Antibiotics & Antiseptics

Question 1

What is triclosan?

Answer 1

Antigingivitis agent

Question 2

What are the active ingredients in antiseptics?

Answer 2

Bisbiguanides
Phenols & essential oils
Stannous fluoride
Oxidising agents
Detergents

Question 3

What is the substantivity of chlorhexidine digluconate?

Answer 3

12hrs

Question 4

What are the mouthwash formulations of chlorhexidine digluconate available?

Answer 4

0. 2% 10ml = 20mg 2x daily

0. 12% 15ml = 18mg 2x daily

Question 5

What bacteria does chlorhexidine digluconate work against?

Answer 5

Active against gram +ve and gram -ve bacteria, fungi, yeasts (candida) and viruses (hep B & HIV)
No bacterial resistance reported

Question 6

How does chlorhexidine digluconate work?

Answer 6

It is dicationic.
One cation adsorbs to pellicle coated teeth.
Other cation acts on bacterial membrane (leads to precipitation of cytoplasm and cell death)

Question 7

What are the side effects of chlorhexidine digluconate?

Answer 7

Staining
Dicationic - inhibits absorption from the gut
Bitter taste - taste disturbances
Occasionally - mucosal erosion, dilute parotid swelling
Interaction with sodium lauryl sulphate

Question 8

What is the substantivity of Triclosan?

Answer 8

5hrs

Question 9

What is the effect of Triclosan?

Answer 9

20-40% decrease in plaque
20-40% decrease in gingivitis
23-55% anti-calculus activity

Question 10

What is the action of Listerine?

Answer 10

14-56% plaque reduction

20-36% gingivitis reduction

Question 11

What is the action of stannous fluoride?

Answer 11

20% decrease gingival index
30% decrease gingival bleeding
Improves gingival health by decreasing plaque virulence but very little plaque reduction.
Staining.

Question 12

Name a bisbiguanide.

Answer 12

Chlorhexidine

Question 13

What is the substantivity of sodium lauryl sulphate?

Answer 13

5-7hrs

Question 14

Name a detergent.

Answer 14

sodium lauryl sulphate

Question 15

What are the benefits of supragingival irrigation?

Answer 15

Enhances effects of toothbrushing
Decreases gingival index
Aids self performed OH

Question 16

Name 3 halogen based antiseptics.

Answer 16

Povidone-iodine
Hypochlorite
Chlorhexidine

Question 17

What are the effects of hypochlorite?

Answer 17

Reduced PGI scores

Reduced BOP

Question 18

Name an oxidising agent.

Answer 18

Hydrogen peroxide

Question 19

What are the problems with antibiotics?

Answer 19

Resistance
Allergic reactions
Superinfection

Question 20

What methods of topical delivery of antibiotics are there when treating periodontal disease?

Answer 20

Minocycline gel
Doxycyline
Chlorhexidine chip

Question 21

What are the benefits of a chlorhexidine chip?

Answer 21

Reduces probing depth
Improves attachment level
(compared with root scaling)

Question 22

What are the advantages of local antibiotic delivery?

Answer 22

High conc in GCF
Low systemic uptake
Compliance is better

Question 23

What are the advantages of systemic antibiotic delivery?

Answer 23

Delivered via the serum to the tissues
Reach reservoirs e.g. tonsils, tongue
Less costly
Less time required for treatment

Question 24

Why may antibiotics/antiseptics be required in periodontal treatment in addition to mechanical therapy?

Answer 24

Mechanical therapy (scaling) may not remove periodontal pathogens.
Some sites are inaccessible to instruments (dentinal tubules).
Non-dental areas may be affected e.g. tonsils, tongue

Question 25

When is systemic delivery of antibiotics indicated in peridontal disease?

Answer 25

Periodontal abscesses ANUG Ongoing disease despite persistent mechanical therapy and good OH Medically compromised patients

Question 26

What antibiotics would you prescribe for treatment of a periodontal abscess?

Answer 26

Amoxicillin 250mg TID for 3 days Metronidazole 200mg TID for 3 days + RSD

Question 27

What antibiotics would you prescribe for treatment of ANUG?

Answer 27

Metronidazole 200mg TID for 3-5 days | + debridement & scaling

Question 28

What is the purpose of systemic antibiotics and mechanical therapy in periodontal disease?

Answer 28

To reduce the bacterial load | To disrupt the biofilm

Question 29

When should tetracycline be avoided?

Answer 29

Children | Risk of staining developing teeth