local and systemic antimicrobials in perio Flashcards
What is periodontitis?
A chronic multifactorial inflam disease associated w a dysbiotic dental plaque biofilm
A. Necrotising
B. As a direct manifestation of systemic disease
C. Molar/incisor, localised and generalised
What do we use to tx perio non surgically?
OHI and PMPR
-change composition of bacterial biofilm
-remove calculus to prevent bacteria harbouring
Antimicrobials
-reduce no of pathogenic bacteria
Why use antimicrobials?
For sites that are difficult to instrument (deep pocket, multiple roots, infraboney defects)
However,
Can’t disrupt biofilm, only adjunct to PMPR, only for pts w v good OH
Why might a pt have failed debridement?
Operator- poor technique, inexperience, insufficient time
Patient- poor OH, smoking, systemic disease
Site- v deep pockets, infra bony defects, root morphology, furcation involvements, difficult access
Bacterial invasion- gingiva, dentinal tubules
What are disadvantages of antibiotics?
Side effects (systemic, GI)
Risk of hypersensitivity (allergies)
Risk of bacterial resistance
When would you use antimicrobials?
S3
1st or 2nd? cycle of PMPR + antimicrobials
However,
‘Drainage of infection and removal of cause’!!
ADJUNCT to PMPR in-
-necrotising forms (M)
-severe forms (A/AM)
-abscess? (M/AC/A)
-deep pockets not responding
-rapidly progressive/active
-peri-implant disease
Prescription should be determined by specialist/special interest perio
What is the difference between systemic and local?
SYSTEMIC
-all sites inc. tongue, tonsillar tissues
-spread all over body, low at sites of interest
-relies on pt compliance
LOCAL
-only tx pocket
-high in tx site
-reinfection from non tx sites, problems w GCF washing
What are antibiotics that can be used?
Azithromycin 500mg OD 3 days
Amoxicillin 500mg TDS and metronidazole 400mg TDS 5 days
Amoxicillin/clavulanic acid
Clindamycin
Doxycycline
What is the antimicrobial stewardship?
NICE guidelines
Should follow local/national guidelines-
-prescribe shortest effective course
-most appropriate dose
-route of administration
Need to consider risk of antimicrobial resistance for individual and pop as whole
Why should you be careful with azithromycin?
Can prolong QT interval
So increased risk of abnormal heart rhythm
Interaction w statins
Must check BNF or w pharmacist/GP
What are problems evaluating systemic antibiotics?
Prospective, randomised, placebo-controlled, double blind trial is IDEAL
Older studies fall short
Change in classification
What are advantages of systemic antimicrobials?
Useful for severe, rapid, progressing, active sites (pus)
Multiple sites tx
Low cost
Less clinical time
What are disadvantages of systemic antimicrobials?
Depends on pt compliance
Unwanted side effects
Can produce microbial resistance
Can lead to sensitivities and allergies
What are the local guidelines to prescribing antimicrobials?
1. Full prep op perio indices
2. Grade C/immune mediated/rapidly progressing
3. Plaque score <40% (pref <25%)
4. Local and systemic risk factors modified
When can prescribing antimicrobials be harmful for the pt?
Interaction w medicine/food/drink
Other illness (eg renal)
Drug allergies
Risk of selection for organisms causing infection (eg C. difficile)
