4

Question 1

Aggressive perio - localized or generalized
severe abscess
NUG (severe only)

All of these are indications for

Answer 1

Systemic antibiotics

Question 2

Consider antibiotic treatment when biofilm tests positive for

Answer 2

P. gingivalis, AA

Question 3

Some bacteria invade soft tissues, making SRP not very effective as treatment - as such, we use

Answer 3

antibiotics

Question 4

Antibiotics also help with SRPs with

Answer 4

deep pockets and furcations

Question 5

Systemic antibiotics are potentially
helpful in periodontal therapy
if

Answer 5

•  They distribute to the pocket 
and its soft tissue wall
•  They reach inhibitory levels in 
the pocket
•  Their levels are maintained for 
an adequate duration
•  They penetrate host cells and 
kill invasive bacteria

Question 6

Bactericidal agent:

Answer 6

kills bacteria (preferred)

Question 7

• Bacteriostatic agent:

Answer 7

slows bacterial growth

Question 8

• Narrow

-spectrum:

Answer 8

effective against specific
families of bacteria (preferred, spares gut
microbiota). Example: metronidazole.

Question 9

• Broad-

spectrum:

Answer 9

acts against a wide range of
clinically important bacteria. Example:
tetracycline..

Question 10

Penicillins

Bactericidal, but inactivated by ———–

Answer 10

ß

-lactamases

Question 11

Penicillins

• Reach effective levels in

Answer 11

gingival fluid

Question 12

Penicillins

strains

Answer 12

AA

Question 13

Penicillins

• Don’t penetrate ———– very well

Answer 13

epithelial cells

Question 14

Penicillins

• ———- has broad spectrum, enhanced tissue
penetration, good activity against gram negatives

Answer 14

Amoxicillin

Question 15

Penicillins

• Augmentin is amoxicillin combined with a

Answer 15

ß

-lactamase inhibitor

Question 16

Metronidazole

————– bactericidal agent that is
active against———-

Answer 16

Narrow-spectrum

strict anaerobes

Question 17

Metronidazole 
•  Activity against facultative bugs like 
A. a. 
is 
--------

Answer 17

less potent

Question 18

Metronidazole

• Inexpensive, usually well —————

Answer 18

tolerated

Question 19

Tetracyclines (minocycline and
doxycycline)

• Bacteriostatic against most

Answer 19

periodontal
pathogens, broad
-spectrum activity

Question 20

Tetracyclines (minocycline and
doxycycline)

• Can reach higher levels in ——– than
in ———–

Answer 20

gingival fluid

blood serum

Question 21

Tetracyclines (minocycline and
doxycycline)

• Inhibit ———–, which mediates ——
breakdown in periodontitis

Answer 21

collagenase

collagen

Question 22

Tetracyclines (minocycline and
doxycycline)

• Actively accumulated by

Answer 22

oral epithelial cells,

gingival fibroblasts and PMNs

Question 23

Fluoroquinolones

Answer 23

•  Bactericidal 
•  Extremely active against 
A. a.,
 but less active 
against anaerobic bacteria like 
P.   g .

Question 24

Fluoroquinolones

Answer 24

gingival fluid

blood

Question 25

Fluoroquinolones • Penetrate ----------- and can kill invasive bacteria

Answer 25

epithelial cells and phagocytes

Question 26

Clindamycin Potent bacteriostatic activity against

Answer 26

strict | anaerobes

Question 27

Clindamycin • Less effective against

Answer 27

facultative pathogens like A. a.

Question 28

Clindamycin | • Penetrates

Answer 28

bone

Question 29

Clindamycin • Can occasionally induce

Answer 29

ulcerative colitis

Question 30

Clindamycin • Used as an alternative antimicrobial agent in

Answer 30

penicillin | -allergic patients

Question 31

Macrolides Azithromycin and Clarithromycin Reach high concentrations in

Answer 31

tissue

Question 32

Macrolides Azithromycin and Clarithromycin • Have good activity against

Answer 32

A. a., P. gingivalis, and many other gram -negative anaerobes

Question 33

Macrolides Azithromycin and Clarithromycin • Penetrates --------- and kills invasive bacteria. Also taken up by ----------

Answer 33

epithelial cells PMNs and fibroblasts

Question 34

Macrolides Azithromycin and Clarithromycin • Macrolides produce

Answer 34

anti | -inflammatory effects

Question 35

----------- levels are higher in | gingival crevicular fluid than in blood

Answer 35

Azithromycin

Question 36

----------- levels are higher in | gingival crevicular fluid than in blood

Answer 36

Azithromycin

Question 37

----------- are active against periodontal bacteria lls

Answer 37

Azithromycin and clarithromycin

Question 38

• -------------- levels in GCF | are higher and more sustained than in blood serum

Answer 38

Azithromycin and clarithromycin

Question 39

• Clarithromycin levels are higher in -------- than in - ---------, and higher in --------- than in - --------

Answer 39

gingiva serum inflamed gingiva healthy gingiva

Question 40

• Tx with azithromycin produces ---------

Answer 40

anti -inflammatory effects

Question 41

• Azithromycin helps eliminate

Answer 41

invasive A. a. infection from cultured oral epithelial cells

Question 42

Bacterial culturing: Advantages

Answer 42

``` Reflects viable bacteria in the pocket • Can assess the predominance of a particular pathogen • Can grow and study unusual bacteria • Can determine antibiotic susceptibility ```

Question 43

Bacterial culturing: Disadvantages

Answer 43

Very few periodontal microbiology labs available • Very time consuming and costly • Problems with transport to the lab • Difficult to grow some organisms (spirochetes) • Accuracy dependent on good sampling technique • Not very sensitive

Question 44

When used as a ----------- (without SRP), there is not sufficient evidence that antibiotics are beneficial in the treatment of periodontitis

Answer 44

monotherapy

Question 45

Penicillins:

Answer 45

rashes, allergy, diarrhea

Question 46

• Tetracyclines:

Answer 46

nausea, diarrhea, dental | staining

Question 47

• Metronidazole:

Answer 47

nausea, diarrhea, altered | taste, antabuse effect

Question 48

• Clindamycin:

Answer 48

rashes, nausea, diarrhea

Question 49

• Azithromycin:

Answer 49

diarrhea, nausea, cholestatic | jaundice (rare), cardiac arrhythmia (rare)

Question 50

Local delivery of antibiotics: | Shortcomings

Answer 50

• Less effective than systemic antibiotics at eradicating invasive bacteria • Can’t eliminate pathogens from the entire oral cavity (recurrent infection possible) • Local delivery technique can be time consuming and may not be cost -effective