Locally delivered antimicrobials in perio Flashcards
Evidence for microbial cause
Acute periodontal infections
Relationship between plaque levels and gingivitis and periodontitis
Host immunological response - elevated serum levels
Pathogenic potential - leukotoxins
Studies using animals
Immunisation of rats - reduced p gingivalis
Efficacy of antibiotics treating aggressive, mod/advanced chronic periodontitis
What are mechanical debridement limitations?
Operator skill
Poorer treatment outcomes with furcation sites compared to molar flat surfaces
Where does mechanical therapy fail to remove pathogens?
Sub epithelial gingival tissues Crevicular epithelial tissues Altered cementum and dentinal tubules Sub gingival calculus Colonisation of dorsum of tongue, tonsils, oral mucosa
Why is chlorhexidine as effective as water in irrigation?
GCF in 5mm pocket has high flow rate leading to rapid clearance of chlorhexidine
What are some names of locally delivered antimicrobials
Actisite Periochip Dentomycin Elyzol Atridox Arestin
How will we know treatment is successful?
Reduction in probing depth
Clinical attachment level
Bleeding on probing - idea of inflammation
Absence is a reliable sign of stability
How to apply actisite?
Wrap fibre around neck of tooth after RSD, apply acrylic adhesive to keep fibre in for 10 days, then remove
Who can’t use periochip?
Pregnant/breastfeeding women
What can be placed in multiple sites?
Dentomycin - plastic cannula fills pockets
What is a form of metronidazole in mono/triglyceride gel?
Elyzol - requires multiple doses after 1 week
What form do arestin take?
Encapsulated microspheres that are bioresorbed over 10 days
What are indications for antimicrobials?
Pocket depths >5mm with BOP
Adjunct to mechanical therapy
Non responding sites after initial therapy
Choice of product relates to number of pockets
Risks
Antibiotic resistance
Effect on gut microbiome
