PerioTherapy-Exam 1-Lecture 5-Rebecca Flash Cards

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Title: PerioTherapy-Exam 1-Lecture 5-Rebecca
Description: These just cover the most important things I gathered from this lecture!
Number of Cards: 45
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Author: uncsod2012
Created: 2009-09-23
Tags: exam1 periotherapy-exam1-lecture5-rebecca uncsod2012
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    • Question
    • Answer
    • Side 3
    • What is a Chemotherapeutic Agent?
    • A Chemotherapeutic agent is a general term that provides clinical therapeutic benefit.
    • What is an Anti-infective agent?
    • An anti-infective agent is a chemtherapeutic agent used to reduce the number of bacteria present.
    • What is an Antibiotic agent?
    • An anti-biotic agent is natural, semi-synthetic, or a synthetic anti-infective agent that inhibits growth or destroys selective microorganisms.
    • What is an Anti-septic agent?
    • An anti-septic agent is a chemical antimicrobial agent applied topically or sub-g to mucous membrane wounds or intact dermal surfaces to destroy microorganisms or inhibit their production or metabolism.
    • We need an antiobiotic that...
    • (1) travels to infected site well
      (2) good substantivity
      (3) Minimal side effects
      (4) Research showing efficacy
      (5) Microbial culture and sensitivity test
    • What is the common treatment for gingivitis and periodontits?
    • For common forms of gingivitis and periodontitis, S&RP should always be carred out before antibiotics are administered (to prevent the development of resistant strains).
    • What four types of bacteria are common in Aggressive Periodontits?
    • (1) AA (2) P. Gingivalis (3) P. Intermedia/Nigrescens and (4) Treponema Species
    • What are common bacteria found in Chronic Periodontitis?
    • (1) P. Gingivalis (2) P. Intermedia/Nigrescens (3) T. forsythensis (4) Fusobacterium species (5) Micromonas Species and (6)Treponema Species
    • When should you use antibiotics for gingivitis?
    • Use antibiotics for txt of gingivitis if (1) acute superficial infection associated with bacteremia and septecemia or (2) associated with systemic disease.
    • When should antibiotics be used for Necrotizing Ulcerative Periodontal Disease?
    • When severe and/or systemic signs and symptoms are present.
    • When do you use antibiotics for periodontits?
    • For aggressive cases or diffuse infection
    • When do you use antibiotics for Periodontal Surgery Therapy?
    • For regenerative surgeries, post-surgery infection, extensive cases
    • When do you use antibiotics for implant dentistry?
    • During and subsequent to surgical placement.
    • What are some problems associated with antibiotic treatment?
    • (1) Allergy/Anaphylaxis (2) Superinfections or Opportunistic microorganisms (3) resistance (4) interactions with other medications (5) GI issues (6) Cost (7) Compliance
    • Describe Penicillin.
    • First Antibiotic used in humans. It is a broad spectrum antibiotic. More than 90% of dose is absorbed. Bactericidal (inhibits synthesis of cell wall. Useful in initial therapy, abscess, NUG, and after periodontal surgery. It has a low toxicity and allergic reaction - it is a safe drug in general.
    • Describe tetracycine.
    • Most commonly prescribed adjunctive agent in periodontal treatment. It is a broad spectrum, bacteriostatic. GCF concentratio is 5-7 times more than serum. GI disturbance. Photosensitivity, discoloration of mucosa, discoloration of children's teeth. Candida super infection.
    • Describe minocycline.
    • Semisynthetic tetracycline.
    • Describe doxycylcine.
    • High compliance (single daily dose). Useful after scaling and root planing in severe periodontal cases such as aggressive periodontits.
    • Describe Metronidazole.
    • Effective against anaerobic bacteria and parasites. No effect on facultative and aerobic organisms. Side effects include metallic taste, headache, vertigo, peripheral neuritis, dilsulfiram like reaction with alcohol. Used in NUG/NUP. Used in combination terapy wit other antibiotics.
    • Describe clindamycin.
    • Usually bacteriostatic but bacteriocidal in high doses. Similar to erythromycin in terms of spectrum. Main feature - "bone penetration. Recommended for ptients allergic to Penicillin. Side effects include diarrhea and gastric upset and pseudomembranous colitiis (rare).
    • Describe Ciprofloxacin.
    • Seems to be beneficial on refractory cases. It may be combined with metronidazole. Adverse effects include GI upset, oral candidiasis, and photosensitivity.
    • What are some advantages to combination therapy?
    • (1) Broadens antimicrobial range of the therapeutic regimen of a single antibiotic (2) Prevent emergence of resistant bacteria through overlapping antimicrobial mechanisms (3) Lowers the dose of individual antibiotics by exploiting possible synergy between two drugs.
    • What are some disadvantages to combination therapy?
    • (1) May increase adverse reactions (2) Potential antagonist drug interactions with improperly selected antbitoics.
    • What are rules of combination therapy?
    • (1) Do not combine bactericidal with bacteriostatic (2) Augmentin is amoxicillan and clavulanic acid (3) Most given drug at UNC is Augmentin or Amoxicillin + Metronidazole.
    • Tetracycline, metronidazole, and a combination of amoxicillin and metronidazole show ____ in AL.
    • Improvements in AL. The mean "gain" in attachment level was 0.3-0.4 mm for most studies (which is the equivalent ot reversing 4-7 years of disease progression).
    • Which benefits more from antibiotic treatment? Aggressive periodontitis patients or chronic periodontitis patients?
    • Aggressive periodontitis benefits more from antibiotics than chronic.
    • So how often should systemic Ab be used in therapy?
    • They should not be used as a monotherapy but shoudl be used as adjuncts to mechanical therapy. They should not be used in cases of poor plaque control.
    • Are there particular instances for Ab?
    • They should be considered specially in aggressive cases of periodontitis. They should be used in some acute conditions and some medical situations.
    • What is the rationale for using topical antimicrobial agents?
    • Pathogens may be unreachable and systemic antibioics sometimes cause adverse rections and have to deal with patient compliance.
    • What are the pinciples of topica antimicrobial agents?
    • Local delivery - pocket irrigation, drug ointment/gel, and prolonged release.
    • Explain cons of supra and sub gingival irrigation.
    • Supragingival irrigation will not reach deeper parts of pocket. Subgingival irrigation is washed out rapidly by the GCF.
    • So, what should a local delivery device ideally have?
    • (1) Establish a drug reservoir (2) Effective concentration and (3) active for prolonged period of time.
    • What are the functional requirements of a local delivery device?
    • (1) Show i vitro activity against main microorganisms (2) Intra pocket dose can be reached and maintained (3) no major adverse effects (4) Favorable clinical outcome (5) practical advantage over conventional alteraitives (6) no bacterial resistance (7) easy application (8) biodegradable.
    • What is the periochip?
    • chlorhexidine gluconate in gelatin chip.
    • What is atridox?
    • Doxycycline in biodegradable polymer.
    • What is arestin?
    • Minocycline microspheres
    • Which local delivery device has an effect on smokers?
    • Arestin - the minocycline microspheres.
    • How is the perodontal host modulated?
    • (1) Pro-inflammatory host: modulation of arachdonic acid metabolites (2) Bone-sparing agents: bisphosphonates (3) Anticolleganse: Periostat
    • Have modulating Arachidonic acid metabolites seemed to help with treatment?
    • systemic NSAIDS - the risks outweigh the benefits; topical NSAIDS - may benefit.
    • What about bone sparing agents? Do these work?
    • They may have potential role in the inhibition of alveolar bone loss.
    • What is periostats role?
    • Periostat decreases levels of pro-inflammatory mediators; decreas colleganse
    • What are some reasons for withholding periostat treatment?
    • (1) Allergy to tetracyclines (2) Pregnancy or nurcing, infancy, childhood up to 8 years (3) other possible drug interactions
    • What are some adverse drug effects with different drugs?
    • (1) Penicillin - allergic reactions (2) Tetracycline - GI disturbance, photosensitivity, discoloration of mucosa, candida super infection (3) Metronidazole - metallic taste, headache, vertigo, peripheral neuritis, dilsulfiram like reaction with alchol (4) Clindamycin - diarrhea and gastric upset and pseudomembranous colitis (5) Ciprofloxacin - GI upset, oral candidiasis, photosensitivity
    • What are the tetracycline doses?
    • 500 mg three times a day for 21 days.
    • What is chlorhexidine?
    • It is used for subgingival irrigation. It has high substantivity but it is unable to remain in pocket due to flushing of GCF.