Dr. Mazood Ahamad

 Chemotherapeutic agent is a general term for chemical substance that provide a clinical therapeutic benefits  Chemotherapeutic agent may be a necessary adjunct in controlling bacterial infection.

Indications for Antibiotic Therapy Acute infections Aggressive (early onset) forms of periodontitis Recurrent (“refractory”) periodontitis Chronic infections Periodontal Surgical therapy: Regenerative technique, Post Surgical Infections Treatment And Prophylaxis 3

Antibiotics Used in Periodontal Therapy Penicillins (e.g., amoxicillin Tetracyclines (e.g., doxycycline) Metronidazole Fluoroquinolones (e.g., ciprofloxacin) Erythromycin Azithromycin 4

 Widely used in treatment of periodontics, Broad spectrum antibiotics  Effective aganist : gram+ ve, Bacteriostatics,  MOA - inhibiting protein synthesis in bacteria  Dose 250 mg four times daily (qid).  Inexpensive but less patient compliance.  This group includes Tetracycline Hydrochloride, Minocycline And Doxycycline. 5

Tetracycline Tetracycline Effective in treating periodontal disease because 1. Their concentration in GCF is 2 to 10 times more than blood serum 2. Ability to concentrate in POCKET 3. Have anti collagenase effect inhibiting tissue destruction 5. Increase bone regeneration 1. Dental use: Localized aggressive periodontitis, Refractory periodontitis. 2. Contra indication Pregnancy & Feeding mother Liver & Kidney disorder 6

 Used in the treatment of adult periodontitis  Dose 200 mg/day Complication  Less photo &renal toxicity, Cause reversible vertigo Doxycycline  Dose is 100mg bid the first day, then 100 mg od.  Given once daily so more patient compliance  To reduce gastro intestinal upset – 50mg bid

 It is bactericidal to anaerobic organisms( gram +ve & gram – ve)  MOA – inhibiting the growth of bacteria by inhibit the bacterial DNA synthesis  DOSE :Orally - 250/500 mg tid For 7-10 day  On set of action – 8 hours,Duration of action hours  More effective against obligate anaerobic gram – ve bacteria

INDICATION 1. Gingivitis 2. ANUG 3. Chronic Periodontitis 4. Aggressive Periodontitis 5. Refractory Periodontitis Contra indication 1. Patient having alcohol habit 2. Patient taking anticoagulant therapy 3. Blood disorder 4. Cirrhosis of liver 5. Renal disorder 9

 Most widely used antibiotic.  Amoxicillin is a semi synthetic antibiotic. Known as Broad spectrum penicillin  Effective against gram+ and - ve bacteria  MOA: Inhibit bacterial cell wall production and are bactericidal.  Induce allergic reactions and bacterial resistance. DOSE: 250 / 500 tid for 8 days (Orally, IM, IV)

For Periodontal therapy : Given combined with clavulanate Amoxicillin + Clavulanate = AUGMENTIN It is against the penicillanase  Augmentin is used for management of LAP or refractory periodontitis. 11

 Clindamycin is effective against anaerobic bacteria.“   It is effective in situations in which the patient is allergic to penicillin.  MOA – Inhibit protein synthesis in bacterial cell wall  As a nature - Bacteriostatic but in high dose Bactericidal  It has ability to penetration in deeper tissue like bone and deep tissue  DOSES:150mg (qid) for 10 days. 300mg(bid) for 8 days. 12

 Effective against gram – ve bacteria including all facultative bacteria &some anaerobic bacteria  Dose- 500 mg bid  MOA -Inhibit bacterial DNA synthesis  Contra Indication Hypersensitivity 13

 Antibiotic from the macrolide group.  it exerts bacteriostatic activity by blocking of bacterial proteins synthesis.  covers gram-negative bacteria  Penetrates epithelial cells-can kill invasive bacteria  oral dosage of 500 mg once daily for three consecutive days.

It is to treat the host side of the host bacterial interaction  it is Treatment concept that aims to reduce tissue destruction and stabilization even regenerate the periodontium by modifying down regulating destructive aspect of host response upregulating protective or regenerative response

BACTERIAL PRODUCTS BACTERIAL COMPONENTS HOST CELLS NSAIDS PERIOSTAT Prostaglandins Cytokines MMPs PERIOSTAT Osteoclasts BISPHOSHONATES PERIOSTAT BONE RESORPTION CONNECTIVE TISSUE BREAK DOWN POCKET AND CAL TOOTH MOBILITY AND LOSS HOST RESPONSE COMPONENTS CLINICAL SEQUELAE Antimicrobials

SYSTEMICALLY ADMINISTERED AGENTS  Subantimicrobial -dose doxycycline  Nonsteroidal anti-inflammatory drugs  Bisphosphonates LOCALY ADMINISTERED AGENTS Nonsteroidal anti-inflammatory drugs Enamel matrix proteins Growth factors Bone morphogenetic proteins

 NSAIDs inhibit the formation of prostaglandins,(PGE2), and therefore reduce tissue inflammation.  Indomethacin (Lasfargues and saffor 1983) 28% decrease bone loss 55% decrease osteoclast activity.  Flurbiprofen: -50 mg BID over 20 months.  Ibuprofen  side effects, including gastrointestinal problems, hemorrhage, and renal and hepatic impairment.

 The bisphosphonates are bone-seeking agents that inhibit bone resorption by disrupting osteoclast activity.  And also possess anticollagenase properties  1 st Generation: eg : etideorate  2 nd Generation: eg. Alerdeonate and pamideonate  3 rd Generation: eg: risedeonate

 Doxycycline Hyclate (Periostat):-  DOSAGE -20-mg capsule, twice daily for 3 to 9 months of continuous dosing..  Inhibition of enzyme,cytokine, and osteoclast  It acts by suppression of the activity of collagen, particularly that produced by PNM’s.  At present, SDD (Periostat) is the only systemically administered HMT specifically indicated for the treatment of chronic periodontitis that is approved (FDA) and (ADA). SUBANTIMICROBIAL DOSE DOXYCYCLINE (SDD)