LOCAL AND SYSTEMIC ANTIMICROBIALS IN THE MANAGEMENT OF INFLAMMATORY PERIODONTAL DISEASES

Question 1

principles of treatment

Answer 1

Mechanical plaque control:
patient performed
non surgical root surface cleaning
surgical root surface cleaning

Question 2

roles of other factors in periodontal disease

Answer 2

smoking
stress
systemic medication
disease (diabetes important)

Question 3

rational for antimicrobials

Answer 3

sites difficult to instrument (deep pockets, multiple roots, infra bony defects)
- can’t disrupt biofilm
role for AM as an alternative to surgery
only should be given to pts with good OH

Question 4

reasons for failed debridment

Answer 4

operator factors (poor technique, inexperience)
patent factors (poor OH, smoking, systemic disease)
site factors (deep pockets, infra bony defects, tooth and root morphology)
bacterial invasion (gingiva, dentinal tubules)

Question 5

options following failed debridement

Answer 5

2nd cycle RSD
2nd cycle of RSD with antimicrobials
periodontal surgery
supportive periodontal care(4-5mm pockets no BOP and good OH)
extraction (pockets of 6mm+ increased risk of progression)

Question 6

BSP guidelines

Answer 6

antimicrobials little place in route therapy
limit use
drainage of infection and remove of cause still pertinent
few circumstances when AM are appropriate

Question 7

systemic vs local antimicrobials

Answer 7

site
- all sites inc tongue, tonsillar tissues
conc spread all over body, lower at sites of interest
limit - relies on pt compliance
local
- only treated pocket
conc high in treated sites
limitations
- reinfection from non treated sites, problems with GCF washing

Question 8

roles of systemic antimirobials

Answer 8

adjunct to mechanical treatment in
- severe periodontitis
necrotising PD
periodontal abcess (if local drainage insufficient)
deep pockets not responding to RSD
rapidly progressive or active disease

Question 9

Antimicrobials for systemic use

Answer 9

metronidazole
tetracycline
combo of metronidazole and amoxicillin
azithromycin

• last 2 used for rapid progression or non responsive
• start within 1 week of final RSD

Question 10

rapidly progressive PDD AM treatmetn

Answer 10

metronidazole 400mg and amoxicillin 500mg TDS 7 days or

azithromycin 500mg 3 days

Question 11

tx for periodontal abcesses

Answer 11

metronidazole
amoxicillin
azithromycin

Question 12

clinical signs of necrotising periodontal disease and AM tx

Answer 12

ulceration
cratering
loss dental papilla
bleeding

usually only in pts that are
immunosuppressed
metronidazole 3x daily 400mh

Question 13

issues with azithromycin

Answer 13

can prolong QTc interval
increased abnormal heart rhythm
iterations with statins
other reactions with medicagions

Question 14

advantages of systemic AM

Answer 14

useful for severe rapidly progressive/active/progressing sites (pus formation)
multiple sites
low cost
less clinical time
less invasive than surgival

Question 15

dis of systemic AM

Answer 15

dependant on pt complaince
unwanted side effects
can produce microbial resistant to AM
can lead to allergies

Question 16

what are the locally applied antimicrobials

Answer 16

metronidazole

chlorhexidine

Question 17

indications for local AM

Answer 17

few sites
poor repsonce to debrident
deep sites on maintenance

Question 18

metronidazole application local

Answer 18

debridement 1st
syringe into pocket until overflowing
wipe off excess
reapply 1wk late

Question 19

ad of locally applied antimicrbiala

Answer 19

high local conc of AM with min side effects
less reliant on complaince
useful for isolated sites

Question 20

dis of locally applied antimicrobials

Answer 20

more expensive

effectiveness is questionable