Systemic Adjuncts To Perio Treatment - Local adjuncts in the treatment of periodontitis

Question 1

For locally applied periodontal adjuncts to be effective what 3 things must they do?

Answer 1

1. Right location
2. High enough conc
3. Long enough time

Agents need to be in the right location, with a high enough concentration, for a long enough period of time, to be effective

Question 2

3 advantages of periodontal locally applied adjuncts

Answer 2

1. Assured pt compliance
   - as given by dent professional
2. Minimal systemic exposure
   - less side effects
3. Drug levels far exceed the MIC for key periodontal pathogens
   - applied directly in pockets so the concentration is high

Question 3

disadvantage of periodontal locally applied adjuncts

Answer 3

Substantivity = time the agents are present in the local area

This can be low due to the rinsing effect caused by the gingival crevicular fluid as a result of the high levels of inflammation

Question 4

Indications for locally applied adjuncts / locally delivered antimicrobials

Answer 4

Isolated pockets which do not react to conventional periodontal treatment, in patients with good OH

Question 5

Give 3 examples of local agents

Answer 5

1. Tetracycline
   
   • Very effective when applied locally.
   • inhibit synthesis of bacterial proteins by attaching to the surface of the bacterial ribosomes.
   • Actisite (tetracyline fiber) which is applied using a FIBER in the pocket. The fiber resists the rinsing effect caused by GCF - increases Substantivity.
     Fiber needs to be manually removed after use.
2. Metronidazole
   
   • Elyzol 25% Met gel - gels can get rinsed away by GCF quite easily so need to apply more.
3. Chlorhexidine
   
   • Periochip 2.5mg of chlorhexidine gluconate - uses fibres that resorb naturally