This document discusses therapeutics used in oral surgery, including antimicrobials, analgesics, and anti-inflammatory drugs. It describes various classes of antimicrobials like antibiotics, antifungals, and antivirals, and how they are classified based on the type of organism they act upon and spectrum of activity. Analgesics discussed include NSAIDs and opioids. Anti-inflammatory drugs mentioned are corticosteroids. The document provides details on specific drugs under each class, their indications, properties, and considerations for administration in oral surgery.

2. Therapeutics in oral surgery

3. Antimicrobials:
 Drugs used to prevent or treat infection caused by pathogenic
microorganism.It includes Antibacterial, Antiviral and Antifungal.
 Antibiotic: A chemical substance produced by microorganisms
having the property of inhibiting the growth of or destroying other
microorganisms.

4. Classification
BASED ON TYPE OF ORGANISM THEYACT UPON:
1. Antibacterial – Penicillin ,Amino Glycoside ,Erythromycin
2. Antifungal – Griseofulvin ,Amphotericin, Ketoconazole
3. Antiviral- Acyclovir,amantidine,zidovudine
4. Antiprotozoal- Metronidazole, Chloroquine

5. BASED ON SPECTRUM OF ACTIVITY
 Narrow Spectrum- Penicillin G, Streptomycin And
Erythromycin.
 Broad Spectrum -Tetracyclines, Chloramphenicol.

6. Properties
 Bactericidal.
 Not to induce Bacterial resistance.
 Absorbed orally
 Not to be toxic
 Readily excreted
 Not to exhibit side effect or drug interaction

7. indications
To Treat infection of oral cavity
 As Pre-operative prophylaxis
 To Prevent Post operative infection and improve healing
at operated site.
 Preventing endocarditis
 Patients with compound musculoskeletal injury,
penetrating wound
 Deep punctured wound .

8. Factors determining the efficiency of
antimicrobial agents
 Host defence
 Source of infection
 Tissue (s) affected
 Margin of safety
 Bacterial susceptibility / Resistance to agent

9. Consideration before administration :
 Aetiology of organisms
 Culture sensitivity
 Route of administration
 Age
 Pregnancy
 Severity of disease
 Spectrum of Antibiotics
 Possibility of drug resistance
 Toxicity of drug
 History of previous allergy

10. COMBINATION THERAPY
 To have additive synergistic effect
 Mixed infections
 Delay the development of drug resistance
 Decrease the incidence of adverse effect
 Reduce the chance of superinfection
 Reduce the cost of therapy

11. Guidelines for Antibiotic prophylaxis
Situation Antibiotic Regimen
Oral Amoxiciilin 2g 50 mg/kg
Unable to take oral
medicine
Ampicillin 2g IM/IV 50 mg/ kg IM/IV
Allergic to Penicillin Clindamycin
Or
Cephalexin,Cephadroxil
Or
Azithromycin or Clarithromycin
500mg
2g
500mg
20 mg/kg
50 mg/kg
15 mg/kg
Allergic to Penicillin
And Unable to take oral
medicine
Clindamycin
Or
Cephazolin
600mg IM/IV
1g IM/IV
15 mg/ kg IM/IV
25 mg/ kg IM/IV

12. Beta lactam antibiotics
PENICILLIN
 Penicillin is the first choice of drug for
initial treatment
 Bactericidal.
 Natural penicillin
 Semisynthetic pencillin

14. Amoxicillin
 Effective against Gram negative as well as Gram
positive
 Drug of choice for treatment of odontogenic infection
 Mainly indicated for treatment of Mixed aerobic
infections (Gram positive And Gram negative)
 Dosage: 500 mg TDS

15.  Amoxicillin plus calvulanic acid – effective against
Bacteroids ,Hemophilus, Staphylococcus Peptostreptococcus
 Dosage- Amox- 500 mg + Clav 125 mg
 Adverse effect: Allergic reaction, Gastrointestinal
disturbances

16. Cephalosporin
 First generation - Gram positive micro organisms , E.coli, Klebseilla,
Pneumonia except enterococci
 Second Generation – Greater activity against Gram positive organism,
Hemophilus, E.coli, Proetus, Klebseilla
 Third Generation – Gram Positive cocci, Pseudomonas, Citrobacter,
 Fourth Generation – Gram postive and negative organism including
streptococci, staphylococci, meningococci , Gonococci, Hemophilus,
E.coli, Proetus

17. Macrolides
 Effective against both Aerobic and anaerobic organism
 C.diptheria, B.Pertussis, Mycoplasma, Chalmydiae
 Bacteriostatic
 Erythromycin – 500mg QID( Secondary choice after penicillin)
 Azithromycin – 500 mg TDS
 Clarithromycin – 500mg BD
 Clindamycin - 300 mg TDS

19. Broad spectrum
 Tetracycline – 500mg QID
 Doxycycline – 200mg BD

20. Metronidazole
 Effective against Obligate anaerobe.
 Bactericidal
 Effective against: Bacteriodes,
Prevotella,Campylobacter, Veillonella,
Treponema, Peptococcus,
Peptostreptococcus
Dosage : 400 mg TDS

21. Fluroquinolones
 Ciprofloxacin-
Pseudomonas
 Ofloxacin – Broad
Spectrum antibiotic

22. aminoglycoside
 Bactericidal
 Effective against Gram
Negative organisms
 Streptomycin- 1-2 g /kg/day
 Gentamycin – 3-5 mg/kg/day
 Amikacin- 15 mg/kg/day

23. Other Antimicrobial agents
 Antiviral agents
 Acyclovir
 Gancicovir
 Famiclovir

24.  Antimycotic agents
 Nystatin
 Amphotericin B
 Ketoconazole
 Flucanazole
 Clotrimazole

25. Analgesics
 Drugs that releive pain
 Divided into
1. Peripherally acting- NSAIDS
2. Centrally acting- Opioids

26. Advantages
 Effective and useful for postoperative pain
 No risk for addiction
 Abuse potential low
 Fewer adverse effect

27. Anti inflammatory drugs
Corticosteroids
 Dexamethasone
 Hydrocortisone

28. Uses:
Reduction of Pain, Oedema , Swelling following oral
surgical procedures
Complication:
Adrenal suppression
Delayed wound healing

29. Antioedematous drugs
 Hyaluronidase
 Streptokinase
 Proteolytic enzymes
1. Chymotrypsin
2. Serratopeptidase