8.+Efficacy+of+Loca+Delivery+of+Antimicrobials+&+Antibiotics



Efficacy of Local Delivery of Antimicrobials & Antibiotics Slots J. Selection of antimicrobial agents in periodontal therapy. //Journal of Periodontal Research,// 2002 (37), 389-398.

Periodontal therapy for all forms of periodontal diseases should include personal oral hygiene, mechanical removal of plaque and calculus and local or systemic administration of anti-infective agents. Carranza emphasize that antimicrobial agents should be selected for treatment based on the microbial analysis to be effective against pathogens. He also summarizes the property of ideal antimicrobial agent which should be inexpensive, specific to periopathogens, allogeneic nontoxic and substantive. The article in the journal also point out that microbiological analysis is used to determine the specificity of pathogens and helps determine the optimal periodontal therapy and effectiveness of antibiotics. Y. B. 23 Chou, C. H., & Walters, J. D. (2008). Clarithromycin Transport by Gingival Fibroblasts and Epithelial Cells. //Journal Of Dental Research//, //87//(8), 777-781. Retrieved from http://ezproxy.mvc.edu:2074/ehost/pdfviewer/pdfviewer?sid=1e256de1-4285-40ee-8f5d- 66d75ea0ef45%40sessionmgr11&vid=6&hid=13 This article really goes into depth on how microlides antibiotics like azithromycin and clarithamycin penetrate the cell of specific periodontal pathogens like A. actinomicomitants and P. gingivalis. and their effects. Studies revealed that although they know that they can potentially eliminate these pathogens what they are really trying to identify is their mechanism of action and by culturing fibroblast they monitor they mechanical action over time. One advantage is that this specific antibiotic has a less gastrointestinal toxicity and the dosage is beneficial that patient can comply with this antibiotic. Carranza describes these macrolides containing a many membrane lactone ring by which one or more deoxy sugars are attached which inhibit protein synthesis. Macrolides are considered bacteriostatic or bactericidal depending on the concentration of the drug. Monica Gutierrez #27 Etienne, D. (2003). Locally delivered antimicrobials for the treatment of chronic periodontitis. //Oral Diseases//, //9// 45-50. Department of Periodontology, School of Odontology, University Paris 7, Paris, France. According to Caranza, scaling and root planing alone is effective in improving the health of the periodontium. When locally deliveredantimicrobials are used in combination with SRP there is a greater improvement in the health of the periodontium such as less inflammation, more reduction in probing depths, and more clinical attachment gain. Local irrigations can be done in a clinical setting as well as self-applied by the patient at home which has shown to be safe and effective. My article has similar information regarding the use of locally delivered antimicrobial agents and their increased effect when used in conjunction with SRP.ES 33

The big picture of my article- gingivitis and periodontitis is from bacterial plaque. The host response can play an important role in how the tissue responds to microorganisms. A I'll functioning immune response can increase the way the way the body responds to these microorganisms and can aggravate the progression of the disease. Antimicrobial therapy is effective at killing the bacteria responsible for causing gingivitis and period disease, however is not effective without mechanical removal of these irritants. Mechanical removal must be established with scaling and root planning and must be maintained by the patient with brushing and flossing. In a study conducted two different groups were divided to establish the effectiveness of antimicrobial therapy alone and antimicrobial therapy with mechanical removal. The study concluded that anticrobial therapy can only have a therapeutic effect when ongoing removal of bacterial plaque and calculus.

Carranza states that scaling and root planning alone as shown to be the most effective method to successful treat oral health conditions associated bacterial plaque. However, antimicrobial therapy can be used in addition to scaling and root planning as an adjunct only to disrupt the remaining bacteria not removed by scaling g and root planning to promote tissue health

Newman, M.G., Takei, H.H.,Klokkevold,P.R.,&Carranza,F.A. (2006). Carranza's Clinical Periodontology (10th ed.).St. Louis

Trombelli, L., & Tatakis, D. (2003). Periodontal diseases: current and future indications for local antimicrobial therapy. Oral Diseases, 911-15. :10.1034/j.1601-0825.9.s1.3.x doi

-KR#32

--- Srivastava, R., Verma, P., Tandon, P., Kumar, M., Gupta, K., & Srivastava, A. (2009). Chlorhexidine chip and tetracycline fibers as adjunct to scaling and root planing -- A clinical study. //Brazilian Journal Of Oral Sciences//, //8//(4), 201-205.

After reading the article and Carranza it can be stated that although scaling and root planning alone is effective in the treatment of periodontitis (reduction of PD, gaining of attachment level, reduction of inflammation) that the addition of locally placed antimicrobials and antibiotics can have greater effects on the pocket depth measurements, attachment level gain, and decreasing inflammation. Ay 37 ___

Kranti, K. K., Seshan, H., & Zope, S. (2010). Clinical evaluation of topical subgingival application of biodegradable xanthan based 1.5% Chlorhexidine gel for treatment of periodontal pockets. //Journal Of Advanced Dental Research//, //1//(1), 47-54

My article discusses the efficacy of topical subgingival application on Xanthan based 1.5% chlorhexidine gel in the treatment of periodontal pockets. In the study there were positive results from using the Xanthan gel compared to a placebo, and showed that it is an effective adjunct in the treatment of periodontal disease. Carranza discusses the uses of locally delivered antimicrobials and explains that it can add to clinical benefits including further reduction in pocket depths, gain in clinical attachment level, and further decrease inflammation. Carranza discusses the use of locally delivered antibiotics such as tetracycline-containing fibers, Atridox which is 10% doxycycline, and Arestin which is 2% minocycline. There are also locally delivered antimicrobials available such as the Periochip which contains chlorhexidine and releases it over a period of 7-10 days. Basically Carranza concludes that SRP alone is effective, but adding a chemotherapeutic agent can add to the benefits.

Amber Starnes 36 My articale also sided with Carranza in regaurds to antimicrobials such as CHX in having a benificial effect when done with scaling and root planing. The efficacy dose deppend on the application process it must have good penitration, concentration and duration to have a benificial effect/ result. The goal is to have reduction in inflammation ,pocket depths and better attachment levels. Verma, Tandon, Kumar, and Srivastaia. "Chlorhexidine chip and tetracycline fibers as adjunct to scaling and root planing."//Brazilian Journal of Oral Sciences// 8.4 (2009): 201-05. Print. CA20

Paquette, D. W., Ryan, M., & Wilder, R. S. (2008). Locally Delivered Antimicrobials: Clinical Evidence and Relevance. //Journal Of Dental Hygiene//, //82//10-15. In my article, several studies were mentioned supporting the efficacy of using locally delivered anitmicrobials in combination with scaling and root planing in treatment of chronic periodontitis. Antimicrobials mentioned were Atridox, Actisite, Arestin, and PerioChip; all considered effective adjuncts in obtaining greater pocket depth reduction and increased attachment levels when combined with scaling and root planing. Carranza was greatly detailed in the role that mechanical removal of calculus and plaque biofilm must be addressed first in order to treat periodontal pockets. Carranza also details how chemotherapeutics work by modulating the host's immune response to bacteria and reducing the host's self-destructive immunologic response to bacterial pathogens. Chemotherapeutics, whether systemic or locally delivered, factors to be considered are patient's willingness and ability to comply with proposed therapy; as well as cost, clinical status, nature of colonizing bacteria, risks and benefits for individual care. Carranza's conclusion concurs with my article that evidence-based research shows that locally delivered antimicrobials are an effective and beneficial adjunct in periodontal treatment. Arlene C. Sides #35

Brault, L. & Spadaro, S. (2004). Local Chemotherapeutics as an Adjunct to Scaling and Root Planing. //The Dental Assistant. pp. 20-23.// Local chemotherapeutics should only be used on a case to case basis as an adjunct to scaling and root planing. Chemotherapeutics can be considered as an adjunct to scaling and root planing with probing depths over 5mm. The main local chemotherapeutics are doxycycline gel, tetracycline, chlorhexidine, and minocycline. Doxycycline gel, tetracycline, and minocycline are all antibiotics that kill the bacteria and chlorhexidine can slow the growth of bacteria. Velinda Davis #24

Deo, V., Ansari, S., Mandia, S., & Bhongade, M. (2011). Therapeutic Efficacy of Subgingivally Delivered Doxycycline Hyclate as an Adjunct to Non-surgical Treatment of Chronic Periodontitis. //Journal Of Oral & Maxillofacial Research//, //2//(1), 1-7.

The article that I read described a study that used doxycycline for the treatment of periodontitis. The study compared the outcomes of SRP alone and the combination of SRP and the use od doxycycline. The results of the study concluded that SRP with the use of doxycycline had an increase in attachment level and decrease in pocket depth in 6-7 mm pockets. There was no statistically significant difference in the use of doxycycline and SRP in pockets of 5 mm or less or SRP alone. Carranza states that in order for a locally delivered antibiotic to be effective it must be able to sustain it’s localized concentration at effective levels for a significant amount of time. -Elina Sandoval #34

Timmerman, M. F., van der Weijden, G. A., van Steenbergen, T. M., Mantel, M. S., de Graaff, J. J., & van der Velden, U. U. (1996). Evaluation of the long-term efficacy and safety of locally-applied minocycline in adult periodontitis patients. Journal Of Clinical Periodontology, 23(8), 707-716. doi:10.1111/1600-051X.ep13462352

My article evaluated the safety, clinical and microbiological efficacy of scaling and root planing combined with the local application of minocycline hydrochloride gel versus a placebo gel in patients with moderate to severe chronic periodontitis. In the study both of the results were similar. Carranza discusses the different types of locally delivered antimicrobials that can be used. He explains that in order for a locally delivered antibiotic can be used it must be able to sustain its concentration in the pocket at effective levels. Charlene Malit #29

This article discussed periodontal disease and how antibiotics or chemotherapeutic agents are used to help patients with periodontal disease. The big idea of this article was to show that locally delivered antibiotics can be used as an option being an adjunct to scaling and root planing and that there is a clinical difference to using it than doing scaling and root planing alone in patients with periodontal disease. Carranza talks about the different types of antibiotics as well, and how effective they are in treating patients with periodontal disease, discussing pros and cons of each type of antibiotic.

Finkelman, R., & Williams, R. (1998). Local delivery of chemotherapeutic agents in periodontal therapy: has its time arrived?. //Journal Of Clinical Periodontology //, //25 //(11 Pt 2), 943-946. SF 25