Antibiotics and Antiseptics in Periodontal Therapy
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Refractory Periodontitis Polymicrobial A. Considerations Number of unresponsive sites Host response Presence of modifying factors Extended antibiotic duration in smokers Metronidazole Obligate anaerobes,A. Aggressive Periodontitis Localised Aggressive A.
Generalised Aggressive Polymicrobial P. Azithromycin Macrolide Few adverse effects Wide antimicrobial spectrum Aerobic and anaerobic bacteria Effective against A. High periodontal tissue concentrations for 5 days after administration Improved patient compliance.
Antibiotics are valuable therapeutic agents Not magic bullets Widespread use bacterial resistance Clinicians need to be responsible for sensible prescribing Limited clinical scenarios Not an excuse for poor surgical technique Risks of complications may be greater than the risk of postoperative infection occurring Risk small at a patient level but significant risk at population level for preventable adverse events Diagnosis important.
Plaque control Toothbrushing When good oral hygiene is practiced, mechanical toothbrushing can remove plaque effectively Motivation tends to decline over time In industrialised countries, the average person brushes for less than one minute Combination of mechanical and chemical oral hygiene appear to offer some benefits.
Antibiotics and Antiseptics in Periodontal Therapy [NEWS]
The concept of chemical plaque control The need to further improve plaque removal forms the basis of chemical plaque control Prevention of gingivitis is based on the assumption that gingivitis is the precursor of periodontitis So how often does gingivitis progress to periodontitis? Poor predictor for future periodontitis The proportion of gingival lesions that convert to periodontitis is currently unknown The factors that cause the conversion are not well understood The most convincing evidence that gingivitis do not progress to periodontitis comes from epidemiological studies on untreated populations in China, Kenya, and Nigeria.
Chemical plaque control agents: First, second, third generation 1. First-generation: do not exhibit any significant substantivity only minutes Second-generation antimicrobial agents: high substantivity hours Third-generation: moderate substantivity hours. Second-generation antimicrobial agents are still the agents of choice Consensus report 2nd European Workshop on Periodontology First generation agents can kill bacteria on contact, but have limited abilities to exert an effect on the oral flora after expectoration e.
Second generation agents have an immediate antibacterial effect and more importantly, have a prolonged effect on the oral flora e. Third-generation agents are characterized by an ability to inhibit or disrupt the formation of plaque while having no demonstrable effect on bacteria. The morpholinoethanol derivative-delmopinol.
Mouthrinse Mouthrinses generally contain three basic ingredients: Alcohol - to enhance flavour impact and solubilize the flavour and some active ingredients; also acts as a preservative. Surfactants - dual function: to assist in the removal of debris from the mouth and provide antibacterial effects; aid in solubilisation of flavour and some active ingredients.
Flavouring agents - provide some breathfreshening properties.
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Bisbiguanide antiseptics 2. Quaternary ammonium compounds 3.
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Essential oils EO 4. Natural products 5. Oxygenating agents 6.
Topical and Systemic Antibiotics in the Management of Periodontal Diseases
Amine alcohols 7. Bisbiguanide antiseptics CHX is the most studied and effective antiseptic in this category Developed in the s in England Cationic antiseptic Broad spectrum antimicrobial After 20 years of use by the dental profession, CHX is recognized as the GOLD standard against which other antiplaque and gingivitis agents are measured. The mechanism of CHX effect The antiplaque effect of CHX can be hypothesized as: Any bacteria adhering to the tooth surface are either killed bactericidal effect or are prevented from multiplying bacteriostatic effect The persistent, bacteriostatic effect of CHX is what makes CHX the gold standard.
Optimizing the use of chlorhexidine CHX should not be used before, or immediately after using toothpaste or else it will reduce the effective delivery of CHX to the tooth surface in an active form. Approved in in America Contain 2 phenol-related essential oils: Thymol 0. How does Listerine work? Microorganisms are killed by disrupting their cell walls and by inhibiting their enzyme activity Prevents bacteria from aggregating, and slows bacterial proliferation Reduces bacterial load. A recent systematic review on essential oils concluded When used as an adjunct to unsupervised oral hygiene, EO provides an additional benefit with regard to plaque and gingivitis reduction as compared to a placebo or control mouthrinse Some studies suggest as an alternative to CHX Pizzo et al.
Safety of Listerine Long-term use safe Walker et al. No evidence of cancer Cole et al. Possibility of producing pathological change should be borne in mind when considering longterm use of a mouthwash over a lifetime Paraskevas H2O2 Most commonly used in cases of ANUG and pericoronitis Limited evidence available to suggest use as an antigingivitis or antiplaque agent.
Considerable promise as antiplaque agents Octapinol was first studied, withdrawn for toxicologic. Delmopinol followed at 0. Other antiseptics Many other agents have been studied but most have been found to have little or no effect clinically. Can mouthrinses treat periodontitis?? The use of mouthrinses is increasing, especially as.
Antibiotic & Antiseptic Use in Periodontal Therapy
Indications for use of mouthrinse as an adjunct 1. After surgical procedures 2. In medically compromised patients: those receiving chemotherapy or radiotherapy and bone marrow transplant patients. Conclusion CHX is the GOLD standard for mouthrinse CHX mouthwash does not affect subgingival plaque due to the lack of subgingival penetration Limited use in treatment of periodontitis Mouthrinses have a role in gingivitis prevention, but considering gingivitis does not necessarily progress to periodontitis, we need to question whether the use of chemical agents for the general population is really necessary.
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Flag for inappropriate content. Related titles. Carousel Previous Carousel Next. Distribution of bacterial uropathogens and their susceptibility patterns over 12—year West Bank, Palestine. Jump to Page. Search inside document. Microorganisms are killed by disrupting their cell walls and by inhibiting their enzyme activity Prevents bacteria from aggregating, and slows bacterial proliferation Reduces bacterial load A recent systematic review on essential oils concluded When used as an adjunct to unsupervised oral hygiene, EO provides an additional benefit with regard to plaque and gingivitis reduction as compared to a placebo or control mouthrinse Some studies suggest as an alternative to CHX Pizzo et al.