Local delivery antimicrobials in the treatment of chronic perio Flashcards
What are the main difference between th 1999 and 2018 disease classification
- Gingival diseases has been changed to gingival health, periodontal health and disease
- chronic and aggressive priodonttiis has now ben changed into stages 1-4, grades A-C and molar incisor patterns are observe
What are the stages of periodontitis?
Stage I
Stage II
Stage III
Stage IV
Describe stage I of periodontitis
Initial periodontitis
Describe stageII of periodontitis
Moderate periodontitis
Describe stage III of periodontitis
Severe periodontitis with potential for additional tooth los
Describe stage IV of periodontitis
Severe periodontitis with potential for loss of dentition
Describe the 3 steps we take to classify periodontitis according to the 2018 classification
- Determine the stage I-IV
- Determine the extent and distribution
- Determine the grade A-C
How do we describe the extent and distribution of perio
Localised or generalised
We can use the molar incisor distribution
Describe grade A of periodontitis
Slow rate of progression
Describe Grade B o periodontitis
Moderate rate of perio progression
Describe grade C of periodontitis
Rapid rate of progression of perio
What are antibiotics?
Drugs that kill or halt the multiplication of bacterial cells at concentrations that are relatively harmless to host tissues
What are antibiotics sued to treat?
Infections caused by bacteria
What is an infection?
Invasion of micro organisms into the host.
The reaction of the most to the microorgaisnsm is the infection
What type of infection is periodontitis?
Polymicrobial
Name the three plaque hypotheses
- Non specific
- Specific
- Ecological
Which of the three plaque hypotheses are themes accepted?
Ecologicalplaque hypothesis
Give some classifications of antibiotics
- Beta lactams
- Aminoglycosides
- Sulphonamides
- Tetacyclines
- Azoles
- Quinolones
- Macrolides
Give an example of a beta lactams
Penicillin
Give an example of an aminoglycoside
Gentamycin
Give an example of an azoles
Metronidazole
Give an example of a quinolone
Ciprofloxacin
Give an example of a macrolide
Erythromycin
Give some headings that can be used to classify antibiotics
- Based on spectrum of activity
2. Based on the action
What are the 2 categories antibiotics can be split into when they are classified based on spectrum
- Narrow spectrum
2. Broad spectrum
Wha does it mean if a bacteria has a narrower spectrum of activity?
That it only targets a certain group of bacteria
Wha does it mean if a bacteria has a broad spectrum of activity?
That it can target a wide range of bacteria species
When making antibiotics what type of spectrum activity do we want?
Narrow spectrum so neighbouring cells aren’t damaged
Name the 2 categories antibiotics can be placed in when categorised based on aciton
- Bacteriostatic
2. Bactericidal
What does bactericidal mean?
Antibiotics that kills bacteria
What does bacteriostatic mean?
Antibiotics that stop or inhibit the multiplication of bacteria
When choosing an antibiotic do you close a bacteriostatic or bactericidal one? Why?
Bactericidal as it will kill the bacteria
Name the 5 mode of actions of systemic antibiotics
- Inhibition of cel wall synthesis
- inhibition of cytoplasmic membrane function
- inhibition of nucleic acid synthesis
- Inhibition of ribosomal function and hence protein synthesis
- Inhibition of folate metabolism
What does systemic mean?
Affects the whole body not just a targeted area
What does amoxycillin do?
Inhibits the cell wall synthesis
What does metronidazole do?
Inhibits nucleic acid synthesis by breaking down strands of DNA
What do tetracyclines and macrocodes do?
Inhibits protein synthesis
What are some of the disadvantages of the use of antibiotics
- Hypersensitivity
- Gastrointestinal disturbances
- Alterations in the commensal flora
- Drug-drug interactions, Drug- alcohol interactions
- Bacterial resistance
How many deaths in the EU per year are taught to be due to multiple drug resistant bacteria?
Estimated 25,000
What does the antimicrobial stewardship programs organised by NICE do?
A organisational or healthcare system wide approach to promote monitoring of judicious use of antimicrobials to preserve their future effectiveness
What are some steps antimicrobial stewardship has played ou to try and reduce the risk of bacterial resistance?
- Evidence based optimal standards for routine antimicrobial prescribing
- Ensuring competency and education for prescribers
- Communication of issue to all stakeholders
- Auditing the impact and uptake of processes above
Optimising outcome for patients prescribed antimicrobials
What 3 things does public health England tell patients to do/ not to do?
- Don’t demand antibiotics
- Take antibiotics as they are prescribed
- Spread the word among friends and relatives
What does efficacy mean
Ability of a drug to produce a desired effect
Give some factors that affect efficacy
- Blinding of drug to tissue
- Protection of key organisms by non target organisms binding or consuming drug
- Bacterial tissue invasion
- Total bacterial load
- Previous drug therapy
- Non pocket infected sites
- Presence of biofilm
- Beta lactase production
What is beta lactamase?
They are enzymes that can cleave an inactivate beta lactic drugs
Name something that can inhibit beta lactamase
Clavulanic acid
Give some reasons for failure of antimicrobial therapy
- Lack of culture and sensitivity
- Failure to achieve drainage
- Non bacterial causative agent
- Incorrect drug duration to dose
- Lack of compliance
- Defective host response
- Persistent risk factors
- Lack of substantivity of local agents
- Drug resistance
How do we prescribe antibiotics?
Empirically
What is the ideal way of determine which antibiotics should be prescribed?
Using culture and sensibility
But theres isn’t that much the to do this
What is it called when when we prescribe one antibiotic?
Mono therapy
What is it called when when we prescribe more than one antibiotic?
Combination therapy
What is the most common combination of drugs prescribed in dentistry?
amoxicillin and metronidazole
Should we prescribe antibiotics for chronic periodontitis?
NO
Should we prescribe antibiotics for aggressive periodontitis ?
Can be used
What is the cause offer periodontitis?
calcification of the biofilm-> calculus
How dow e treat chronic periodontitis?
Scaling and RSD
Should we prescribe antibiotics for periodontitis is manifested due to a systemic disease?
Don’t need it just need t remove calculus
Should we prescribe antibiotics for necrotising periodontal disease?
YES
If you want to prescribe antibiotics what should you do?
Refer your patient to a specialist
Should we prescribe antibiotics for abscesses of periodontium
Maybe
Should we prescribe antibiotics for periodontitis associated with endodontic lesions
No
What should antimicrobials be used in conduction with when treating periodontitis
Mechanical therapy
Give some rationale fo systemic therapy
- Panoral infection in aggressive perio
- Other oral niches colonised with periodontal pathogens
- Drugs are concentrated in GCF
- Maintains minimal inhibitory concentration for long duration
Give some examples of possible antibiotic regimens for aggressive periodontitisq
- Penicillins with or without clavulanic acid
- Tetracyclines
- Macroides
- Nitroimidazole
What instructions do you give to a patient when you prescribe them amoxicillin?
Take 500mg 2-3 times a week for 8 days
What does amoxicillin target?
Gram positive agn gram negative bacteria
How does amoxicillin affect bacteria?
It is bactericidal
What is amoxicillin sensitive to?
Penicillinase
What instructions do you give to a patient when you prescribe them amoxicillin and clavulanic acid?
Take 500mg 2-3 times for 8 days
How does amoxicillin and clavulanic acid affect bacteria?
It is bactericidal
Give some side effects of amoxicillin and clavulanic acid?
Diarrhea
Colitis
Nausea
What instructions do you give to a patient when you prescribe them tetracycline?
Take 500mg 4 times for 21 days
How does tetracycline affect bacteria?
Bacteriostatic
What does tetracycline target?
Gram positive bacteria more than gram negative
Give some side effects of tetracycline
Can cause severe sunburn if exposure to bright sunlight
Severe stomach pain
Nausea
What instructions do you give to a patient when you prescribe them minocycline?
Tale 100-200mg 1 time a day for 21 days
How does minocycline affect bacteria?
it is bacteriostatic
What does minocycline target?
Gram positive bacteria more than gram negative
What instructions do you give to a patient when you prescribe them doxycycline?
take 100-200mg once a day for 21 days
How does doxycycline affect bacteria?
It is bactericidal
What does doxycycline target?
Affects Gram positive bacteria more than gram negative
What instructions do you give to a patient when you prescribe them ciprofloxacin?
Take 100-200mg twice a day for 8days
How does ciprofloxacin affect bacteria?
It is bactericidal
What does ciprofloxacin target?
Gram negative rods
Give some side effects of ciprofloxacin?
Nausea
Gastrointestinal discomfort
