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2nd yr- CSA - Antimicrobials for perio > Locally delivered antimicrobials > Flashcards

Locally delivered antimicrobials Flashcards

1
Q

What evidence suggests that periodontitis has a bacterial cause?

A
  1. People an develop acute periodontal infections following periodontitis
  2. We know the relationship between plaque levels, gingivitis and periodontitis
  3. Theres an efficacy of antibiotics in treating periodontitis
  4. Host immunological responses to periodontitis s
  5. Plaque bacteria has pathogenic potentila
  6. Theres studies present using snail models showing periodontitis has a bacterial cause
  7. Immunisation studies in animals also shows evidence for periodontitis having a. bacterial cause
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2
Q

What is the main treatment we use to treat periodontal disease?

A

Mechanical therapy like scaling

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3
Q

What are the limits to mechanical therapy?

A

Poorer treatment options for sites with furcation involvement compared to molar flat surfaces

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4
Q

When might mechanical therapy fail to remove periodontal pathogens?

A
  1. Sub epithelial gingival tissues are out of reach so can’t remove bacteria from them
  2. If plaque is located in the connective tissue its hard to reach
  3. Crevicular epithelial cells are hard to remove
  4. The cementum and dentinal tubules are altered
  5. Sub gingival calculus is hard to remove
  6. Some anatomical features make it harder to remove bacteria
  7. Colonies on the dorsal of the tongue. tonsils an oral mucosa aren’t affected by scaling
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5
Q

Give examples of some antimicrobials we use in dentistry

A
  1. 0.2% chlorhexidine gluconate
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6
Q

What does research show about the use of 0.2% chlorhexidine gluconate?

A

In the mouth studies have shown that chlorhexidine gluconate has no effect

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7
Q

Why does 0.2% chlorhexidine gluconate have no effect in the mouth?

A

Due to gingival crevicular fluid

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8
Q

Why is gingival crevicular fluid the reason 0.2% doesn’t work?

A

Theres a low volume but a high flow rate

GCF is cleared out 40 times an hour so if anything is added it is rapidly cleared

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9
Q

Give examples of devices that have been used to try and delivery antibiotics?

A
  1. EVA fibre containing 25% tetracycline HCl
  2. Chlorhexidine (2.5mg) in hydrolysed gelatine
  3. Minocyline 2% lipid gel
  4. Metronidazole 25% in a mono/triglyceride gel
  5. Doxycycline hyclate (8.8%) resorbable gel
  6. Minocycline HCl (1 mg) encapsulated microspheres
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10
Q

Which of the devices used to try and deliver antibiotics is not Resorbable?

A

EVA fibre containing 25% tetracycline HCl

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11
Q

How do we evaluate the effectiveness of varying devices used to deliver antibiotics?

A
  1. Read studies critically and be clear about what is being measured
  2. We check Pocket probing depth
  3. We check Gingival recession
  4. We check Clinical attachment level
  5. We check Bleeding on probing
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12
Q

What is a reliable indicator of periodontal stability?

A

The absence of bleeding on probing

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13
Q

What product is used to administer 25% tetracycline in an ethylene vinyl acetate fibre?

A

Actisite

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14
Q

What is Actisite?

A

It is a thin fibre that contains tetracycline that reduces the number of bacterial which infect gums

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15
Q

Where is Actisite placed?

A

It is places into the infected pocket between the gum and tooth

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16
Q

When is Actisite removed?

A

Usually after 10 Days

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17
Q

Is tetracycline usually bacteriostatic or bactericidal?

A

Bacteriostatic

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18
Q

When used in Actisite is tetracycline bacteriostatic or bactericidal?

A

bactericidal

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19
Q

6 months after treatment what results does Actisite show?

A
  1. Pocket depth decreases

2. percentage of sites with no bleeding on probing increases from 50% fo 63%

20
Q

What product is used to administer 2.5 mg chlorhexidine gluconate in a biodegradable gelatine chip?

A

Periochip

21
Q

What do you have to weary of when giving patients a periochip

A

Must tell your patient that perio chips contain gelatine as some patients may not be comfortable with this

22
Q

How do periochips work?

A

They release chlorhexidine via diffusion

A chip is put into the patients mouth and this gel breaks down to release chlorhexidine

23
Q

What is the benefit of periochips over Actisite ?

A

You don’t have to remove periochips as the work by breaking down

24
Q

After 3 month what changes are seen in the mouth following placement of a periochip?

A

pocket depth decreases by -1.36

25
Q

After 6 month what changes are seen in the mouth following placement of a periochip?

A

Pocket depths decrease by 1.77mm

26
Q

What product is used to administer 2% minocycline in a lipid gel

A

Dentomycin

27
Q

How is Dentomycin used/

A

It comes in a syringe with a canal attached to it that allows you to slide the canal down into the pocket
This allows you to fill the pocket with minocycline

28
Q

What is a disadvantage of dentomycin?

A

Requires several visits as need to be re applied a few times

29
Q

After 6 weeks what changes are seen in the mouth following placement of a Dentomycin?

A

Pocket depth decreases very slightly compared with a control
-2.4 with dentomycin and -2.11 without

30
Q

After 13 weeks what changes are seen in the mouth following placement of a Dentomycin?

A

Pocket depth decreases very slightly compared with a control
-2,64 with dentomycin and -2.3 without

31
Q

What product is used to administer 25% metronidazole in a monoglyceride and triglyceride gel

A

Elyzol

32
Q

How is elizol administered

A

metronidazole is loaded into a cartridge and is deposited straight into the pocket
This needs to be applied twice

33
Q

What can elyzol be used in conjunction with?

A

Atridox
THese two together is show not be more effective after 3 months alone than just dong a full mouth scale and root planning

34
Q

What does elizol have a molar result too?

A

similar outcomes as SRP

35
Q

What is atridox?

A

8.5% doxycycline gel that can be used with elyzol

36
Q

What product is used to administer 1 mg of minocycline HCl in encapsulated microspheres

A

Arestin

37
Q

How is Arestin administered

A

You inject it into the pocket

38
Q

After 6 weeks what changes are seen in the mouth following placement of a Arestin ?

A

Periodontal depth decreases to -2.4 (in comparison ro -2.11 control)

39
Q

After 6 weeks what changes are seen in the mouth following placement of a Arestin ?

A

Periodontal depth decreases t§o -2.64 (in comparison ro -2.30 control)

40
Q

What are some if the indications for local antimicrobials?

A
  1. Need Pocket depths of more than 5mm with bleeding on probing
  2. Adjunct to mechanical therapy
  3. Non-responding sites after initial therapy
  4. Choice of product influenced by the number of pockets to be treated
41
Q

Name the antibitotic acitsite delivers and how it delivers it

A

By using 25% tetracycline in an ethylene vinyl acetate fibre

42
Q

Name the antibiotic periochips deliver and how it delovers it

A

2.5 mg chlorhexidine gluconate in a biodegradable gelatine chip

43
Q

Name the antibiotic dentomycin delivers and how it delivers it

A

2% minocycline in a lipid gel

44
Q

Name the antibiotic elyzol delivers and how it administers them

A

25% metronidazole in a monoglyceride and triglyceride gel

45
Q

Name the antibiotic arestin delivers and how It delivers it?

A

1 mg of minocycline HCl in encapsulated microspheres

2nd yr- CSA - Antimicrobials for perio (2 decks)

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