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Antibiotic Adjuncts To Perio treatment
 

Antibiotic Adjuncts To Perio treatment

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    Antibiotic Adjuncts To Perio treatment Antibiotic Adjuncts To Perio treatment Presentation Transcript

    • ANTIBIOTIC ADJUNCTS TO PERIO DONTAL TREATMENT Aneesha abdu Final year bds GUIDED BY DR BINIRAJ K R PROF&HOD PERIODONTICS
      • Bacterial specificity
      • Should not produce resistant strains
      • Does not cause allergy or toxicity
      • Does not cause other side effects
      • Does not eliminate normal oral flora
      • Cost effective
      • Hence the ideal has not been found!
      Properties of an Ideal Antibiotic
    • PERIODONTITIS
      • IS A COMPLEX DISEASE THAT INVOLVES THE LOSS OF ATTACHMENT AROUND TEETH RESULTING FROM ACTIONS OF MICROORGANISMS AND THE RESPONSE OF THE HOST TO THESE ORGANISMS.
    • PERIODONTITIS
      • THE MOST EFFECTIVE TREATMENT CURRENTLY REQUIRES MECHANICAL ROOT PREPARATION IN THE PRESENCE OR ABSENCE OF SURGICAL REVISION OF THE PERIODONTIUM.
    • PERIODONTITIS
      • TREATMENT CAN BE TIME CONSUMING, EXPENSIVE AND FRIGHTENING TO PATIENTS .
    • PERIODONTITIS
      • THE SEARCH FOR A MAGIC BULLET IS A HIGH PRIORITY
    • PERIODONTAL PATHOGENS
      • GRAM-NEGATIVE ANAEROBIC RODS
      • GRAM-POSITIVE FACULTATIVE AND ANAEROBIC COCCI AND RODS
      • GRAM-NEGATIVE FACULTATIVE RODS
    • PERIODONTITIS
      • A.a.
      • P. gingivalis
      • T. denticola
      • B. forsythus
      • P. intermedia
      • E. nodatum
      • Spirochetes
    • PERIODONTAL PATHOGENESIS DEPEND ON…
      • TOTAL BACTERIAL LOAD
      • BINDING OF THE DRUG TO TISSUES
      • BIOINACTIVATION OF THE DRUG BY NONTARGET ORGANISMS
      • BIOFILM PRESENCE AFFORDING THE PATHOGEN PROTECTION
      • DRUG RESISTANT PATHOGENS
      • IMPAIRED HOST RESISTANCE
      • RECOLONIZATION FROM SUPRAGINGIVAL SITES AFTER TERMINATION OF ANTIMICROBIAL THERAPY
    • ANTIBIOTICS
      • PENICILLIN
      • MACROLIDES
      • TETRACYCLINE
      • CLINDAMYCIN
      • CIPROFLOXACIN
      • METRONIDAZOLE
    • SPECTRUM MACROLIDE CLINDA CEPHA AMPI/ AMOXY PEN G/ PEN V ORODENTAL INFECTIONS
    •  
    • Antibiotic Adjunctive Therapies
      • Treatment of aggressive periodontal diseases, chronic periodontitis, refractory periodontitis
        • Initial identification of pathogens
        • Appropriate antibiotic selection
        • Debridement should be carried out first
      • Systemic antibiotics commonly prescribed:
        • tetracyclines, metronidazole
        • amoxicillin, Augmentin, ampicillin
        • ciprofloxacin, clindamycin
        • Periostat ( doxycycline )
    • PENICILLINS
      • INHIBIT BACTERIAL WALL SYNTHESIS
      • INDICATED IN ACUTE INFECTIONS FROM GRAM-POSITIVE BACTERIA
      • RESISTANT ORGANISMS
      • AMOXICILLIN MORE EFFECTIVE
      • CAN BE COMBINED WITH CLAVULINIC ACID WHICH PROTECTS AMOXICILLIN FROM DEGRADATION
      • NOT EFFECTIVE AGAINST Aa
    • MACROGLIDES
      • CLINICALLY ADMINISTRATION DECREASED PLAQUE BUT PATIENTS DEVELOPED ABSCESSES DURING THE STUDY WHICH WORSENED THE CLINICAL PARAMETERS
      • NO SIGNIFICANT OR LASTING EFFECT WAS SEEN
    • MACROGLIDES
      • ERYTHROMYCIN
      • CONTAINS A LACTONE RING TO WHICH SUGARS ARE ATTACHED WHICH BIND TO BACTERIAL RIBOSOMES AND DISRUPT PROTEIN SYNTHESIS
      • BACTERIOSTATIC
      • LIMITED ACTIVITY AGAINST PERIODONTAL PATHOGENS
      • LIMITED USE IN PERIODONTAL TREATMENT
    • TETRACYCLINES
      • MOST COMMONLY PRESCRIBED ANTIMICROBIALS IN PERIODONTICS
      • INHIBIT PROTEIN SYNTHESIS BY BINDING TO BACTERIAL RIBOSOMAL UNITS
      • BROAD SPECTRUM
      • INCLUDES TETRACYCLINE, DOXYCYCLINE,AND MINOCYCLINE
      • MORE EFFECTIVE AGAINST GRAM POSITIVE
      • GOOD ACTIVITY AGAINST SPIROCHETES, ANAEROBIC AND FACULTATIVE BACTERIA
      • HIGH CONCENTRATIONS IN CREVICULAR FLUID
    • TETRACYCLINES
      • CLINICAL USE IN ADULT PERIODONTITIS FOUND TETRACYCLINE TO BE NO DIFFERENT THAN PLACEBO
      • RELATIVE TO CHANGES IN PROBING DEPTHS, ATTACHMENT LEVELS AND PERCENTAGE OF SPIROCHETES.
      • HAVE BEEN WIDELY USED IN TREATMENT OF BOTH GENERALIZED AND LOCALIZED JUVENILE PERIODONTITIS
      • RELATIONSHIPS WERE FOUND BETWEEN THE DECREASE OF Aa IN THE POCKET AND AN INCREASE IN PROBING ATTACHMENT LEVELS.
    • TETRACYCLINES
      • CLINICAL USE IN REFRACTORY PERIODONTITIS WAS BENEFICIAL BY SIGNIFICANTLY REDUCING SPIROCHETES, MOTILE RODS,PROBING DEPTHS AND SUPPURATION.
    • Tetracycline – Side Effects
      • Intrinsic tooth staining
      • GI upset, abdominal pain
      • Diarrhea, vomiting
      • Fungal overgrowth
      • Resistant bacterial strains
      • Interferes with bactericidal activity of penicillin's & cephalosporins
    • DOXYCYCLINE
      • A SIMILAR EFFICACY AND SPECTRUM OF ACTIVITY AS TETRACYCLINE
      • ELEVATED IN GINGIVAL CREVICULAR FLUID AT LEVELS COMPARABLE TO TETRACYCLINE
      • ABSORPTION OF DOXYCYCLINE IS LESS SENSITIVE TO THE PRESENCE OF FOOD
    • CLINDAMYCIN
      • EFFECTIVE AGAINST GRAM-POSTITIVE AND MOST ANAEROBIC BACTERIA
      • INHIBITS BACTERIAL PROTEIN SYNTHESIS BY BINDING TO BACTERIAL RIBOSOMES
      • USE OF CLINDAMYCIN IN THE TREATMENT OF PERIODONTAL DISEASE HAS BEEN LIMITED BECAUSE OF POTENTIALLY SEVERE SIDE EFFECTS, SUCH AS ABDOMINAL DISCOMFORT, DIARRHEA, AND PSEUDOMEMBRANOUS COLITIS
    • CIPROFLOXACIN
      • A BROAD-SPECTRUM ANTIMICROBIAL THAT INHIBITS BACTERIAL DNA SYNTHESIS THROUGH ITS BINDING TO DNA GYRASE, AN ENZYME RESPONSIBLE FOR THE UNWINDING AND SUPERCOILING OF DNA.
      • EFFECTIVE AGAINST GRAM-NEGATIVE BACTERIA, STAPHYLOCOCCI, AND PSEUDOMONAS AERUGINOSA.
      • MAY PROMOTE THE REPOPULATION OF THE PERIODONTIUM WITH BENEFICIAL MICROFLORA BY VIRTUE OF ITS SELECTIVITY.
    • CIPROFLOXACIN
      • IT HAS A MINIMAL EFFECT ON STREPTOCOCCAL MICROBES
      • CIPROFLOXACIN THERAPY MAY FACILITATE THE REPOPULATION OF THE POCKET WITH MICROFLORA MORE ASSOCIATED WITH PERIODONTAL HEALTH
    • METRONIDAZOLE
      • A BROAD- SPECTRUM ANTIMICROBIAL, DISPLAYING ACTIVITY AGAINST ANAEROBIC COCCI, GRAM-NEATIVE BACILLI, AND GRAM-POSITIVE BACILLI
      • PERMEABLE THROUGH THE BACTERIAL CELL WALL, THE DRUG BINDS DNA AND DISRUPTS THE HELICAL STRUCTURE. BREAKAGE OF THE DNA STRANDS FOLLOWS LEADING TO CELL DEATH.
      • LEVELS OF THE DRUG IN CREVICULAR FLUID CAN APPROACH TWICE THAT IN THE SERUM.
    • METRONIDAZOLE
      • THE EFFECT OF THE METRONIDAZOLE WAS MAINTAINED FOR A TWO TO THREE YEAR RE-CALL PERIOD. IT CAN SIGNIFICANTLY REDUCE THE NEED FOR PERIODONTAL SURGERY COMPARED TO DEBRIDEMENT ALONE.
      • Mechanism of action:
        • Bactericidal antimicrobial
        • Disrupts DNA synthesis leading to cell death
        • Selectively kills bacterial associated with periodontal disease
        • Susceptible bacteria include:
          • Fusobacterium, Bacteroides
          • Peptostreptococcus
          • Treponema, Campylobacter
          • Veillonella
      • Clinical Considerations:
        • GCF concentrations > blood serum levels
        • When combined with oral hygiene & debridement = beneficial effect on periodontitis
          • Periodontal surgery may not be necessary
        • Doxycycline may be substituted for metronidazole
          • If client can’t abstain from alcohol
    • Before & AfterTreatment with Metronidazole
      • Probing depth of 6 mm-before
      • Tissue shrinkage -after
    • Before & After Treatment with Metronidazole
      • 6 mm probing depths
      • Surgery has not been required
      • Some evidence of bone gain – client 2.5 years after initial debridement and use of metronidazole
      • Dosage:
        • 250 mg tid for 7-10 days
        • 500 mg bid for 1-2 weeks
      • Doxycycline
        • 100 mg per day or BID
      • Metronidazole and amoxicillin or Augmentin
        • 250 mg (of each) TID for 7-10 days
    • AntibioticProphylaxis (Prevention)
      • Bacterial Endocarditis.
      • Prosthetic Joint Infections.
      • Immuno-Compromised Hosts.
      • Procedures and others.
    • SBE PROPHYLAXIS
      • RECOMMENDED
      • Extractions, Periodontal procedures
      • Prophylactic cleaning
      • Implant placement, Re-implantation
      • Endodontic Instrumentation/Surgery beyond root apex, Placement or removal of orthodontic bands
      • Intraligamentary LA
    • SBE PROPHYLAXIS - 1
      • (1 hr before procedure)
      • STANDARD REGIMEN
      • Amoxicillin 2 g
      • PENICILLIN ALLERGY
      • Clindamycin 600 mg
      • Cephalexin/Cefadroxil 2 gm
      • Clarithromycin/Azithromycin 500 mg
    • SBE PROPHYLAXIS - 2
      • 30 mins before procedure)
      • Failure to take P/O
      • Ampicillin 2 gm IM/IV
      • Penicillin allergy & Failure to take P/O
      • Clindamycin 600 mg IV
      • Cefazolin 1 gm IM/IV
    • LOCAL DELIVERY OF ANTIBIOTICS
      • RECURRENT POCKETS IN THE PERIODONTAL MAINTENANCE PATIENT
      • THE FAILING IMPLANT
      • PERIODONTAL ABSCESSES
      • Work by suppressing destructive enzymes produced during inflammatory process or suppressing microbes
    • LOCAL DELIVERY OF ANTIBIOTICS
      • TETRACYCLINE FIBER (ACTISITE)
      • DOXYCYCLINE POLYMER (ATRIDOX)
      • MINOCYCLINE OINTMENT (PERIOCLINE)
      • ARESTIN (MINOCYCLINE)
    • Advantages of Controlled Release Agents
      • Client compliance not an issue
      • GCF concentration greater than serum levels
      • Delivery is localized – reduces systemic effects
      • Reduced side effects
    • Actisite  Periodontal Fiber
      • Clinical use:
        • Pockets measuring  5 mm, bleed on probing
        • Localized treatment for sites that have not responded to previous mechanical therapy
      • How supplied:
        • Cartons of 4 or 10 fibers
        • 23 cm in length
        • 12.7 mg tetracycline hydrochloride
        • Stored at room temperature
    • Actisite 
      • Application:
        • Treat one quadrant or one side of mouth at a time
        • Client may request anaesthesia
        • Fiber inserted into pocket (circumferential or not)
          • Takes about 10 minutes/tooth
        • Some control of saliva
        • Should contact pocket base
    • Actisite 
      • Application:
        • Sealed in place with adhesive
          • Apply in thin even line along gingival margin
          • Surgical dressing not necessary but has been used
        • Removed 7-10 days after placement
          • Curette and/or cotton pliers
          • Fiber comes out in mass or pieces
          • Debride areas as necessary
        • Tissue may appear red following removal
    • Actisite 
      • Adverse effects:
        • Discomfort
        • Local erythema
        • Little systemic reaction
        • Used with caution in client with history of candidiasis
        • Application around 12+ teeth may result in oral candidiasis
    • Actisite 
      • Client instructions:
        • Avoid brushing & flossing
        • Use antimicrobial rinse
          • Use of CHX may have syngerstic effect
        • Avoid hard or crunch foods, stick foods, chewing gum
    • Actisite 
      • Clinical Efficacy:
        • Reduction in bleeding on probing and pocket depth
          • More significant reductions in deeper pockets
        • Reduction in periodontal pathogens
        • Effects of fiber on bone loss, tooth mobility or tooth loss not established
    • Arestin 
      • Clinical use:
        • Periodontitis with pockets  5 mm
      • How supplied:
        • Box containing 2 trays each containing 12 cartridges
        • Cartridge contains 1 mg of minocycline (semisynthetic tetracycline derivative) microencapsulated in Poly dry powder
        • Cartridge inserted into a cartridge handle
    • Arestin 
      • Premeasured, premixed, no refrigeration necessary
      Preparing for Arestin
      • Mechanism of action:
        • Broad spectrum
        • Bacteriostatic
        • GCF levels maintained at high levels for at least 14 days
      • Application:
        • Insert tip to base of periodontal pocket
        • Expel powder into pocket
        • Bioadhesive microspheres activate & adhere on contact with moisture
        • Cartridge contains enough Arestin for one periodontal pocket
        • Clinical trials: 30 sites treated in less than 10 minutes
        • Dressings or adhesives not required
      • Adverse effects:
        • Headache
        • Pain
        • Mouth ulceration
        • Slu syndrome
        • Stomatitis
      • Client instructions:
        • Do not eat hard or sticky foods for 1 week
        • Postpone brushing for 12 hours
        • Do not use interproximal cleaning aids for 10 days
      • Clinical efficacy:
        • 27,000 sites treated,
        • Arestin with debridement demonstrated 27% greater pocket reduction in molars compared to debridement alone
          • Mean reduction of 2 mm (pockets 7 mm +)
        • Effective in furcations
    • ATRIDOX
      • A LIQUID BIODEGRADABLE DRUG DELIVERY SYSTEM THAT HARDENS IN THE PERIODONTAL POCKET AND GIVES A CONTROLLED RELEASE OF THE INCORPORATED AGENT
      • ADMINISTERED VIA SYRINGE
      • STUDIES IN PROGRESS UTILIZING THIS MATERIAL IN CONJUNCTION WITH ROOT PLANING AND SCALING
      • NOT FDA APPROVED
    • PERIOCLINE
      • MANUFACTURED IN JAPAN
      • APPLIED INTO THE POCKET WITH A SYRINGE AND BLUNT CANNULA
      • REDUCTION IN PROBING POCKET DEPTH IN SITES TREATED WITH SCALING AND ROOT PLANING
    • PERIO CHIP
      • CHLORHEXIDINE CHIP PLACED IN THE POCKET FOR LONG DRUG DELIVARY
    • BIBLIOGRAPHY
      • TEXT BOOK OF PERIODONTOLOGY-CARRANZA
      • TEXT BOOK OF PERIODONTOLOGY-SHANTHIPRIYA REDDY
      • WWW.WIKIPEDIA.COM
      • WWW.CLINICS OF NORTH AMERICA.ORG
    • THANKS A LOT FOR YOUR ATTENTION......!!!