systemic antimicrobials in perio. Flashcards
what is antimicrobials used alongside ?
mechanical therapy
What can antimicrobials do to biofilms?
incrase min. inhibitory conc.
what does chronic perio. severity correlate with ?
Oral hygiene
Why dont we just ONLY prescribe antimicrobials for periodontitis?
Antimicrobial resistance risk from MRSA allergic reactions Fungal overgrowth cost
What is chlorhexidine?
strong antimicrobial
What is conventional therapy?
sticking to treatment without need of antimicrobials
Problem with conventional therapy?
Cost - patient and NHS Pain - use LA Time - multi appts. Instrumentation Skill
Why use Antimicrobials?
may not respond to scaling (NST)
Agress. Perio may have specific microbial aetiology
Bacterial reinvasion
What is Periostat?
low dose of doxycycline 20mg twice a day
what can periostat reduce?
bystander damage, damage caused to healthy host tissue
How can Porphyromonas gingivalis be passed?
can be between spouses
2 types of chronic and aggressive periodontitis ?
localised or generalised
Types of perio. disease?
Agressive
Chronic
NUG
Symptoms of aggressive periodontitis ?
red gingival inflammation
bone loss
Indications for use of antibiotics?
NUG
perio. abscesses with no drainage
to reduce risk of post op infection after perio surgery
What to question when you see a perio. abscess?
is tooth vital?
can be drained?
systemic effects?
can occlusal force be reduced?
WHAT is NUG?
fuso-spirochete infection invading SOFT tissue
what does NUG cause?
- soft tissue necrosis
- loss of gingival contour which leads to chronic periodontal pocketing
Microbiology of non specific periodontitis?
bacteria in large quantities left long enough
microbiology of specific periodontitis ?
colonies of P.Gingivalis seen in aggressive perio. and high levels of antibodies formed
What is ecological microbiology ?
good bacteria thrive and stop harmful bac. growing
what are indicators for systemic antimicrobials?
NUG
Perio. abscess
Agressive perio
What treatment planning is there for periodontitis?
- NST ( Scaling & rsd)
- Monitor response
- if all fails then surgical therapy
What does NST do?
- decrease bacterial load
- may produce resolution
How do you monitor response after 6 weeks?
- see IF PPD reduced and no BOP
- if still active, repeat NST with decontamination protocol
what is decontamination protocol?
- scaling over 2 visits in same week
- THEN OHI and chlorhexidine
- antibiotics start on day 1 of decontamination
do you ever have a surface free of all necrotic cementum and calculus?
NEVER! just enough to allow for healing
why do we do systemic therapy?
- aggressive perio- affects whole mouth and sites re infect
- drugs concentrated within GCS and targers pocket flora
what factors affect eficacy?
- binding 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 – patients will be resistant to therapy if always have systemic antimicrobials
• Non-pocket infected sites – just become re infected
what can some bacteria produce?
beta lactamase that inactivates beta lactam drugs like penicillin
what beta lactamase inhibitor is used with amoxicillin sometimes?
Clavulanic acid- prevent bacteria making beta lactamase
what do antibacterial drugs inhibit?
- cell wall synthesis
- protein synthesis
- bacterial cell metabolism
- they interfere with bacterial nucleic acid synthesis
What is microbial testing?
-culture using PCR/ELISA/CHeck hybridisation
why do we microbial test?
to see of perio. is chronic or aggressive
- identifies specific bacteria
what does tetracycline do?
- Good because of their antibacterial effect
- Concentrated in GCF
- Binds to root surface
- Released slowly
- Fibroblast stimulation
- Osseous induction
- Anticollagenase (inhibits matrix metalloproteinases)
what are current regimes adjunctive to mechanical therapy in LDI?
- Tetracycline’s – 250mg – 4 times a day – 14 days
- Doxycycline 100mg – twice a day for 1st day, once a day for 13 days
- Amoxicillin 250 mg with metronidazole 200 mg – 2 a day for 7 days
When to use Amoxocillin?
500 mg, 2-3 times for 8 days it’s Bacteriocidal for
Gram + and Gram –
what is bacteriostatic?
agent prevents the growth of bacteria
What is bactericidal?
KILLS BACTERIA
when to use tetracycline?
500 mg, 4 times for 21 days its bacteriostatic (Gram+ > Gram –)
When to use Minocycline?
100-200 mg, 1 time for 21 days Bacteriostatic (Gram+ > Gram –)
When to use doxycycline?
100-200 mg, 1 time for 21 days Bacteriostatic (Gram+ > Gram –)
when to use ciprofloxacin?
500 mg, 2 times for 8 days Bacteriocidal (Gram – rods)
When to use Azithromycin?
500mg 1 time 4-7 days Bactericidal or bacteriostatic
depending upon the dose, broad spectrum
when to use Clindamycin?
300mg 2 times for 5-6 days Bactericidal
When to use Metronidazole?
500mg 2 times for 8 days Bactericidal to Gram-
reasons for failure of antimicrobial therapy?
- Lack of culture and sensitivity
- Failure to achieve drainage
- Non-bacterial causative agent (viral)
- Incorrect drug use
- Lack of compliance
- Defective host response – AIDs patient
- risk factors e.g. smoking
- Lack of substantivity of local agents
- Drug resistance
- Diabetes
What does diabetes do to a patient with perio disease?
chance of managing it is redcued
What is exogenous infecting agents for perio?
•A. actinomycetemcomitans and P. gingivalis
