ANTIBIOTICS AND ANALGESICS IN PERIODONTICS

BY: SHIVANGINI SINGH BDS 3rd Prof

INDEXANTIBIOTICS -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

ANTIBIOTICSDEFINITION

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

SYSTEMIC ADMINISTRATIN OF ANTIBIOTICSBackground and RationaleThe 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

Biological implicationsThe 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 performedAntinfective agents can be used for enhancing

regenerative healing

Antibiotics used in priodontal diseases

TETRACYCLINEPHARMACOLOGY: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

METRONIDAZOLEPHARMACOLOGY: 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

PENICILLINSPHARMACOLOGY: 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

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

CLINDAMYCINPHARMACOLOGY: 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.

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 .

MACROLIDESPHARMACOLOGY: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

LOCAL DELIVERY OF ANTIBIOTICSRecently,advances in delivery technology

have resulted in close release of drugsThe 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 FibersSubgingival DoxycyclineSubgingival MinocyclineSubgingival Metronidazole

ANALGESICS

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

CLASSES OF ANALGESICS DRUGSNON OPIOD TYPE OF ANALGESICS(mild analgesics)

OPIOID TYPE OF ANALGESICS(strong analgesics)

Salicylates-aspirin-diflunisalOther NSAIDs-ibuprofin-ketrolacAcetaminophen

Natural opium alkaloid

Morphine,codeine Semisynthetic

derivatives-Heroin and pholcodeine

Synthetic opioids Pethidine fentanyl

NON OPIOD TYPE OF ANALGESICAspirin

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.

AcetaminophenAcetaminophen 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

Overuse and overdoses can lead to acute liver failure and kidney damage

IbuprofenIbuprofen 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

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

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

Heroin•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

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

Mechanism of Strong AnalgesicsThe human body contains “natural opiates” in

the brain called endorphinsThese 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

Side Effects of Strong AnalgesicsShort 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

BIBLIOGRAPHYCARRANZA’ CLINICAL PERIODONTOLOGYSites – Google scholar