This document provides information on antibiotics and analgesics used for periodontal diseases. It defines antibiotics as agents that destroy or inhibit the growth of microorganisms. Various antibiotics discussed that are used for periodontal diseases include tetracyclines, metronidazole, penicillins, cephalosporins, clindamycin, ciprofloxacin, and macrolides. It also discusses local delivery methods for antibiotics. Analgesics are defined as drugs that selectively relieve pain. The classes discussed include non-opioid types like aspirin, acetaminophen, ibuprofen and opioid types like morphine, codeine, synthetic opioids, and their mechanisms and side effects.

1. BY: SHIVANGINI SINGH
BDS 3rd Prof

2. INDEX
ANTIBIOTICS
-Definition
-systemic administration of antibiotics
-Biological implication
-Antibiotics used
 ANALGESICS
-Definition
-classes of antibiotics
-Non opioid type of analgesics
-opioid type of analgesics
-Mechanism of strong analgesics
-side effects of analgesics

3. ANTIBIOTICS
 DEFINITION
 An Antibiotic is a naturally
occuring,semisynthetic,or synthetic type of anti
infective agent that destroys or inhibits the growth
of selective microorganism,generally at low
concentrations

4. SYSTEMIC ADMINISTRATIN OF
ANTIBIOTICS
Background and Rationale
 The treatment of periodontal disease is based on the
infectious nature of the disease.An ideal antibiotic for
use in prevention and treatment of periodontal disease
should be specific for periodontal pathogens,allogenic
and nontoxic,substantive,not in general use of other
diseases and inexpensive.
 The treatment of patient should be based on the
patient’s clinical status ,nature of colonizing bacteria
and risk and benifits associated with the proposed
treatment plan

5. Biological implications
 The clinical diagnosis and situation dictate the need for possible
antibiotic therapy as a adjunct in controlling active periodontal
disease. The patient diagnosis can change over a period of time.
 Continuing disease activity,as measured by continuing
attachment loss ,purulent exudate,and continuing periodontal
pockets of 5mm or greater that bleed on probing is an indication
of periodontal intervention.
 Antibiotics for the periodontal disease are selected on the
patient’s medical and dental status,current medications and
results of microbial analysis if performed
 Microbiological plaque sampling can be performed
 Antinfective agents can be used for enhancing regenerative
healing

6. Antibiotics used in priodontal
diseases
 TETRACYCLINE
 PHARMACOLOGY:Tetracyclines are group of antibiotics
produced naturally by certain species of streptomycin or derived
semisynthetically.They are bacteriostatic and are affective against
rapidly multiplying bacteria
 CLINICAL USE :tetracycline is used in treatment of
LAP.A.actinomycetemcomitans is a frequent causative
microorganisam in LAP and is tissue invasive.Systemic
tetracycline can elminate tissue bacteria and has been shown to
arrest bone loss and supress A.actinomycetemcomitans in
congunction with scaling and root planing
 It is not advisable to advisable to prescribe long-term regimens of
tetracycline because of possible development of resistant bacterial
strains
 Specific Agents : Tetracycline,Minocycline,Doxycycline

7. METRONIDAZOLE
 PHARMACOLOGY: It is a bactericidal to anaerobic
organism and is believed to disrupt bacterial deoxyribonucleic
acid synthesis in condition with a low reduction potential.
 It is also effevtive against anaerobes such as Poryphyromonas
gingivalis and Prevotella intermedia
 CLINICAL USE : It has been used clinically to treat
gingivitis ,acute necrotizing ulcerative gingivits ,chronic
periodontitis ,and aggresive periodontitis
 It is used as monotherapy and used with root planning and
surgery
 Most common regimen is 250 mg three times daily
 SIDE EFFECT: metronidazole is an Antabuse effect when
alcohol is ingested ,it can result in severe cramps ,nausea ,and
vomiting

8. PENICILLINS
 PHARMACOLOGY: They inhibit bacterial cell
wall production and therefore are bactericidal.
 CLINICAL USE : Penincilins other than
amoxicillin and amoxicillin-clavunate
pottasium have not been shown to increase
periodontal attachment levels.
 SIDE EFFECT :It may induce allergic reactions
and bacterial ressistance

9. CEPHALOSPORINS
 PHARMACOLOGY:The family of beta lactams
is similar in action and structure to
penicillin.They are ressistance to number of
beta lactamases .
 CLINICAL USES :they are not generally not
used to treat dental –related infection .Penincil
are superior to cephalosporin in their range of
action
 SIDE EFECT: Rashes,urticaria,fever,and GI
upset have been associated

10. CLINDAMYCIN
 PHARMACOLOGY: it is effective against
anaerobic bacteria .it is effective in situation in
which patient is allergic to penincillin
 CLINICAL USE :Clindamycin has shown
efficasy in patients with periodontitis refractory
to tetracyclin therapy
 SIDE EFFECT :It has been associated with
pseudomembranous colitis.

11. CIPROFLOXACIN
 PHARMACOLGY: it is a quinolone active
against gram negative rods ,all facultative and
some anaerobic putative periodontal
pathogens.
 CLINICAL USE :It is the only antibiotic in
periodontal therapy to which all strains of
A.actinomycetemcomitans are susceptible.
 SIDE EFFECT: Nausea ,headache,mettalic taste
in the mouth and abdominal discomfort .

12. MACROLIDES
 PHARMACOLOGY:Macrolides antibiotics
contain a many membered lactone ring to which
one or more deoxy sugars are attached .They
inhibits protein synthesis by binding to the 50S
ribosomal subunits of sensitive microorganism
 CLINICAL USE : (i)Erythromycin: it is not
effective against most prutative periodontal
pathogens (ii)Spiramycin:it is active against
gram –positive organism (iii)Azithromycin:it is
effective against anaerobes and gram negative
bacilli

13. LOCAL DELIVERY OF ANTIBIOTICS
 Recently,advances in delivery technology have
resulted in close release of drugs
 The requirements for targeting an antiinfective
agent to infection sites and sustaining its localized
cocentration at efective levels for a sufficient time
while concurrently evoking minimal or no side
effects. The drugs used are:
 Tetracycline-Containing Fibers
 Subgingival Doxycycline
 Subgingival Minocycline
 Subgingival Metronidazole

15.  DEFINITION: A drug that selectively relieves
pain by acting in CNS or peripheral pain
mechanism, without significantly altering
consciousness
 Analgesics are common pain relievers.
 Many analgesics also have antipyretic
properties as well. They can be used to
reduce fever
 Some analgesics are also anti-inflammatory
drugs as well

16. CLASSES OF ANALGESICS DRUGS
NON OPIOD TYPE OF
ANALGESICS(mild
analgesics)
OPIOID TYPE OF
ANALGESICS
(strong analgesics)
Salicylates
-aspirin
-diflunisal
Other NSAIDs
-ibuprofin
-ketrolac
Acetaminophen
Natural opium alkaloid
 Morphine,codeine
 Semisynthetic
derivatives-Heroin and
pholcodeine
Synthetic opioids
 Pethidine
 fentanyl

17. NON OPIOD TYPE OF ANALGESIC
Aspirin
 Aspirin is believed to inhibit the enzyme,
Prostaglandin synthase which is formed at
the site of an injury.
 This inhibits the production of
prostaglandins which produce fever and
swelling as well as transmitting pain signals
to the brain.

18. Acetaminophen
 Acetaminophen is a pain reducer, such as
Tylenol but does not reduce inflammation
 When taken at recommended doses, it
has negligible side effects
 It can be used efficiently in controlling
postoperative pain after open flap
debridement in patients with bleeding
tendency

19. Ibuprofen
 Ibuprofen is a more powerful pain
reliever than aspirin in high doses.
 It helps to relieve both pain and
inflamation of the gums
 Side effects include gastrointestinal
bleeding and irritation

20. OPIOD TYPE OF ANALGESICS
Morphine
 Naturally occurring in the poppy- Only needs
to be isolated
 Very strong pain reliever but also very
addictive (2nd to Heroin)
 Usually injected but can be smoked, sniffed
or swallowed
 The scientific result shows that morphine
treatment reduced fiber attachment and
alveolar bone loss without affecting the
increased leukocyte count in gingivae

21. Codeine Most commonly used strong analgesic
• Similar to Morphine except for the
replacement of a (OH-) group for (OCH3)
group
 Commonly used with Tylenol as a more
mild analgesic
 1/6 as strong as Morphine and less
addictive

22. •Synthesized from morphine in a
esterification reaction with acetyl chloride.
•It has higher lipid solublity because of
which euphoric effects are faster and greater
resulting in higher abuse potential.
•Though it can be used asanalgesic but is
banned in many countries

23. Synthetic opioids
 The active area of morphine has been
identified and can be synthesized.
 This has produced many synthetic analgesics
and has allowed scientists to eliminate some of
the harmful side effects of more natural
analgesics.
 Pethidine is one of synthetic opioids being
used

24. Mechanism of Strong
Analgesics
 The human body contains “natural opiates” in the brain
called endorphins
 These are produced in the body during extreme
conditions such as “running high” and extreme injuries.
 When these are absorbed by receptors in the brain the
body feels analgesia and the pain is reduced.
 Opiates derieved from the poppy act in same way as
endomorphins ,the “high” is produced because of the
absorbtion is quicker than endorphins

26. Side Effects of Strong Analgesics
Short term
• Dulling of Pain
• Euphoria
• Slow Nervous system
• Overdoses can lead to
death
• Possibility of stroke
• Overall slowdown of
biological systems
Long Term
• Addiction and very strong
withdrawal effects
• Constipation
• Disruptions in menstruation
• “Cross-tolerance”
• Loss of appetite

27. BIBLIOGRAPHY
 CARRANZA’ CLINICAL PERIODONTOLOGY
 Sites – Google scholar