Local delivery antimicrobials in the treatment of chronic perio Flashcards
(85 cards)
1
Q
What are the main difference between th 1999 and 2018 disease classification
A
- Gingival diseases has been changed to gingival health, periodontal health and disease
- chronic and aggressive priodonttiis has now ben changed into stages 1-4, grades A-C and molar incisor patterns are observe
2
Q
What are the stages of periodontitis?
A
Stage I
Stage II
Stage III
Stage IV
3
Q
Describe stage I of periodontitis
A
Initial periodontitis
4
Q
Describe stageII of periodontitis
A
Moderate periodontitis
5
Q
Describe stage III of periodontitis
A
Severe periodontitis with potential for additional tooth los
6
Q
Describe stage IV of periodontitis
A
Severe periodontitis with potential for loss of dentition
7
Q
Describe the 3 steps we take to classify periodontitis according to the 2018 classification
A
- Determine the stage I-IV
- Determine the extent and distribution
- Determine the grade A-C
8
Q
How do we describe the extent and distribution of perio
A
Localised or generalised
We can use the molar incisor distribution
9
Q
Describe grade A of periodontitis
A
Slow rate of progression
10
Q
Describe Grade B o periodontitis
A
Moderate rate of perio progression
11
Q
Describe grade C of periodontitis
A
Rapid rate of progression of perio
12
Q
What are antibiotics?
A
Drugs that kill or halt the multiplication of bacterial cells at concentrations that are relatively harmless to host tissues
13
Q
What are antibiotics sued to treat?
A
Infections caused by bacteria
14
Q
What is an infection?
A
Invasion of micro organisms into the host.
The reaction of the most to the microorgaisnsm is the infection
15
Q
What type of infection is periodontitis?
A
Polymicrobial
16
Q
Name the three plaque hypotheses
A
- Non specific
- Specific
- Ecological
17
Q
Which of the three plaque hypotheses are themes accepted?
A
Ecologicalplaque hypothesis
18
Q
Give some classifications of antibiotics
A
- Beta lactams
- Aminoglycosides
- Sulphonamides
- Tetacyclines
- Azoles
- Quinolones
- Macrolides
19
Q
Give an example of a beta lactams
A
Penicillin
20
Q
Give an example of an aminoglycoside
A
Gentamycin
21
Q
Give an example of an azoles
A
Metronidazole
22
Q
Give an example of a quinolone
A
Ciprofloxacin
23
Q
Give an example of a macrolide
A
Erythromycin
24
Q
Give some headings that can be used to classify antibiotics
A
- Based on spectrum of activity
2. Based on the action
25
What are the 2 categories antibiotics can be split into when they are classified based on spectrum
1. Narrow spectrum
| 2. Broad spectrum
26
Wha does it mean if a bacteria has a narrower spectrum of activity?
That it only targets a certain group of bacteria
27
Wha does it mean if a bacteria has a broad spectrum of activity?
That it can target a wide range of bacteria species
28
When making antibiotics what type of spectrum activity do we want?
Narrow spectrum so neighbouring cells aren't damaged
29
Name the 2 categories antibiotics can be placed in when categorised based on aciton
1. Bacteriostatic
| 2. Bactericidal
30
What does bactericidal mean?
Antibiotics that kills bacteria
31
What does bacteriostatic mean?
Antibiotics that stop or inhibit the multiplication of bacteria
32
When choosing an antibiotic do you close a bacteriostatic or bactericidal one? Why?
Bactericidal as it will kill the bacteria
33
Name the 5 mode of actions of systemic antibiotics
1. Inhibition of cel wall synthesis
2. inhibition of cytoplasmic membrane function
3. inhibition of nucleic acid synthesis
4. Inhibition of ribosomal function and hence protein synthesis
5. Inhibition of folate metabolism
34
What does systemic mean?
Affects the whole body not just a targeted area
35
What does amoxycillin do?
Inhibits the cell wall synthesis
36
What does metronidazole do?
Inhibits nucleic acid synthesis by breaking down strands of DNA
37
What do tetracyclines and macrocodes do?
Inhibits protein synthesis
38
What are some of the disadvantages of the use of antibiotics
1. Hypersensitivity
2. Gastrointestinal disturbances
3. Alterations in the commensal flora
4. Drug-drug interactions, Drug- alcohol interactions
5. Bacterial resistance
39
How many deaths in the EU per year are taught to be due to multiple drug resistant bacteria?
Estimated 25,000
40
What does the antimicrobial stewardship programs organised by NICE do?
A organisational or healthcare system wide approach to promote monitoring of judicious use of antimicrobials to preserve their future effectiveness
41
What are some steps antimicrobial stewardship has played ou to try and reduce the risk of bacterial resistance?
1. Evidence based optimal standards for routine antimicrobial prescribing
2. Ensuring competency and education for prescribers
3. Communication of issue to all stakeholders
4. Auditing the impact and uptake of processes above
Optimising outcome for patients prescribed antimicrobials
42
What 3 things does public health England tell patients to do/ not to do?
1. Don't demand antibiotics
2. Take antibiotics as they are prescribed
3. Spread the word among friends and relatives
43
What does efficacy mean
Ability of a drug to produce a desired effect
44
Give some factors that affect efficacy
1. Blinding of drug to tissue
2. Protection of key organisms by non target organisms binding or consuming drug
3. Bacterial tissue invasion
4. Total bacterial load
5. Previous drug therapy
6. Non pocket infected sites
7. Presence of biofilm
8. Beta lactase production
45
What is beta lactamase?
They are enzymes that can cleave an inactivate beta lactic drugs
46
Name something that can inhibit beta lactamase
Clavulanic acid
47
Give some reasons for failure of antimicrobial therapy
1. Lack of culture and sensitivity
2. Failure to achieve drainage
3. Non bacterial causative agent
4. Incorrect drug duration to dose
5. Lack of compliance
6. Defective host response
7. Persistent risk factors
8. Lack of substantivity of local agents
9. Drug resistance
48
How do we prescribe antibiotics?
Empirically
49
What is the ideal way of determine which antibiotics should be prescribed?
Using culture and sensibility
| But theres isn't that much the to do this
50
What is it called when when we prescribe one antibiotic?
Mono therapy
51
What is it called when when we prescribe more than one antibiotic?
Combination therapy
52
What is the most common combination of drugs prescribed in dentistry?
amoxicillin and metronidazole
53
Should we prescribe antibiotics for chronic periodontitis?
NO
54
Should we prescribe antibiotics for aggressive periodontitis ?
Can be used
55
What is the cause offer periodontitis?
calcification of the biofilm-> calculus
56
How dow e treat chronic periodontitis?
Scaling and RSD
57
Should we prescribe antibiotics for periodontitis is manifested due to a systemic disease?
Don't need it just need t remove calculus
58
Should we prescribe antibiotics for necrotising periodontal disease?
YES
59
If you want to prescribe antibiotics what should you do?
Refer your patient to a specialist
60
Should we prescribe antibiotics for abscesses of periodontium
Maybe
61
Should we prescribe antibiotics for periodontitis associated with endodontic lesions
No
62
What should antimicrobials be used in conduction with when treating periodontitis
Mechanical therapy
63
Give some rationale fo systemic therapy
1. Panoral infection in aggressive perio
2. Other oral niches colonised with periodontal pathogens
3. Drugs are concentrated in GCF
4. Maintains minimal inhibitory concentration for long duration
64
Give some examples of possible antibiotic regimens for aggressive periodontitisq
1. Penicillins with or without clavulanic acid
2. Tetracyclines
3. Macroides
4. Nitroimidazole
65
What instructions do you give to a patient when you prescribe them amoxicillin?
Take 500mg 2-3 times a week for 8 days
66
What does amoxicillin target?
Gram positive agn gram negative bacteria
67
How does amoxicillin affect bacteria?
It is bactericidal
68
What is amoxicillin sensitive to?
Penicillinase
69
What instructions do you give to a patient when you prescribe them amoxicillin and clavulanic acid?
Take 500mg 2-3 times for 8 days
70
How does amoxicillin and clavulanic acid affect bacteria?
It is bactericidal
71
Give some side effects of amoxicillin and clavulanic acid?
Diarrhea
Colitis
Nausea
72
What instructions do you give to a patient when you prescribe them tetracycline?
Take 500mg 4 times for 21 days
73
How does tetracycline affect bacteria?
Bacteriostatic
74
What does tetracycline target?
Gram positive bacteria more than gram negative
75
Give some side effects of tetracycline
Can cause severe sunburn if exposure to bright sunlight
Severe stomach pain
Nausea
76
What instructions do you give to a patient when you prescribe them minocycline?
Tale 100-200mg 1 time a day for 21 days
77
How does minocycline affect bacteria?
it is bacteriostatic
78
What does minocycline target?
Gram positive bacteria more than gram negative
79
What instructions do you give to a patient when you prescribe them doxycycline?
take 100-200mg once a day for 21 days
80
How does doxycycline affect bacteria?
It is bactericidal
81
What does doxycycline target?
Affects Gram positive bacteria more than gram negative
82
What instructions do you give to a patient when you prescribe them ciprofloxacin?
Take 100-200mg twice a day for 8days
83
How does ciprofloxacin affect bacteria?
It is bactericidal
84
What does ciprofloxacin target?
Gram negative rods
85
Give some side effects of ciprofloxacin?
Nausea
| Gastrointestinal discomfort
