3. ! Mechanical removal of
bacterial plaque
! by scaling and root planning
“anti-infective therapy”
! Manual or ultrasonic
! Chemotheraputic agents
“anti-infective agents”
! Systemic or local
modulate host response + dec. no
of bacteria
! Decrease bone loss
i.e. adjunctive but not substitute
5. ! An ideal antibiotic for treatment of PD diseases should
be:
1. Specific for PD pathogens
2. Non toxic
3. Substantive
4. Not in general use for Rx of other diseases
5. Inexpensive
Ideal antibiotic for treatment of periodontal diseases
DOES NOT EXIST
6. " Ideally , the causative MO should be identified using
antibiotic-sensitivity test BUT It is difficult to
identify specific etiologic MOs in PD dis.
! Indications for microbial plaque testing include:
1. Aggressive forms of PD dis.
2. Purulent exudates(abscess) and continuous
attachment loss.
3. Refractory PD dis. to standard mechanical
therapy.
4. Periodontitis associated with sys. conditions
7. ! Acute infection(NUG & NUP)
! Abscess
! Aggressive periodontitis.
! Recurrent (Refractory) periodontitis.
ANTIBIOTIC PROPHYLAXIS
(PREVENTION)
1- History or risk of infective endocarditis and heart
defects.
2- Prosthetic cardiac valve.
3-Immunocomrized patients.
9. ! Broad spectrum antibiotic
! Bacteriostatic…. against rapidly multiplying bacteria.
! Used to treat LAP and refractory cases.
! G+ve >> G-ve bacteria.
! Its conc. in the GCF is 2-10 times than in serum which make it
more effective for PD dis. (studies!! Tetracyclines in
low conc. in GCF (2 -4µg/ml) are very effective
against many PD pathogens)
Actions:
1.conc. In PD tissues.
2.Inhibit growth of A.a.
3.Anticollagenase effect!Inhibit tissue destruction!Aid in
bone regeneration.
4. Has anti-inflammatory action! suppress PMN activity.
10. Tetracycline have been investigated as adjunct in
the treatment of LAP, y?
It is not advisable to describe long term regimens of
tetracycline ,y???
dt development of resistant bacterial strains + side effects
NOW , replaced
More effective combination “amoxicillin + metronidazole“
11. ! Administration 250mg 4 times daily (qid).
! Inexpensive but doubtful compliance.
Side effects:
GI disturbances, photosensitivity, hypersenstivity,
increased blood urea nitrogen(BUN),headache,
tooth discoloration when administered to children under
12 years.(breast feeding mother-pregnant woman)
12. ! Suppresses spirochetes and motile rods.
! Given 100mg twice daily(bid) or 200mg per a day(qd) for 1
week facilitating compliance.
Side effects:
! Similar to tetracycline BUT Lessphotosensitivity
and renal toxicity.
! Reversible vertigo.
N.B Only tetracycline can discolor permanent teeth and
gingival tissues .
13. ! Has same spectrum as minocycline, but only given
once daily(qd) more compliant!!
! It is not altered the absorption of the Ca, metal ions,
or antacids as other tetracycline
! THE Most Photosensitive Agent in Tetracyclines
family.
DOSES:
100 mg bid 1st day, then 100 mg qd
OR 100mg qd or 50mg bid( GI upset) .
14. ! Bactericidal(kill) to anaerobic bact.including
spirochetes because it disrupts the bacterial DNA
synthesis.
! Present in both serum and GCF
! Effective against P. gingivalis & P. intermedia but
not against A.a unless combined to other antibiotics!!!!
Used to treat:
1. NUG.
2. Chronic periodontitis.
3. Aggressive periodontitis.
15. Doses:
1. 250mg 3 times daily(tid) for a week.
Side effects:
1. Antabuse interaction, when alcohol is ingested (cramp,
nausea, vomiting).
2. Inhibits warfarin metabolism and anticoagulant drugs.
3. Avoided in patients on lithium (psychiatric treatment).
4. Metallic taste in mouth.
5. Not recommended as mono-therapy.
16. ! β-lactam …Most widely used antibiotic.
! Inhibit bact. cell wall production ! bactericidal.
Side effect:
! Bact. resistance
! Induce allergic reactions
17. Amoxicillin
is semisynthetic penicillin with extended anti-infective
spectrum (G+ve, G-ve)
Dose:500mg 3 times/ day(tid) for 8 days.
Uses : for treatment of LAP & GAP.
Augmentin
is combination = amoxicillin +clavulanate potassuim.
(resist pencillinase enz.)
Uses: management of AP or refractory periodontitis.
(It also arrests alv. Bone loss )
Dose : 625mg/ml 3 times per day for 8 days
18. ! Is similar in action and structure to penicillins
! Generally, it ISN’T used to treat dental infections,
because the penicillins are SUPERIOR in action
against PD pathogenic .
Side effect:
! Patients allergic to penicillins must be considered
allergic to all beta-lactams.
! Rashes, urticaria, fever, and GI upset.
19. ! Effective against anaerobic bacteria
on osseous tissues.
in situations of penicillin allergy.
in Rx of refractory periodontitis .
Dose: 300 mg 2 times/day(bid) for 8 days
Side effects: pseudomembranous colitis.(cramps and
diarrhea)
20. ! It is active against G-ve rods.
! It has minimal effect on Streptococcus species, which facilitates
the establishment of a microflora associated with PD health.
! The only antibiotic that affects all strains of Aa.
! It also used in combination with Metronidazole.
Side effect:
! Nausea , headache
! Metallic taste
! Inhibit the metabolism of theophylline (branchodilatotor)and
caffeine, concurrent administration can produce toxicity.
! Enhance warfarin effect and other anticoagulants.
21. ! Inhibit protein synthesis.
! Bacteriostatic or Bactericidal depending on
drug conc. and nature of MO.
! Macrolids used in periodontal Rx include
Erythromycin, Spiramycin ,and Azithromycin.
! DOSES: 250mg/day for 5 days after an initial
loading dose of 500mg.
22. Erythromycin
! Not recommended ,Y???
1. Does not concentrate in GCF
2. Not effective against most PD pathogens
Spiramycin
" Active against G+ve .
" Excreted in high conc. in saliva
" Has minimal effect on increasing attachment levels
Azithromycin
Is effective against anaerobes and G-ve bacilli
It penetrates fibroblasts and phagocytes. It is transported to
sites of inflammation by phagocytes, then released directly as
the phagocytes rupture during phagocytosis.
23.
24. WHEN both types of DRUGS are described, they are
best given SERIALLY, not in COMBINATION .
example
Bacteriostatic antibiotics(e.g., tetracycline) generally
require rapidly dividing MO to be effective. They
do not function well if a bactericidal antibiotic
(e.g., amoxicillin) is given concurrently.
Bacteriostatic Bactericidal
Tetracycline Penicillin
Clindamycin Cephalosporin
Erythromycin Metronidazole
26. ! Management of periodontitis
mechanical debridement +patients’ oral hygiene
efforts + effective and safe systemic antibiotics
The use of antibiotic in treatment of gingivitis
is contraindicated. Y?? Bec. local factor can
easily removed.
27. Misuse or overuse of
prophylactic antiinfective agent
Increase bacteria resistance
Useless
