefit
Amoxicillin and metronidazole combination

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11
Q

Evidence base 2: Herrera et al 2008

A

Antibiotics should start at the completion of rsd which should be completed within one week

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12
Q

According to evidence, what does amxoicilin and metronidazole improve the clinical outcomes in?

A

Aggressive periodontitis

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13
Q

According to evidence, what does azithromycin improve outcomes in?

A

chronic periodontitis in deep pockets

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14
Q

According to evidence, what should be used to treat periodontal abscess?

A

amoxicillin/clavulanic acid

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15
Q

What are the advantages of using systemic antimicrobials?

A

Useful for: aggressive/active/progressing sites
Multiple sites
Low cost
Less clinical time

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16
Q

What are the disadvantages of using systemic antimicrobials

A

Dependent on patient compliance
Unwanted side effects
Can produce microbial resistance to antimicrobials
Can lead to sensitivities and allergens

17
Q

What are examples of locally applied antimicrobials?

A

Metronidazole (elyzol)
Chlorhexidine (periochip, chlodite gel)
Minocycline (atridox)

18
Q

What are indications for locally applied antimicrobials?

A

Few sites
poor response to debridement
deep sites in maintenance patients
repeat applications

19
Q

What is metronidazole 25% (elyzol), how does it work?

How long is it stable for?

A

Semi-solid suspension gel which forms crystals on contact with water
Water in matrix dissolves the metronidazole so can diffuse
3 years at <25 degrees

20
Q

How do you use Elyzol?

A

Subgingival debridement first
Syringe into pocket until overflowing
re-apply one week later

21
Q

Does Elyzol work?

A 
Effective antimicrobial conc <1day 
Substantial amount in swallows
Decrease in BOP and PD's
Another study showed P<0.001 in favour of SRP and Elyzol 
May enhance the effect of SRP
22
Q

What are indications for using elyzol?

A

Progressing periodontitis
Grade II furcation’s
angular bony defects

23
Q

What are contraindications for using elyzol?

A

refractory or aggressive periodontitis
Periodontitis in pt’s with predisposing illness or under medial treatment
Grade III furcations
Patient’s allergic to sesame seeds

24
Q

What is the periochip?

A

Chlorhexidine digluconate 2.5mg in gelatine

25
Q

What is the minimum depth of periochip?

A

> 5mm

26
Q

How does periochip work?

A

Biodegrades releasing chlorhexidine over 7-10 years

27
Q

Does the periochip work?

A

Enhanced effects of SRP (scaling and root planing), especially in deep pockets
Gain in bone and/or no loss compared to 25% bone loss with SRP

28
Q

What is chlostie (Ghima) made up of?

A

Xanthan gel and chlorhexidine

0.5% as digluoconate and 1% dihydrochloride

29
Q

What is Minocycyline 2% (dentomycin) used for?

How is it used?

A

Moderate to severe chronic periodontitis
Adjunct to RSD of sites >5mm in depth
Not to be repeated within 6 months

30
Q

Does dentomycin work?

A

conflicting results

Various application recommendations

31
Q

What is doxycycline 8.5% atridox? how does it work?

A 
Gel that solidifies in minutes 
Does not flush out
Sustained release 7-10 days 
Absorbed, doesnt require removal
Effective against periodontal pathogens
32
Q

Does atridox work?

A

Enhaced effects of RSD
Works in smokers
suggested use in non-responding sites
NO LONGER AVAILABLE IN UK

33
Q

What are the advantages of locally applied antimicrobials

A

High local concentration of antimicrobial with minimum unwanted side effects
Less reliance on patient compliance
useful for isolated sites

34
Q

What are the disadvantages of locally applied antimicrobials?

A

More expensive

Effectiveness questionable

35
Q

Do locally applied antimicrobials work?

A

Huge variation in studies
Additional improvement in probing and clinical attachment (mean<1mm) vs RSD alone
Increased number of sites with PPD reductions of greater than or equal to 2mm

36
Q

Which ones work best?

A

Elyzol
Atridox
Periochip

37
Q

Which locally applied antimicrobials showed the most reduciton in PPD?

A

tetracycline fibres> doxycycline> minocycline all <1mm

Minimal reductions for chlorhexidine chips and metronidazole

38
Q

Which local antimicrobial showed the greatest improvement in clinical attachment?

A

Chlorhexidine/xanthan gel

Metronidazole and chlorhexidine products had no effect

39
Q

What can the locally applied antimicrobials not be used to treat

A

Local aggressive periodontitis

Periodontology (7 decks)

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