systemic and local delivery systems

Question 1

Define “antiseptic” or “antimicrobial.”

Answer 1

A substance that prevents or inhibits the growth of microorganisms or kills microbes on contact.

Question 2

Define “antibiotic.”

Answer 2

A substance synthesized by microorganisms that prevents or inhibits bacterial growth by either stopping multiplication or killing the bacteria

Question 3

What is the difference between bacteriostatic and bactericidal agents?

Answer 3

• Bacteriostatic: Suppresses bacterial multiplication.
• Bactericidal: Kills bacteria.

Question 4

Differentiate between systemic and local delivery systems.

Answer 4

• Systemic delivery: Oral medication distributed through circulation to the subgingival pocket.
• Local delivery: Controlled-release agents placed directly into the periodontal pocket for prolonged release.

Question 5

Differentiate topical and controlled-release delivery systems.

Answer 5

• Topical delivery: Applied to exposed surfaces (teeth, gingiva).
• Controlled-release delivery: Sustained release in periodontal pockets (e.g., fibers, gels, microspheres).

Question 6

What is one advantage and one disadvantage of systemic delivery systems?

Answer 6

• Advantage: Reaches gingival crevicular fluid and all intraoral sites.
• Disadvantage: Can lead to antibiotic resistance.

Question 7

List systemic antibiotics commonly used in periodontal treatment.

Answer 7

• Tetracyclines (Tetracycline HCl, Minocycline, Doxycycline)
• Penicillins (Penicillin VK, Amoxicillin, Augmentin)
• Metronidazole
• Erythromycin
• Clindamycin
• Ciproflaxin

Question 8

What bacteria are targeted by tetracycline and metronidazole?

Back:

Answer 8

• Tetracycline: Targets Aggregatibacter actinomycetemcomitans and inhibits bone resorption.
• Metronidazole: Targets spirochetes, Porphyromonas species, and Prevotella species.

Question 9

List the characteristics of systemic agents (tetracycline, metronidazole, etc.).

Answer 9

• Tetracyclines: Bacteriostatic, concentrated in GCF, inhibits osteoclast function, and controls spread of periodontal pathogens.
• Penicillins: Bactericidal, used in aggressive periodontitis, may cause allergic reactions.
• Metronidazole: Bactericidal, inhibits DNA synthesis, effective against anaerobes.
• Erythromycin: Bacteriostatic, concentrates in inflamed tissues.
• Clindamycin: Bacteriostatic, suppresses protein synthesis.
• Ciproflaxin: Bactericidal, effective against gram-negative anaerobes.

Question 10

Differentiate between bacteriostatic and bactericidal systemic agents.

Answer 10

• Bacteriostatic: Suppresses bacterial growth (e.g., tetracyclines, erythromycin).
• Bactericidal: Kills bacteria (e.g., penicillin, metronidazole, ciproflaxin).

Question 11

What are the characteristics of local delivery systems?

Answer 11

• Local delivery systems retain concentrated drugs at the site, reduce pocket depths, improve clinical attachment levels, and biodegrade in the body.

Question 12

List controlled-release antimicrobials used in periodontal therapy.

Answer 12

• Actisite: Tetracycline (fiber)
• Atridox: Doxycycline (gel)
• Arestin: Minocycline (microspheres)
• PerioChip: Chlorhexidine gluconate (chip)

Question 13

How is Atridox administered?

Answer 13

Atridox is a doxycycline hyclate gel that is refrigerated, mixed before use, and applied into the periodontal pocket for controlled release up to 7 days.

Question 14

How is Arestin administered?

Answer 14

Arestin is a minocycline microsphere powder that is placed in the periodontal pocket, releasing the drug for up to 21 days.

Question 15

What is the difference between therapeutic and cosmetic oral rinses?

Answer 15

• Therapeutic rinses: Treat dental diseases (e.g., plaque and gingivitis control).
• Cosmetic rinses: Freshen breath and provide no therapeutic benefit.

Question 16

What is “substantivity” in the context of oral rinses?

Answer 16

Substantivity is the ability of an agent to remain at the site of action and resist dilution or washing away by saliva or gingival crevicular fluid.

Question 17

What are the characteristics of therapeutic oral rinses?

Answer 17

Therapeutic rinses must be antimicrobial, have good substantivity, be effective at killing bacteria, be stable at room temperature, and be safe for oral tissues.

Question 18

When should oral irrigation be utilized?

Answer 18

Oral irrigation should be used after periodontal debridement procedures to reduce gingival inflammation, bleeding, and bacterial load. It can also be used as an alternative to flossing.

Question 19

List the medicaments used in oral irrigation.

Answer 19

Common medicaments include water, chlorhexidine, Listerine (essential oils), and hydrogen peroxide

Question 20

What are contraindications to the use of oral rinses, systemic drugs, and local delivery systems?

Answer 20

Contraindications include pregnancy, allergies (e.g., iodine, penicillin), alcoholism (for alcohol-containing rinses), and interaction with other medications (e.g., anticoagulants, oral contraceptives, lithium).

Question 21

What is the purpose of systemic and local delivery systems in periodontal therapy?

Answer 21

The purpose is to reduce bacterial load, enhance the host’s defense, and aid in treating aggressive or refractory periodontitis, especially in cases where non-surgical periodontal therapy alone is insufficient

Question 22

What is an example of a systemic delivery system for periodontal therapy?

Answer 22

Systemic delivery systems include oral antibiotics, such as tetracyclines or penicillins, which are distributed through circulation to the subgingival pockets.

Question 23

How do tetracyclines function in periodontal therapy?

Answer 23

Tetracyclines are bacteriostatic, concentrate in the gingival crevicular fluid, inhibit osteoclast function, and control the spread of periodontal pathogens like A. actinomycetemcomitans.

Question 24

What are the side effects of tetracyclines?

Answer 24

Side effects include photosensitivity, reduced effectiveness of oral contraceptives, and interference with calcium absorption (should not be taken with dairy).

Question 24

What are controlled-release delivery systems?

Answer 24

Controlled-release systems, like Atridox or Arestin, are placed directly into periodontal pockets and release antimicrobial agents over a prolonged period.