The microbial etiology of inflammatory periodontal diseasehas provided the basis for the introduction of antibiotics intheir overall management
RATIONALE FOR THE USE OF ANTIBIOTICS Certain specific organisms are closely associated with some forms of periodontal disease All the suspected periodontal pathogens are indigenous to the oral flora Consequently, the long-term and total elimination of these organisms with antibiotics will be very difficult to achieve as immediate repopulation with the indigenous bacteria will occur when the therapy is Completed. Antibiotics provide a useful adjunct to root planing, which by itself may not remove all subgingival deposits and certainly would not affect any invading organisms that had already penetrated the soft TISSUE.
ROUTES OFADMINISTRATIO NAntibiotics can be administered localy(immediate or controlled release) systemically
CHOICE OF ANTIBIOTICSMay be based on microbiological analysis of the samples obtained from affected sitesMore often, therefore, the choice ofantibiotic is empirical and based onthe clinical signs.
Tetracyclines (doxycycline, minocycline)SPECTRUM ROUTE DOSAGEbroad spectrum of Orally, although •The oral dose=activity against both topical application 1g/day, 250mgGram-positive and have been used in tabletes at six-hourlyGramnegative periodontal intervalsspecies, although treatment regimens for two weeksmore suitable adjunct to both non-antibiotics are usually surgical and surgicalpreferred for Gram-positive infections treatment. •The oral dose for the doxycycline and minocycline is 100- 200mg/day, for 21
MetronidazoleSPECTRUM PREPARATION DOSAGEThe antibacterial activity In periodontal •The oral doseagainst anaerobic cocci, treatment 750mg/day,anaerobic Gram - metronidazole has 250mg tabletes atnegative bacilli, and been used both in eighthourly intervalsanaerobic Gram - positivebacilli had led to its use tablet forms, and less for eight days.in the treatment of commonly, as a topical •The oral dose forperiodontal disease metronidazole application. +amoxicillin 750 mg/day (for each drug) for eight days.
CLINDAMYCINSPECTRUM ROUTE DOSAGEClindamycin is oral The oral doseeffective against 900mg/day,gram-positive 300mg tablets cocci and at eight-hourlygram-negative intervals foranaerobic rods, eight days adjunct to both non-surgical and surgical treatment.
OTHER ANTIBIOTICS• The β-lactams, including amoxicillin, are broadspectrum drugs that are frequently prescribed by periodontists for treating periodontal abscesses.•Ciprofloxacin is effectiveagainst several periodontalpathogens
INDICATIONS FOR ANTIBIOTICS IN PERIODONTAL THERAPYOccasionally, the local infection of a periodontalabscess can spread within tissue planes to causemarked facial swelling and systemic involvementIn severe cases both of acute necrotizingulcerative gingivitis and periodontitis, especiallyif there are signs of systemic involvement.Multiple abscess formation and gross periodontalinfection would necessiate the administration ofantibiotics (metronidazole and tetracycline) Antibiotic therapy is warranted in cases ofperiodontal disease, which, despite through non-surgicalmanagement and good plaque control, continue to showbreakdown and loss of attachment
CONTRAINDICATIONS ANDUNWANTED EFFECTSDisease or impaired function of the hepatic or renaltracts should warrant caution in prescribing systemicantibiotics.When penicillins are prescribed it is vitallyimportant to determine whether or not there isa history of hypersensitivity to the drug.The unwanted effects of penicillin are oftenmild and characterized by rashes,urticaria,joint pains, and dermatitis, although severeanaphylactic reactions have been reportedand can be fatal
LOCAL ADMINISTRATION OF ANTIBIOTIC local delivery antibiotics are recommended as adjuncts to scaling and root debridement, and not as stand-alone treatments.fewer side effects, and fewer chances of resistant bacteriaforming the concentration of the antibiotic at the diseased site can be 100 times greater than taking the medication orally.
• Controlled released doxycycline hyclate, 10%• PerioChip is a thin wafer that contains chlorhexidine. While chlorhexidine is not an antibiotic, it is a powerful antiseptic and kills most pathogens. The wafer slides under the edge of the gum into the pocket.• Arestin Small spheres of minocycline, a derivative of tetracycline is very effective in killing the bacteria that are thought to cause periodontal disease.