Use of antimicrobial agents in periodontal therapy Flashcards
Discuss the properties of chlorhexidine in the management of gingival and periodontal disease
Anti-plaque agent – prevents plaque
accumulation on tooth surface
Anti-microbial: mode of action - membrane
disruption – highly cationic
Highly effective - gold standard:
Gm+ve/Gm-ve bacteria, aerobic and
anaerobic, yeasts
Substantivity: ability to bind to soft and
hard tissues, increasing working time
Discuss the delivery systems of chlorhexidine in the management of gingival and periodontal disease
UK/Europe: 0.2%
chlorhexidine gluconate,
10ml rinse (20mg)
Corsodyl Daily Defence
0.06% Chlorhexidine
Digluconate
0.0553% sodium
fluoride (250ppm)
Everyday usage
Staining??
Chlorhexidine gel
* Gingivitis associated with Mouthbreathing
* Use on Tepe brushes to access interproximal
sites
Periochip
Slow release chlorhexidine from
bovine gelatin carrier
Contains 2.5mg chlorhexidine
Peak concentration @ 2 hours
Continued release over 10 days
Self-retentive in pocket
No bacterial resistance
≥5mm pocket depth
Repeat placement every 3
months
explain use of chlorhexadine to a patient
Interacts with toothpaste components (sodium
lauryl sulphate): use at least 1 hour before/after
toothbrushing
Avoid longterm usage – advise once/twice per
day for up to 7 days during active treatment
Side-effects: staining (so avoid tea, coffee and red wine, these have high levels of tannins which bind to (root) surfaces), taste sensation, parotid
swelling, hypersensitivity/anaphylaxis
Discuss the use of chlorhexidine in the management of gingival and periodontal disease
Aid to toothbrushing and interdental cleaning
Post-scaling and root instrumentation when tissues may be sore/sensitive; patient’s plaque control not optimal; significant gingival inflammation.
Post periodontal surgery
Acute gingival infections
Prescribe chlorhexadine mouthwash to a patient
0.2%
chlorhexidine gluconate,
10ml rinse (20mg)
Corsydyl daily defence
0.06% Chlorhexidine
Digluconate
0.0553% sodium
fluoride (250ppm)
Everyday usage
Staining??
more used as maintenance therapy than active treatment
esp good for patients post periodontal therapy that have gingival recession exposure of roots- sodium flouride and chlorhexadine protect the roots from root caries
Chlorhexidine gel
- Gingivitis associated with Mouthbreathing (applied on upper anterior segments-localised gingivitis due to drying out in sleep and therefore plaque accumilation )
- Use on Tepe brushes to access interproximal
sites
(antiplaque and antibacterial properties)
Periochip
Slow release chlorhexidine from
bovine gelatin carrier
Contains 2.5mg chlorhexidine
Peak concentration @ 2 hours
Continued release over 10 days
Self-retentive in pocket
No bacterial resistance
≥5mm pocket depth
Repeat placement every 3
months
you want to avoid surgical therapy in the upper anterior segment and instead use a non surgical approach so what do you do here
re instrument the root surface
insert periochip
(push it to the base of the pocket and leave it there, gelatinises when contacts blood/fluid and releases chlorhexadine locally)
you want to avoid surgical therapy in the upper anterior segment and instead use a non surgical approach so what do you do here
re instrument the root surface
insert periochip
(push it to the base of the pocket and leave it there, gelatinises when contacts blood/fluid and releases chlorhexadine locally)
you want to avoid surgical therapy in the upper anterior segment and instead use a non surgical approach so what do you do here
re instrument the root surface
insert periochip
(push it to the base of the pocket and leave it there, gelatinises when contacts blood/fluid and releases chlorhexadine locally)
use of periochip
some use some don’t.
not a significant difference shown in effect of pocket depth reduction but some use it 3 times once post Tx once 3 months after and then 3 months after that
Use of antimicrobial agents in
mouthwashes/toothpastes
(do not contain chlorhexadine most patients just use to freshen their breath)
Quaternary ammonium compounds
Cetylpyridinium chloride (CPC)
Triclosan
Sanguinarine
Metal ions: Zinc
Oxygenating agents
Hydrogen peroxide, sodium perborate
Phenolic antiseptics: (used in lysterine)
Menthol, thymol,
Eucalyptol, essential oils
ClosSYS II active ingredient:
Chlorine dioxide
(used in chlorine dioxide)
issue with alcohol mouthwash and why it is no longer done?
increased risk of oral cancer
(ethanol free lysterine is made now)
Explain the rationale of use of antiobiotics in periodontal therapy
Periodontal diseases are
infections
The primary goal of
periodontal treatment is
the removal of sub-
gingival bacteria
Why should you not use antiobiotics in periodontal therapy?
No penetration of
antibiotics without
mechanical disruption of
the plaque biofilm
Systemic upset
Bacterial resistance!
Drug availability in the
pocket?
Non-surgical periodontal
therapy is successful
without antibiotics
Describe the advantages and disadvantages of systemic compared with local delivery antibiotic therapy
Local delivery-
Direct to site of action
* Low dosage required
* No systemic upset
* Reduced risk of
resistance
* Localised disease
Systemic-
* Access to periodontal
and other oral sites
* Cost
* Generalised disease
Describe those conditions where local antibiotic therapy may be used in the management of periodontal diseases
Topical antimicrobials are used for…
Sites showing poor response to mechanical
treatment in otherwise stable patients:
residual pocketing >5mm + BOP
Localised molar/incisor periodontitis
Chronic, recurrent periodontal abscesses
Currently available local delivery antimicrobial systems?
Dentomycin: 2% minocycline gel
Atridox: 8.5% doxycycline gel
Actisite: 25% tetracycline fibre
Arestin: minocycline microspheres
Elyzol: 25% metronidazole gel
Periochip: 2.5mg chlorhexidine chip
Dentomycin
2% minocycline
hydrochloride
Repeat placement after 14
Atridox
Active - doxycycline
Liquid polymer, hardens
on contact with fluid
Remains in pocket for 7
days
Mainly used as
adjunctive therapy and in
maintenance
Actisite
Tetracycline HCl
dispersed in an
ethylene/vinyl acetate
copolymer
Removed after 10 days
What is periostat? not in LO
Low-dose doxycycline
sub-MIC levels
Anti-collagenase effect
Single dose daily over 9
months
No bacterial resistance
problems
Part of maintenance
programme for patients
with generalised,
aggressive periodontitis
Write appropriate prescriptions for systemic antibiotic therapy
Amoxycillin 250mg tid 5-7 days + Metronidazole
200mg tid 5-7 days
Tetracycline 250mg qid 7 days
Periostat- single dose daily over nine months
