Current Use of Antimicrobials Flashcards
(41 cards)
G O A L S O F _______ T H E R A P Y
Arrest the disease
Alter the microflora to prevent reinfection
Maintain the disease in an arrested state
Antimicrobial
An effective \_\_\_\_\_ does the following things: • kills or inhibits target microflora • reaches the site • has an adequate concentration • has a sufficient duration • does not harm
Antimicrobial
Crevicular concentration is high using ______ delivery with a very
small dose of antimicrobial
Local delivery
T/F; Antimicrobial agents are never used in the absence of mechanical
debridement
True
Is it effective to give ABX to a perio pt without mechanically debriding?
Not effective: Debride then prescribe
I N D I C A T I O N S F O R _______
Applications :
✓Localized & Generalized aggressive periodontitis (old classification) / Grade C
✓Necrotizing gingivitis and periodontitis
✓Periodontitis associated with or aggravated by systemic disease (e.g. poorly
controlled diabetes)
✓Diffuse periodontal abscess with fever, malaise, etc
✓Patients in whom periodontal surgery is contraindicated
A D J U N C T I V E
A N T I M I C R O B I A L T H E R A P I E S D U R I N G
P H A S E I ( N O N - S U R G I C A L ) T R E A T M E N T
(ABX prescription with phase 1 debridement)
: the most studied and most effective rinsing
agent for plaque inhibition and prevention of gingivitis
No systemic toxicity, rare hypersensitivity
Active against most bacteria and fungi
No microbial resistance reported
Taste and tooth discoloration side effects
Cannot reach the site subgingivally
Chlorhexidine gluconate (CHX) (0.12-0.2%)
Extrinsic _______ of the teeth of an individual rinsing
twice a day for 3 weeks with a 0.2% chlorhexidine mouth rinse
(Europe), can be alleviated with 0.12% formulation (US).
Beverages like tea, coffee and red wine will aggravate this
superficial staining. Can be removed using prophy paste.
brown discoloration
Which conc of CHX can be used to decrease the amount of extrinsic staining? Can the stains be removed with prophy paste?
.12%; Can be removed with prophy paste
_____ mechanism of action
Cationic, binds to negatively charged bacterial cell membranes
that, at lower concentrations leads to increased permeability and leakage, at higher
concentrations this membrane leakage leads to cytoplasmic entry and precipitation
of cytoplasmic contents inducing microbial cell death.
Cationic nature contributes to high substantivity once it binds to salivary pellicle: slow
release from tooth surfaces over 12 hours!
CHX MOA
W H E N D O W E
P R E S C R I B E ______?
• As adjunct to regular oral hygiene methods during Phase I therapy (SRP)
only in high risk individuals (systemically compromised, refractory
cases, etc)
• Mentally or physically challenged patients with low manual dexterity
• Jaw fixation
• 1st - 2nd week post surgery
C H X
R I N S E ?
Studies have shown conflicting results
1.5% effective as rinse (Boyd, 89)
oral ulcerations with 3% rinse (Rees, 86)
3% and 30% used as twice weekly rinse had issues
long term use can lead to pre-neoplastic lesions (Weitzman, 86)
ADA and FDA have concerns regarding long term use
possible co-carcinogen and impaired wound healing
Hydrogen peroxide
reaches the site with a sufficient concentration has a poor duration of action
Antimicrobial irrigation
What 2 things are used in antimicrobial irrigation?
CHX .12%
Betadine
kills the pathogens effectively reaches the site very well has a very good concentration has a very good duration of action Ideal properties: effective against periodontal pathogens low systemic absorption low risk of bacterial resistance biodegradable easily to use enhances scaling and root planing
Local delivery of antimicrbials
Systemic or local drug delivery? Site specific therapy Better control of concentration, local effective dose Limited or no systemic adverse effects In office delivery, ensures compliance
Local delivery
: 10% povidone-iodine and 1% free iodine and can be used diluted as an irrigant.
do not use if any history of iodine sensitivity
use with caution in pregnancy and lactation because of the possibility of inducing
transient hypothyroidism in newborns
Betadine®
What is the most popular direct delivery antimicrobial?
Arestin
______ is (minocycline hydrochloride) in microspheres
(bioresorbable polymer of Poly(glycolide-co-dl-lactide)
or PGLA
available in 1 mg unit doses of dry powder
bacteriostatic, broad spectrum, inhibits protein synthesis
Arestin®
When do we use _______?
Always as adjunct to SRP, never stand alone therapy
Residual isolated pockets ≥5mm, not responding favorably to
initial SRP, especially if BOP is present at re-evaluation.
Residual pockets after phase II (periodontal surgery)
Used at time of reevaluation
Used during maintenance
Used to treat a periodontal abscess
Used before regenerative therapy
local antimicrobial
drug delivery
Is local drug delivery effective around implants?
Not effective
T/F: T H E “ I D E A L ” A N T I B I O T I C F O R P E R I O D O N T I T I S
D O E S N O T E X I S T
True
Broad spectrum bacteriostatic High concentration in GCF (2-10 fold>serum). Highly e f f e c t i v e a g a i n s t A . actinomycetemcomitans, but re s i s t a n t s t r a i n s a re n o w c o m m o n . I n a d d i t i o n t o antimicrobial they also have anti-collagenolytic effects: i n h i b i t c o n n e c t i v e t i s s u e d e s t r u c t i o n a n d p ro m o t e repair Photosensitivity: severe skin burns
Tetracyclines
Broad spectrum bactericidal Used in combination with metronidazole Up to 10% of humans are allergic to penicillins (can substitute with ciprofloxacin, clindamycin or erythromycin)
Penicillins
(Amoxicillin and
Augmentin)
