1) The document discusses the rationale for use of antibiotics after periodontal surgery. While some studies support their use to reduce pain and swelling and improve healing, other studies found no benefit when surgery was performed under strict aseptic conditions.
2) The prevalence of postoperative infections after periodontal surgery is low (<1-4.4%) even without antibiotics. Strict aseptic protocols during surgery are important to prevent infections.
3) More recent studies and reviews have found no clear benefit to routine use of antibiotics after surgery to prevent infection alone. They may be indicated if infection is already present or for medical reasons.
Surgical v/s Non surgical periodontal therapy Achi Joshi
Both surgical and nonsurgical therapy produced improvement in the periodontal health.
Treatment approach was based on the comfort level of the practitioner.
In the late 60’s and continuing into the 70’s and 80’s, many series of longitudinal studies were conducted, aimed to document the immediate and most importantly long term clinical results following several types of periodontal therapy.
Periodontitis is a chronic infectious inflammatory disease caused by microbes; however the presence of microbes is not enough for the cause of its complex nature of disease. Inflammation is the prime cause of periodontal disease. It commences with the aggregation of pathogenic microbes that induce the host to stimulate a cascade of inflammatory response reactions which in-turn leads to the destruction of the host tissues itself. There is a complex interplay of innate and adaptive immune responses which fights against the pathogens by direct interaction or by release of certain molecules including cytokines.
Cytokines are cell signalling molecules that aid cell to cell communication in immune responses and stimulate the movement of cells towards sites of inflammation, infection and trauma. Cytokine biology reveals that there are some subsets of cytokines which are pro-inflammatory cytokines which stimulate the inflammatory responses and cause tissue destruction.
A periodontist is expected to have a sound basis of the cytokine profile to understand the pathogenesis of periodontitis and also to discover the new treatment modality of anti-cytokine therapy.
Surgical v/s Non surgical periodontal therapy Achi Joshi
Both surgical and nonsurgical therapy produced improvement in the periodontal health.
Treatment approach was based on the comfort level of the practitioner.
In the late 60’s and continuing into the 70’s and 80’s, many series of longitudinal studies were conducted, aimed to document the immediate and most importantly long term clinical results following several types of periodontal therapy.
Periodontitis is a chronic infectious inflammatory disease caused by microbes; however the presence of microbes is not enough for the cause of its complex nature of disease. Inflammation is the prime cause of periodontal disease. It commences with the aggregation of pathogenic microbes that induce the host to stimulate a cascade of inflammatory response reactions which in-turn leads to the destruction of the host tissues itself. There is a complex interplay of innate and adaptive immune responses which fights against the pathogens by direct interaction or by release of certain molecules including cytokines.
Cytokines are cell signalling molecules that aid cell to cell communication in immune responses and stimulate the movement of cells towards sites of inflammation, infection and trauma. Cytokine biology reveals that there are some subsets of cytokines which are pro-inflammatory cytokines which stimulate the inflammatory responses and cause tissue destruction.
A periodontist is expected to have a sound basis of the cytokine profile to understand the pathogenesis of periodontitis and also to discover the new treatment modality of anti-cytokine therapy.
Antibiotics for surgical prophylaxis.
Surgical site infections(SSIs) are a significant cause of morbidity and mortality.
Approximately 2% to 5% of patients undergoing clean extra-abdominal operations and 20%undergoing intra-abdominal operations will develop an SSI.
SSIs have become the second most common cause of nosocomial infection and these data are likely underestimated.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
DOI:10.21276/ijlssr.2016.2.4.1
ABSTRACT- Introduction: Surgical Site Infections (SSI) still remains a significant problem following an operation
and the third most frequently reported nosocomial infections. SSI contributes significantly to increased health care costs in
terms of prolonged hospital stay and lost work days.
Objective: The current study was undertaken to identify incidence of SSI and the risk factors associated with it, and the
common organism isolated and its antibiotic sensitivity and resistance.
Material and Methods: A total number of 3211 patients admitted in general surgical wards for elective surgery in the
study period, out of which 1225 were clean and clean contaminated cases, fulfilling our study criteria. Totally 56 cases
had surgical site infections which had been taken up for this study. Wound discharges were sent for culture and sensitivity.
Results and Conclusions: The overall infection rate was 4.57%. The SSI rate was almost equal in clean surgeries and
clean contaminated ones. Superficial surgical site infections in the most commonest type and accounted for about 66.07%
of all the SSI’s and deep surgical site infection accounted for about 25% with 8.92% was organ space. The most
commonly isolated organism from surgical site infections was staphylococcus aureus followed by pseudomonas and then
E. coli. Drains, prosthesis usage and other risk factors of SSI have been identified. Most of the organisms which were
isolated were multidrug resistant. The high rate of resistance to many antibiotics underscored the need for a policy that
could promote a more rational use of antibiotics. Key-words- Surgical site infections, National Nosocomial Infections Surveillance (NNIS) risk index, Antibiotic
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Rationale for use of antibiotics after periodontal surgery
1. RATIONALE FOR USE OF ANTIBIOTICS
AFTER PERIODONTAL SURGERY
DR.VIDYA VISHNU
SENIOR LECTURER
MALABAR DENTAL COLLEGE AND RESEARCH CENTRE
1
2. INTRODUCTION
Of the various factors that affect the outcome of
periodontal surgery, the most important aspect is
prevention of infection during and following
surgery.
2
3. As postoperative infection can have a significant
effect on the surgical outcome, preventive
measures like strict aseptic protocol, anti-infective
measures like proper sterilization, disinfection,
barrier techniques, and other measures should be
taken.
3
4. Although studies have shown a low rate of
postoperative infection when periodontal surgery
was done under strict aseptic conditions, some
studies supported the concept that healing was rapid
and discomfort was lesser when antibiotics were
used.
4
5. Other studies did not support the routine use of
antibiotics after periodontal surgery and concluded
that antibiotics should be used only when there is a
medical indication or when the infection has
already set in.
5
6. With increase in use of bone grafts, GTR
membranes and implants, the use of antibiotics have
further increased.
This seems to be based totally on empiricism and a
self developed protocol rather than based on
evidence.
Hence, it is necessary to evaluate the role of
antibiotics after routine periodontal surgery, when
done under strict aseptic conditions.
6
7. Prevention of infection following
dental surgical procedures
There are numerous local surgical and dental
surgical procedures and medical conditions that are
routinely covered by systemic antibiotics in an
attempt to prevent postoperative infections. These
can be considered as follows:
local wound infection that may not jeopardize the
procedure (e.g. removal of an impacted lower third
molar);
7
8. local infection that may jeopardize the
procedure (e.g. installation of endosseous
implants);
distant metastatic infection (e.g. infection of an
indwelling vascular stent); and
fulminant sepsis (e.g. the severely immuno-
compromised patient).
8
9. Local surgical procedures
Antibiotic prophylaxis can generally be justified for
surgical procedures when it may safely and cost
effectively reduce the risk for:
exposing a sterile body area to infection; or
acquiring an infection likely to cause major
morbidity, including the implantation of
prostheses.
9
10. Considering these criteria, there are few clear
indications to provide antibiotic coverage for
dental and oral surgical procedures in fit and
healthy individuals (Pallasch TJ, Slots J.1996).
10
11. PERIODONTAL SURGERY
Periodontal surgery, irrespective of the procedure,
has a low risk of postoperative infection. An analysis
of 1,053 periodontal surgical procedures showed a
prevalence of 22 infections (2.09%).
Patients who received systemic antibiotics as part of
the surgical procedure (administered both pre- and
postoperatively) developed eight infections in 281
procedures (2.85%).
POWELL et al 2005
11
12. POST-OP INFECTIONS
Infection is defined as an invasion of the body
tissues by pathogenic organisms.
Oral cavity, which harbours billions of
microorganisms as their natural habitat, is also
influenced by a multitude of external factors, leading
to its susceptibility for infection.
12
13. Though in actual practice, only a minority of
surgical procedures performed in the oral cavity
result in any significant post-surgical infection,
they could result in needless complications,
discomfort to the patient, delay in healing, and
can influence the final outcome as well.
13
14. Sources of infection during surgery in oral cavity
include:
• Instruments,
• Hand of surgeon & assistant,
• Air of the operatory, and
• Patient’s perioral skin, nostrils, & saliva.
14
15. Infection rates following periodontal surgery when
no antibiotics were used have been reported to be
low, ranging from <1% (Pack PD, Haber J.1983) to
4.4% (Checchi L, 1992) for routine periodontal
surgery and 4.5% following implant surgery
(Gynther et al, 1998).
15
16. A literature review on effects of antibiotics on
implants showed success rate of 92% when no
antibiotics were used, 96% when prophylactic
antibiotics were used and 97% when postoperative
antibiotics were used.
16
17. Prevalence of postoperative infections after a
range of periodontal surgical procedures is low and
systemic antibiotics are of little value in reducing
the incidence of postoperative infection. (Powell
2005)
17
20. to reduce pain & swelling,
to improve wound healing
To control the subgingival microflora
To improve treatment outcomes following
gingivectomy, osseous resective, regenerative,
and implant surgery
20
22. Surgical aseptic protocol and
infection control measures
All the periodontal surgical procedures should be
carried out in a fumigated enclosed surgical room
with restricted entry and proper drainage and water
supply system in place.
22
23. Anybody with any source of infection should not
be allowed to enter the room.
All personnel assigned in the operating room
should practice standard presurgical procedures
which included autoclaved surgical gowns, head
caps, masks, and separate in-house footwear.
23
24. Dental operatory tools, including dental chair,
should be cleaned daily with a disinfectant.
Exposed areas should be covered with aluminum
foils.
Disposable glasses and autoclaved disposable
suction tips must be used along with distilled water
as water source.
24
25. High-volume evacuation suctions should be used
for decreasing the aerosol production.
Spittoon and tumbler water lines must be flushed
for at least 5 min before and after the surgical
procedure.
All instruments to be used should be precleaned,
segregated, and packed in autoclavable sealed
pouches which had chemical spore testing test
strips attached to them and then autoclaved
25
26. Operator and assistant should perform a presurgical
scrub with a germicidal soap using vigorous friction
before the surgical procedure.
Patient preparation was done with povidone iodine
presurgical facial scrub.
Pre-procedural mouthrinse with 10 ml of 0.2%
chlorhexidine must be done.
26
27. STUDIES
Ariaudo, 1969 :-
Conducted a study on 68 patients to study the
efficacy of antibiotics after periodontal surgery .
Lincomycin 500mg was given 1 capsule four times
a day for 6 days, 2 days before and four days after
surgery.
Compared with placebo in control group reduced
the incidence of malaise, edema, necrosis and pain.
27
28. David, Strahan 1972
Postoperative administration of phenoxymethyl
penicillin reduces the pain experience following
periodontal surgery, and may prevent postoperative
complications.
As pain is normally controlled by analgesics, it may
be that their use is indicated where post operative
pain occurs following surgery, leaving antibiotics to
be used in cases where post operative complications
occur.
28
29. Thomas Marco, Edwin V . Kluth 1972
Concluded that there will be no obvious
advantage to administering Cleocin post-
operatively to periodontal surgery patients.
29
30. Kidd EA, Wade AB 1974
17 patients with a split mouth design, given a
course of Phenoxymethyl penicillin 250mg q.d.s
for 5 days compared to placebo.
Resulted in lesser infection and better healing
following routine periodontal flap operation.
30
31. Scopp et al 1977
Study on 20 patients - Tetracycline
hydrochloride 250mg 6th hourly for
5 days was compared to placebo after
periodontal surgery.
Did not show any adverse outcome in both the
groups.
31
32. K. Pendrill and J. Reddy 1980
This study investigated the efficacy of prophylactic
penicillin in 19 human subjects undergoing
periodontal surgery.
Following initial therapy, flap surgery was
undertaken in at least two comparable quadrants in
each patient.
Using a split mouth technique, patients were either
given phenoxymethyl penicillin or a placebo
following flap surgery for 5 days.
32
33. Pain, infection, plaque levels, gingivitis and
crevicular fluid flow were measured during a 4
week period.
There were no differences between the placebo or
penicillin sides in any of the parameters studied,
except that the pain experience was significantly
lower on the penicillin operated side.
33
34. Pack PD, Haber J 1983
A large scale study done in 218 patients in which 927
surgical techniques performed including flap surgeries,
grafts, osseous surgeries, frenectomy, root amputation.
Prophylactic antibiotics were given in 43 surgeries
and 884 were done without antibiotics (Penicillin or
Erythromycin 250mg orally 4 times daily for 7 days).
Antibiotic group- 1/43 (2%)
Without antibiotics- 8/884 (<1%)
Incidence of clinical infection was very low in both the
groups; prophylactic antibiotic therapy was ineffective in
preventing postoperative infection.
34
35. Mahmood, Dolby 1987
In a double-blind cross over study done to
compare the effect of Metronidazole with placebo
in patients treated with Modified Widman flap
procedure
Results showed that Metronidazole did not exert a
significant greater beneficial effect than placebo.
35
36. Chechi , Trombelli, Nonato 1992
A retrospective study of 498 surgical procedures
done on 231 patients.
250mg Tetracycline hydrochloride given 4 times a
day or Minocycline 100mg twice daily for 7 days
for 53 procedures and for 445 procedures no
antimicrobials was given.
No statistical significant difference between the
incidence of infection in both the groups.
36
37. Powell 2005
A retrospective review of 395 patients who underwent
1053 surgical procedures which included osseous
resective surgery, flap curettage, distal wedge
procedure, gingivectomy, root resection, implant
surgery, sinus augmentation, ridge preservation and the
impact of various treatment variables examined
including the use of bone grafts, membranes,
chlorhexidine rinses, soft tissue grafts, systemic
antibiotics and dressings
37
38. Of the 1,053 surgical procedures, there were a total of
22 infections - 2.09%.
Patients who received antibiotics (pre- and/ or post-
surgically) developed eight infections in 281
procedures (2.85%); compared to 14 infections in 772
procedures (1.81%) where antibiotics were not used.
Procedures in which chlorhexidine was used during
post-surgical care had a lower infection rate (17
infections in 900 procedures, 1.89%) compared to
procedures after which chlorhexidine was not used as
part of post-surgical care (five infections in 153
procedures, 3.27%).
38
39. The use of a post-surgical dressing demonstrated a
slightly higher rate of infection (eight infections in
300 procedures, 2.67%) than non-use of a dressing
(14 infections in 753 procedures, 1.86%).
Concluded that there was no benefit in using
antibiotics for the sole purpose of preventing post
surgical infection.
39
40. Herrera et al- Systematic review
2008
Concluded that unless there is a medical
indication, there is no justification for using
prophylactic antibiotic in periodontal surgery.
Even in some reports, an indiscriminate and
prolonged use of antibiotics may result in a higher
rate of infection.
In addition, the risks involved with the use of
systemic antibiotics (adverse events, etc.) must
always be considered against the limited benefits.
40
41. Oswal et al 2014- RCT
(1) To evaluate the need of antibiotics in periodontal
surgeries in reducing postsurgical infections and
explore if antibiotics have any key role in
reducing or eliminating inflammatory
complications.
(2) To establish the incidence of postoperative
infections in relation to type of surgery and
determine those factors, which may affect
infection rates.
41
42. Patients undergoing periodontal surgery were divided
into three categories: Group A (prophylactic), Group B
(therapeutic), and Group C (no antibiotics).
Patients reported less pain and postoperative
discomfort when prophylactic antibiotics were given.
But, no statistical significant differences between the
three groups.
42
43. There was no postoperative infection reported in
all the 90 sites operated in this study.
The prevalence of postoperative infections
following periodontal surgery is <1% and this low
risk does not justify the routine use of systemic
antimicrobials just to prevent infections.
Use of prophylactic antibiotics may have role in
prevention of inflammatory complication, but
not infection.
43
44. Mohan, et al. 2014
Conducted a RCT to evaluate the role of
antibiotics to prevent postoperative complications
after routine periodontal surgery and also to
determine whether their administration improved
the surgical outcome.
45
45. Forty-five systemically healthy patients with
moderate to severe chronic periodontitis
requiring flap surgery were enrolled in the study.
They were randomly allocated to Amoxicillin,
Doxycycline, and control groups.
46
46. Surgical procedures were carried out with
complete asepsis.
Postoperative assessment of patient variables
like swelling, pain, temperature, infection,
ulceration, necrosis, and trismus was performed
at intervals of 24 h, 48 h, 1 week, and 3 months.
Changes in clinical parameters such as gingival
index, plaque index, PPD, and CAL were also
recorded.
47
47. There was no incidence of postoperative
infection in any of the patients.
Though there was significant improvement in
the periodontal parameters in all the groups, no
statistically significant result was observed for
any group over the others.
48
48. Results of this study showed that when periodontal
surgical procedures were performed following
strict asepsis, the incidence of clinical infection
was not significant among all the three groups, and
also that antibiotic administration did not influence
the outcome of surgery.
Therefore, prophylactic antibiotics for patients who
are otherwise healthy administered following
routine periodontal surgery to prevent
postoperative infection are unnecessary and have
no demonstrable additional benefits.
49
49. ABs in conjunction with periodontal
surgery aiming for periodontal
regeneration
Studies evaluating regenerative procedures with
barrier membranes show a wide variability and lack
of predictable results.
Negative outcomes: membrane exposure,
subsequent membrane infection and contamination
of the healing wound (Murphy 1995, Nowzari et al.
1996) resulting in reduced regeneration.
50
50. Because of this, most researches investigating
regenerative procedures have used adjunctive
systemic antibiotics as part of the surgical
protocol (Cortellini & Bowers 1995, Machtei &
Schallhorn 1995, Cortellini & Tonetti 2000,
Kornman & Robertson 2000, Sanz & Giovannoli
2000).
51
51. Powell et al. (2005) : use of regenerative
membranes did not significantly increase infection
rates (3.00%) compared with the non-use of
membranes (1.88%).
52
52. The rationale for using antibiotics in these
procedures is to try to
increase the predictability of the results by
controlling the subgingival microflora in the early
healing phase,
in order to reduce the risk of post-operative
infection and
Thus, reduce the chance of bacterial
contamination of the exposed membranes.
53
53. Some of the studies have shown an additional
benefit in the regenerative outcomes in the test
group, either with amoxicillin plus clavulanate
(Nowzari et al. 1995) or ornidazole (Mombelli et
al. 1996).
54
54. Other reports indicate that the group with
adjunctive antibiotics showed significant
improvements in the evaluated clinical parameters,
but did not have any significant effect on osseous
healing in class II furcation defects (Vest et al.
1999).
Demolon et al. (1993, 1994) found large differences
among individuals and lack of sufficient bone
formation to fill any of the furcation defects,
indicating a low predictability of the procedure.
55
55. In addition, they observed, at the 1-year reentry
surgery, that bone filling was limited and not
consistent with the observed clinical improvements.
They concluded that the use of antibiotic may have
helped to control initial inflammation (Demolon et
al. 1993), but it had no direct effects of clinical
significance on bone regeneration or soft tissue
attachment at 12 months (Demolon et al. 1994).
56
56. Other authors question the added clinical benefit of
applying barrier membranes and systemic
antibiotics, because none of them were relevant
factors, and only smoking has a strong impact on
the therapeutical outcomes in intra-osseous defects
(Loos et al. 2002).
Studies of guided tissue regeneration with and
without antibiotics have used different regimens :
57
57. Study design, patients and treatment features of selected
papers assessing systemic antimicrobials as adjuncts to
regenerative surgery
Herrera et al 2008 58
59. In most of the published studies evaluating the
efficacy of the application of enamel matrix
derivatives (EMD) in regenerative periodontal
surgery, a post-operative antibiotic regimen was
used.
Very few studies have compared this surgical
approach with and without the systemic
administration of antibiotics.
60
60. Sculean 2001: observed no differences between
treatments, indicating that the positive healing can
be in great part be attributed to the use of EMD.
This shows that careful patient selection, a
meticulous surgical technique and close post-
operative plaque control are more important
factors for the outcome of the therapy than the
routine administration of antibiotics.
61
61. It should be emphasized that the application of
EMD in periodontal regenerative surgery leads to
fewer post-surgical complications than for other
regenerative approaches, such as the use of barrier
membranes or graft materials and, consequently, the
possibility of a post-operative infection is lower
(Sculean et al. 2001).
62
62. Y. Liu et al. 2017
Investigated the systemic antibiotic usage in the
perioperative period of periodontal flaps and its
relevance to the infection after surgeries through
reviewing RCTs between 2005 and 2014 that reported
periodontal flaps in chronic periodontitis patients.
The rate of the systemic antibiotic use, the infection
rate after surgeries and the number needed to treat
(NNT) to prevent one infected case were calculated.
The impact of antibiotic use and materials used in
surgeries on the infection was evaluated.
63
63. Eighty-three trials were included.
In general, 73.7% of patients and 75.4% of
surgeries used systemic antibiotics in the
perioperative period of the periodontal flaps.
Most surgeons from both developing and
developed countries chose to use antibiotics.
64
64. The rate of antibiotic use was lower in developed
countries compared with developing countries,
whether a patient or a flap was used as the
statistical unit (p<.001).
Infection occurred in only five flaps where EMD
or EMD+bone grafts were used in intrabony
defects.
Only 0.170% of the surgeries got infected in total.
65
65. When all kinds of surgeries were included for
analysis, the infection rate was 0.073% for the
surgeries using antibiotics, which was lower than
the infection rate 0.693% for the surgeries not
using antibiotics (p<.05).
The infection rate was very low in general. NNT
was 203 when all the surgeries were included for
analysis.
Therefore, the difference of the infection rates
between using antibiotics and not, might lack
clinical significance.
66
67. Abu-Ta’a et al. 2008
RCT compared the usefulness of pre- and
postoperative antibiotics while strict asepsis was
followed during periodontal implant surgery
Two groups of 43 patients each with fully or
partially Antibiotics group (GrAB1): 23 men,
received oral amoxicillin 1 g, 1 h pre-operatively
and 2 g for 2 days post-operatively.
Non-antibiotics group (GrAB): 20 men, received
no antibiotics.
69
68. There were no significant differences between
both groups, neither for the clinical parameters nor
for the microbiota. Staphylococcus aureus was
detected in the nares of one patient only.
The patients’ subjective perception of post-
operative discomfort was significantly smaller in
the group receiving antibiotics.
Three patients lost one or two implants.
70
69. Thus the study concluded that Antibiotics do not
provide significant advantages concerning
postoperative infections in case of proper
asepsis.
It also does not reduce peri-oral microbial
contamination.
It does on the other hand reduce post-operative
discomfort.
71
70. Ahmad et al 2012 :
Implants performed with the use of antibiotics had
a success rate of 96.5% while surgeries performed
without antibiotics had a slightly lower success rate
of 92%. When pre and post-op antibiotics were
compared, success rates of 96% and 97% were
found respectively.
The overall success rate of implants when
antibiotics were used and when they were not used:
no significant difference .
72
74. development of gastrointestinal tract problem,
drug interactions with concomitant medications
increased cost of treatment
76
75. AMOXYCILLIN
diarrhoea, rash, vomiting and nausea
rare but life-threatening reactions like toxic
epidermal necrolysis
Stevens–Johnson syndrome
77
76. CONCLUSION
Antimicrobials are powerful agents when used in
well-focused ways.
Various retrospective and prospective controlled
studies have reported no benefit seen from the use
of antibiotics even in low to moderate risk dental
implant patients.
78
77. Hence, it is important that the dental profession
diligently consider its responsibility to curb the use
of unnecessary antibiotics and keep antibiotic
efficacy high for when they are truly necessary.
79
78. They should be held in reserve for treatment of
certain forms of advanced periodontal diseases
(refractory, aggressive), in systemically
compromised individuals with a reduced host
response and in treatment of postsurgical infections.
The other reasons can be when surgery is performed
in an infected site, when the procedure is extensive
taking >2 h or when large foreign materials are
implanted.
80
79. Various other factors are more important in
protecting the patient from postoperative infections
include aseptic protocol, skill and experience of
surgeon, tissue manipulation and surgical
technique, duration of surgery and control of
systemic and local risk factors with increased
susceptibility to infections.
Hence, use of antibiotics should not be generalized
or used blindly just to be extra cautious in
preventing infection.
81
80. REFERENCES..
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Post surgical infections: Prevalence associated with various
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81. Appleman MD, Sutter VL, Sims TN. Value of antibiotic
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82. Oswal S, Ravindra S, Sinha A, Manjunath S. Antibiotics in
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84
In India, it is a common observation that, most of the dental schools and periodontists prescribe antibiotics routinely after periodontal surgery.
Periodontal surgical procedures by their nature carry with them an attendant risk of developing complications, including infection.
RETROSPECTIVE REVIEW…
* Guided tissue regeneration with or without bone graft.
† Enamel matrix derivative alone done in conjunction with flap curettage or
osseous resective surgery.
‡ Bone graft alone done in conjunction with flap curettage or osseous resective
surgery.
§ Includes biopsy, distal wedge, external bevel gingivectomy, extraction with
alveoloplasty, frenectomy, gingivoplasty, uncovering impacted teeth, vestibuloplasty.
The rationale of using antibiotics with regenerative procedures is to try to increase the predictability and reduce the risk of postoperative infection.
Within the limitations of this study it is difficult to substantiate the routine use of antibiotics following periodontal surgery.
The incidence of postoperative infection for all procedures was 1% or 9 of 927 (Table 2). There was no difference in the incidence of postoperative infection between patients treated with and without prophylactic antibiotic therapy.
open flap debridement with and
without bone grafting, FGG, subepithelial connective tissue
grafting, soft tissue augmentation, coronally advanced flap, and crown lengthening with and without ostectomy. Patients were followed up for 1‑week after surgery on the day of suture removal and were evaluated for pain, swelling, fever, infection, delayed wound healing and any other significant findings
OSWAL 2014
However, the clinical utility and the long-term efficacy of the use of systemic antibiotics during regenerative surgical procedures can be questioned
The most relevant study design to assess the value of systemic antimicrobials in regenerative procedures is the one including a group with surgery plus antibiotic and another group with surgery plus placebo or nothing.
PEN, phenoxymethyl penicillin; AMO, amoxicillin; CLAV, clavulanate; CIP, ciprofloxacin; DOX, doxycycline; MET, metronidazole; MIN,
minocycline; ORNI, ornidazole; IBU, ibuprofen; OHI, oral hygiene instruction; SRP, scaling and root planing; SURG, surgery; supra, supragingival
prophylaxis; SPT, supportive periodontal therapy; DFDBA, demineralized freeze-dried bone allograft; GTR, guided tissue regeneration; ePTFE,
expanded polytetrafluoroethylene; RCT or CCT, randomized or controlled clinical trial; w, weeks; d, days; m, months; y, years.
Literature review
N¼not using antibiotics; Y¼using antibiotics.
Each unit showed the number of the infected cases/the number of the total procedures (infection rate %).
aResults of Fisher’s exact test: there is a significant difference of the infection rates between the surgeries using antibiotics and not.
Thus a literature review and comparison of survival rates of dental implants with regimens of no, pre or post prophylaxis was performed using systematic literature review using reliable electronic databases.
colonization of resistant or fungal strains,
cross‑reaction with other drugs,