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Periodontitis

Adjunct Periodontal Therapies

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Penicillin is a broad-spectrum bacteriocidal antibiotic that inhibits bacterial cell wall synthesis. Allergic hypersensitivity is a potential adverse reaction for this drug as is development of antibiotic resistance. Penicillins are susceptible to the β-lactamase enzyme that is carried by resistant organisms. A newer drug combines semisynthetic amoxicillin and the β-lactamase inhibitor clavulanic acid and is effective for penicillin-resistant infections. However, the few clinical trials available that test augmentin showed conflicting results.

 

In addition to being a broad-spectrum bacteriostatic drug that inhibits bacterial protein synthesis, clindamycin is very effective against many of the gram-negative periodontal pathogenic anaerobes. Unfortunately, the use of it may cause harmful adverse effects, especially pseudomembranous colitis, which may be life-threatening. The use of clindamycin should be reserved for confirmed refractory forms of periodontitis or when specifically indicated by bacterial sensitivity testing.

 

Metronidazole targets anaerobic organisms and is effective against many of the periodontal pathogens. Numerous clinical studies testing this drug have shown varied results. The adjunctive use of systemic metronidazole seems to be more effective in chronic periodontitis with deeper pockets. Local delivery is available in Europe and Asia as 25% metronidazole in a gel form delivered from a syringe to periodontal pockets for adjunctive treatment with scaling and root planing.

 

Because of its broad-spectrum antimicrobial activity, chlorhexidine has often been utilized as an adjunct to mechanical debridement. Clinical trials of subgingival irrigation with the drug, however, did not show additional benefit to scaling and root planing. A biodegradable gelatin chip containing 2.5 mg chlorhexidine gluconate is available. As with other local delivery systems, there is no strong evidence that local chlorhexidine provides significant clinical benefits beyond that of traditional scaling and root planing.

 

In general, systemic and local chemotherapeutic therapies offer a variety of options as adjuncts to traditional mechanical treatment, but they should not be used routinely for every patient. In fact, initial debridement to disrupt the biofilm and remove calculus prior to drug treatment may enhance results when they are used. Dentists will need to use their clinical judgment based on disease nature and severity to make treatment decisions with the knowledge that these therapies may be best utilized in the few localized persistent lesions present following thorough scaling and root planing.


I love this article!
bob257 at 4/26/2011 4:43 PM


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