chemical periodontal therapy
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CHEMICAL PERIODONTAL
THERAPY
Chemical Periodontal Therapy
Antimicrobial agents;- Antiseptics- Antibiotics
Miscellaneous agents;- Matrix protein- Growth factor- Hydrogen peroxide
Can be used: topically, locally applied & systemically
Any antimicrobial use is ADJUCT to mechanical therapy.
Antimicrobial used in periodontal therapy can be divided in 2 groups:
- Directed against supra-gingival plaque development
- Directed against sub-gingival bacteria
Chemical Periodontal Therapy
Periodontitis can be classified by:
• Disease activity (chronic/aggressive)• Cause (specific bacterial, fungal / viral infection)• Site (localized or generalized)• Extent (size & morphology defects)• Type of associated gingivitis (chronic/necrotizing)• Type of patient (child, adolescent, adult/ compromised)
Non-specific plaque theory (reduction of bacterial load)
Specific plaque theory (specific plaque therapy)
Chemical Periodontal Therapy
ANTIBIOTICS
1. Use of antibiotics (systemically / local application) mainly directed against specific bacteria & sub-gingival plaque to target identified periodontal pathogens. Eg. In ANUG & localized aggressive periodontitis.
2. Antibiotics is directed against specific microorganisms, eg. Aa in specific plaque hypothesis in ANUG/P & aggressive periodontitis.
3. While mechanical removal of plaque aimed at reduction of bacterial load for non-specific plaque theory.
Chemical Periodontal Therapy
ANTIBIOTICS
4. If unresponsive pockets (after reassessment therapy done & no response to therapy), chlorhexidine in slow release of polymer can be used locally, advantage of that, agents can be sustained release within the pocket. Locally applied antibiotics also can be used in this situation.
5. Used of antibiotics in periodontal abscess usually not necessary if the abscess only localized unless there are signs of spread of infection to systemic area / sign of cellulitis/ lymphadenopathy.
Chemical Periodontal Therapy
ANTIBIOTICS
6. Post surgical rinsing with chlorhexidine mouthwash mainly due to inability to mechanically removed plaque because discomfort.
7. Post surgical systemic antibiotic prescription may not indicated, unless complex surgical procedures been carried out (post-implant surgery) / patient is medically compromised.
Chemical Periodontal Therapy
ANTIBIOTICS
8. Indication of use of antimicrobial agents to patient with lack of manual dexterity or with patients with mental disability is clear.
9. Patient wearing orthodontics appliances cannot used chlorhexidine mouthwash for a long term due to tooth & tongue staining side effects.
Chemical Periodontal Therapy
Antibiotics agents:
Local applicationSystemic use
Chemical Periodontal Therapy
Antibiotics – Local Application
Antibiotics can be in form of:Gel – for topical application onto surface or sub-gingival application.May present in polymer.Also present in the form of biodegradable slow, release gel, hollow or solid fibers.
Chemical Periodontal Therapy
Antibiotics – Local Application
Examples:a. Elyzol gel - 25% of metronidazoleb. Dentomycin gel - 2% of minocyclinec. Actisite – tetracycline fibers (hollow/solid)d. Periocline - 2% minocyclinee. Atridox - 42.5 mg doxycyclinef. Arestin - 1 mg minocycline
Chemical Periodontal Therapy
Antibiotics – Systemic Uses
• In the form of liquid, tablets or capsules –suitable if patients diagnosed with aggressive periodontitis ONLY.
• Must finish antibiotic simultaneously with the therapy/ root debridement.
Chemical Periodontal Therapy
Antibiotics – Systemic Uses (Aggressive Periodontitis )
Amoxicillin in combination with metronidazole (if allergic to penicillin give clindamycin);
- 250 mg amoxicillin & 200 mg metronidazole tds for 4 to 7 days.
Tetracycline
- 250 mg tetracycline for 14 days- Doxycycline 100 mg once a day for 14 days (double dose for first
day because half of it will bind to plasma & another half will be in blood).
Chemical Periodontal Therapy
Antibiotics – Systemic Uses
• In case of ANUG/P, metronidazole may be needed for 3 – 4 days only.
- 200 mg metronidazole tds for 3 – 4 days.- Analgesic may be prescribed to patient diagnosed with
ANUG/P due to pain.- Since the ANUG/P lesions being very painful to
mechanical plaque control, chlorhexidine may be given.
Chemical Periodontal Therapy
Antibiotics – Systemic Uses
• For post-surgical systemic antibiotic, metronidazole may be needed for 1 – 7 days.
- 400 mg metronidazole tds for 1 day.- Analgesic may also prescribed.- Chlorhexidine mouthwashes must be given since
the wound may be painful to mechanical plaque removal.
Chemical Periodontal Therapy
Antibiotics – Systemic Uses
• Periostat® is available as a
- 20 mg doxycycline taken twice daily about an hour before or 2 hours after meals.
- Adjunct to scaling & root planning.- Act as collagenase inhibitor (degrade collagen at
periodontal ligament/gingiva but not to controlled the bacteria) at low concentration.
- Danger to develop bacterial resistance.- Take about a month.
Chemical Periodontal Therapy
Indications Chlorexidine mouthwash indicated to post-surgical to reduce the bacterial load or to prevent plaque formation at the time when mechanical cleaning difficult due discomfort.
Patient with mental & physically disabilities lack manual dexterity. Examples:
- Parkinson disease- Adjuct to immunocompromised patient (HIV/AIDS)- Cerebral palsy
Chemical Periodontal Therapy
Indications
In cases like refractory periodontitis (due to smoking), as an adjunct instrumentation, locally applied antimicrobial agents can be used.
Antibiotic prophylactic agents in which the risks of bacterimia & infective endocarditis is high.
Chemical Periodontal Therapy
Indications
Systemic antibiotics prescribed are directed against specific microorganisms as an adjunct to mechanical instrumentation in aggressive periodontitis & ANUG/P.
The used of systemic antibiotic without cautions can lead to development of bacterial resistance.
Certain individual may suffered from immediate hypersensitivity which can be fatal.
Chemical Periodontal Therapy
ANTISEPTICS
• Topically (mothwashes)- Oradex – chlorhexidine 0.12%- Listerine® antiseptic mouthwash (phenolic
compound/ essential oil)- Plax® (triclosan)
Typically act supra-gingivaly.
Chemical Periodontal Therapy
ANTISEPTICS – Mouthwashes
• Quaternary ammonium compound (cetylpyridium chloride)• Hexidine – Bactidol®• Oxygenating agents – hydrogen peroxide• Amine alcohols – Delminol• Povidone iodine natural products – sanguinarines
All these available either as mouthwashes, irrigation, toothpaste, gel/ spray.
Chemical Periodontal Therapy
ANTISEPTICS
• Locally applied
- Slow release devices (biodegradable polymer, gel, fibers, collagen)
- Applied into periodontal pockets:Perio Chip® (2.5 mg chloroxedine in gelatin matrix) Atrigel® (5% sanguinarine)
Typically act sub-gingivally.
Chemical Periodontal Therapy
ANTISEPTICS – Chlorhexidine
• Bisguanide compound• Dicationic and strong base• Prolonged action• Concentration – 0.2% or equivalent• The only product to kill bacteria• Not act as anti-adhesive• Only can penetrate into thin plaque not thick /mature (calculus)
plaque.• Can inhibit the plaque formation but cannot eliminate the plaque in
untreated mouth.
Chemical Periodontal Therapy
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