This document discusses the use of antibiotics in treating periodontal disease. It begins by defining periodontal disease as a pathological condition involving the supporting tissues of the teeth, usually caused by bacterial infections. It then discusses how periodontal pockets form through the accumulation of plaque and destruction of bone. The document outlines guidelines for using antibiotics as an adjunct to mechanical debridement for treating periodontal pockets. It provides details on common systemic and local antibiotic regimens, including agents like metronidazole, amoxicillin, doxycycline, and minocycline. The document concludes by discussing approaches like serial or combination antibiotic therapy and local delivery agents for targeted treatment of periodontal infections.

1. ANTIBIOTICS USED
IN PERIODONTAL
DISEASE
PRESENTED BY:
DR. HAFSA SARA ZUBAIR
BDS

2. OBJECTIVES:
• What is periodontal disease?
• How periodontal pockets are formed?
• How to treat periodontal pockets?
• What are antiinfective agents?
• Guidelines for use of antibiotics in periodontal therapy.
• systemic administration of antibiotics
• common antibiotics regimens to treat periodontal disease.
• Serial or combination antibiotics.
• Local delivery agents

3. WHAT IS PERIODONTAL
DISEASE?
Periodontal disease refer to all the diseases of peridontium;
this means that a periodontal disease is any
pathological state that
involves the supporting tissue
of the teeth.
•Usually caused by bacterial infections.

4. HOW PERIODONTAL POCKETS ARE FORMED?
THIS SUPRAGINGIVAL PLAQUE BECOMES COMPLEX
AFTER TEETH HAVE BEEN CLEANED
BACTERIA BEGINS TO REATTACH AND FORM BIOFILM
EVENTUALLY BONE IS DESTROYED A PERIODONTAL POCKET
IS FORMED
BACTERIAL GROWS IN APICAL DIRECTION AND BECOME
SUBGINGIVAL
LEADING TO SUCCESSION OF BACTERIA

5. HOW TO TREAT PERIODONTAL POCKETS??
• BY MECHANICAL REMOVAL OF LOCAL FACTORS:
calculus
plaque
MECHANICAL REMOVAL INCLUDES:
1. Manual instrumentation
a. Scaling
b. root planing
2. Machine drive instrument
Ultrasonic scalers
• THESE PROCEDURES ARE CONSIDERED TO BE
ANTIINFECTIVE THERAPY

6. ANTIINFECTIVE AGENTS:
“A Anti-infective agent is a chemotherapeutic agent that act
by reducing the number of bacteria present. It destroys or
inhibits the growth of selective microorganisms .”
• Can be administered ORALLY OR LOCALLY.
•SYSTEMIC ADMINISTRATION OF ANTIBIOTICS controls
bacterial infections.
•LOCAL ADMINISTRATION OF ANTIINFECTIVE AGENTS
provide greater concentration directly to the infected area and
reduce possible side effects.

7. GUIDELINES FOR THE USE OF ANTIBIOTICS IN
PERIODONTAL THERAPY
 Clinical diagnosis and situation dictate the need for possible
antibiotic therapy.
 Antibiotics should be selected based on patient’s medical and
dental status ,current medications,and plaque sampling
analysis.
 Adjunct therapy has shown more benefits in periodontal
treatment rather than alone therapy.
 Biofilm should be disrupted physically so that antibiotics can
access to periodontal pathogens

8. SYSTEMIC ADMINISTRATION OF
ANTIBIOTICS
CATEGORY AGENT MAJOR FEATURES
Penicillin Amoxicillin
Augmentin
• Extended spectrum of
antimicrobial activity; excellent
oral absorption used systemically.
• Extended against penicillinase
producing microorganisms ; used
systemically.
Tetracycline Minocycline
Doxacycline
Tetracycline
• effective against broad spectrum
of microorganism; used
systemically, applied locally (
subgingivally)
• used systemically; applied locally.
•Used in sub-antimicrobial dose
for host modulation.

9. CATEGORY AGENT MAJOR FEATURES
Quinolone Ciprofloxacin • Effective against gram negative
rods, promotes health associated
microflora.
Macrolide Azithromycin • concentrate at site of
inflammation; used systemically.
Lincomycin derivatives Clindamycin •Used in penicillase-allergic
patients; effective against anaerobic
bacteria; used systemically.
Nitroimidazole Metronidazole •Effective against anaerobic
bacteria; used systemically and
applied locally (subgingivally) as gel.
CONT……

10. COMMON ANTIBIOTICS REGIMENS USED TO
TREAT PERIODONTAL DISEASE
SINGLE AGENT REGIMENS DOSAGE/DURATION
Amoxicillin 500mg Three times daily for eight
days.
Azithromycin 500mg Once daily for 4-7 days
Ciprofloxacin 500mg Twice daily for 8 days
Clindamycin 300mg Three times daily 10 days
Doxacycline or minocycline 100-200mg Once daily for 21 days
Metronidazole 500mg Three times daily for 8 days
COMBINATION THERAPY REGIMENS DOSAGE/DURATION
Metronidazole + amoxicillin 250mg of each Three times daily for 8 days
Metronidazole + ciprofloxacin 500mg of each Twice daily for 8 days

11. MECHANISM OF
ACTION
CLINICAL USE SIDE EFFECTS
Binds reversibly
to 30s ribosome
subunit
Blocks bacterial
translocation.
This prevent
binding of
aminoacly tRNAs
to A-site of the
ribosome.
• used to treat:
- Aggressive
periodontitis in
children.
• GI disturbance
• Photosensitivity
• Hypersensitivity
• Increase blood
urea nitrogen
• Blood dyscrasias
• Dizziness
• Headache
• Tooth
discoloration
occurs when
administered to
children up to age
12 years.
TETRACYCLINE

12. MINOCYCLINE
MECHANISM OF
ACTION
CLINICAL USE SIDE EFFECTS
Binds reversibly
to 30s ribosome
subunit
Blocks bacterial
translocation.
This prevent
binding of
aminoacly tRNAs
to A-site of the
ribosome.
• Used to treat:
- Adult
periodontitis by
suppressing
spirochetes and
motile rods.
• GI disturbance
• Renal toxicity
• Photo toxicity
• Hypersensitivity
• Blood dycrasias
• Increase blood
urea nitrogen
• Dizziness
• Headache
• vertigo

13. DOXYCYCLINE:
MECHANISM OF
ACTION
CLINICAL USE SIDE EFFECTS
Binds reversibly
to 30s ribosome
subunit
Blocks bacterial
translocation.
This prevent
binding of
aminoacyl tRNAs
to A-site of the
ribosome.
• Used to treat:
- Adult
periodontitis by
suppressing
spirochetes and
motile rods
• GI disturbance
• Photosensitivity
• Hypersensitivity
• Increase blood
urea nitrogen
• Blood dyscrasias
• Dizziness
• Headache
• Tooth
discoloration
occurs when
administered to
children up to age
12 years.

14. ..
METRONIDAZOLE:
MECHANISM OF ACTION CLINICAL USE SIDE EFFECTS
Entry into the microorganism
Reductive activation by intracellular
transport proteins- Metronidazole is
reduced by the pyruvate:ferredoxin
oxidoreductase system in the
mitochondria of obligate anaerobes,
which alters its chemical structure.
Reduced intermediate particle
interacts with intracellular targets-
Cytotoxic intermediate particles
interact with host cell DNA, resulting
in DNA strand breakage.
Breakdown of cytotoxic intermediate
products
•Used to treat:
- Gingivitis
- ANUG
- Chronic
periodontitis
- Aggressive
periodontitis
• When combined
with amoxicillin,
metronidazole is
used in the
management of
patient with LAP or
refractory
periodontitis.
• Has an antabuse
effect when alcohol is
ingested and can
result in :
- Cramps
- Nausea
- Vomiting
- Metallic taste
• Alcohol products
should be avoided.
• pt undergoing
anticoagulant therapy
should avoid
metronidazole.
• should be avoided in
pt who are taking
lithium.

15. PENICILLINS:
MECHANISM OF
ACTION
CLINICAL USE SIDE EFFECTS
It inhibit cell wall
synthesis by
following ways:
- Inactivates
protien present on
the bacterial cell
membrane.
- Inhibit
transpeptidase
catalayzed reaction.
- By production of
autolysins
There use in
periodontal therapy
does not appear to
be justified.
• Allergic reactions
• Hypersensitivity
• Nephritis
• Neurotocxicity
• hematologic
toxicity
• Cation toxicity

16. CEPHALOSPORINS:
MECHANISM OF ACTION CLINICAL USE SIDE EFFECTS
It inhibit cell wall synthesis
by following ways:
- Inactivates protien
present on the bacterial cell
membrane.
- Inhibit transpeptidase
catalayzed reaction.
- By production of
autolysins
Not used to treat dental
related infections.
• Rash
• fever
• GI disturbance

17. CLINDAMYCIN:
MECHANISM OF
ACTION
CLINICAL USE SIDE EFFECTS
Binds to 50s subunit
Inhibit protein
synthesis
Used to treat
- Periodontitis
• Diarrhea
• Rash
• Neutropenia

18. CIPROFLOXACIN:
MECHANISM OF ACTION CLINICAL USE SIDE EFFECTS
Inhibits bacterial folic acid
synthesis thereby killing
bacteria.
• may facilitate the
establishment of microflora
associated with periodontal
health.
• Nausea
• Headache
• Metallic taste
• Abdominal discomfort

19. MACROLIDES:
(erythromycin, spiramycin,
and azithromycin)
MECHANISM OF ACTION CLINICAL USE SIDE EFFECTS
Binds irreversibly to a site of
50s subunit of bacterial
ribosome
Inhibit the translocation
step of protein synthesis
•Spiromycin is used as
adjunct to periodontal
treatment.
• Azithromycin can be used
to treat
- Aggressive
periodontitis
- gingival enlargement
• Epigastric distress
• ototoxicity
• cholestatic jaundice

20. SERIAL OR COMBINATION ANTIBIOTIC THERAPY:
• In some cases it is necessary to use more then one
antibiotic, either serially or in combination.
EXAMPLES:
• Metronidazole-amoxicillin and metronidazole-augmentin
combination provide excellent elimination of organism in adult
and LAP
• Metronidazole-ciprofloxacin is effective against A.
actinomycetemcomitans

21. LOCAL DELIVERY AGENTS:
• They control growth of bacteria on barrier membranes.
•AMERICAN ACADEMY OF PERIODONTAL STATED:
“ The clinician decisions to use LDA
should be based upon clinical
findings, patient's dental and
medical history, patient
preference and advantages
and disadvantages of therapies.”

22. SUBGINGIVAL CHLORHEXIDINE:
This include:
• Periochip is a small chip composed of:
• Biodegradable hydrolysed gelatin matrix
• glycerin
• water into which 2.5 chlorhexidine gluconate has been
incorporated per chip.
•This system releases chlorhexidine and maintain drug
cocentration in GCF.
•Chips biodegrades in 7-10days.
PLACEMENT OF
CHLORHEXIDINE GLUCONATE
CHIP.

23. TETRACYCLINE CONTAINING FIBRES:
•An ethylene/vinyl acetate copolymer fibre
containing tetracycline 12.7mg per 9 inches.
•When packed into periodontal pocket it inhibit the
growth of pathogens.
•Tetracyclin fibres reduce - probing depth
- bleeding on probing
- periodontal pathogens

24. SUBGINGIVAL DOXYCYCLINE:
•Gel system using syringe with 10% doxycycline.
•It reduces:
- probing depth
- bleeding on probing
- growth of oral pathogens
PLACEMENT OF 10%
DEOXYCYCLINE GEL.

25. SUBGINGIVAL MINOCYCLINE:
• 2% minocycline is encapsulated into bioresorbable
microspheres in a gel carrier.
•It reduces:
- probing depth
- bleeding on probing
- growth of oral pathogens
PLACEMENT OF
MINICYCLINE
MICROSPHERE.

26. SUBGINGIVAL METRONIDAZOLE:
• contain oil-based metronidazole 25% dental gel.
•Applied in viscous consistency to the pockets.
•It reduces:
- probing depth
- bleeding on probing
- growth of pathogens

27. REFRENCES:
CARRANZA
IMAGES FROM GOOGLE