DEPARTMENT OF PERIODONTCS

ANTIBIOTICS IN
PERIODONTCS

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 ANTIBIOTIC
• Antibiotics , which are chemical substance originally
produced by microorgnism,either retard the growth of
microorganism
or result in their death

• Now some antibiotics are chemically

synthesized or semi synthesized

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An Ideal Antibiotcs Should be

1. Selective and effective against micro organism

2. Bactericidal more than bacteriostatics

3 Not ineffective as a result of bacterical

resistance

4. Not be inactivated by enzyme, plasma, protein

or by body fluid

5. Maintained for sufficient period in blood plasma

6. Have minimal adverse effect

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 Classification of Antibiotic
• Based on chemical structure

1 sulfonamides- sulfadiazine, PAS

2 Quinolones - ciprofloxacin , Nalidixic acid
3 Tetracyclines – Doxycycline, Tetracycline
4 Aminoglycosides – Gentamycin,
streptomycin
5 Macrolides – Erythromycin, Roxithromycin,
Azithromycin
6 B lactam antibiotic- Penicillins
Cephalosporacin 4
7 Nitroimidazoles - Metronidazole,
Tinidazole
8 Imidazoles derivatives- ketoconazole,
9 Polypeptides Antibiotic – Bacitracin
Polymyxin -B
10 Nicotinic acid derivatives
Isoniazid, Pyrazinamide

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Common Antibiotic used in
PERIODONTCS
Tetracycline
Metronidazole
Amoxicillin
Clindamycin
Cephalosporin
Ciprofloxin

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 Antibiotic Resistance
• Microorganism are some time resistance or
unaffected by an antibiotic
• Resistance can be
Natural, that present before contact with drug
Acquired, that developed during exposure
with drug
• The development of acquired resistance
is genetic, with change in DNA , and is
inherited by subsequent generation

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* Micro organism are resistance to particular drug
frequently are resistance to other chemically
related antimicrobial agent
This is referred as Cross Resistance
* In antibiotic resistance implies
In activation of antibiotic by bacterial
enzyme
Development of alternate pathway of
drug metabolism by bacteria
Biochemical alternation in the bacteria that
prevent the uptake or binding of the antibiotic

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 TETRACYCLINE
• Widely used in treatment of periodontics
• Broad spectrum antibiotics
• Effective aganist remove > gram- ve
• MOA - inhibiting protein synthesis in
bacteria
• Bacteriostatics, effective against rapidly
multiplying bacteria
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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. Inhibit the growth of
Actinobacillus actinomycetemcomitans
4. Have anti collagenase effect inhibiting tissue
destruction
5. Increase bone regeneration
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 Classification of Tetracycline
based on generation
Group 1 Chlortetracycline
oxy tetracycline
Tetracycline
Group 2 Demeclocycline
Methacycline
Lymecycline
Group 3 Doxycycline
Minocycline
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 Tetracyclines..........
INDICATION
Dental condition
1. Localized aggressive periodontitis
because effective against
A. actinomycetemcomitans
2. other Aggressive periodontitis.
3. Refractory periodontitis.
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 Tetracyclines..........

• Other condition
Mixed bacterial infection
- in respiratory infection
- in genital urinary infection
- G I T infection
Contra indication
Pregnancy
Feeding mother
Liver disorder
Kidney disorder

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 Tetracyclines.........
Adverse Effect
• Permanent discoloration of teeth in offspring due to
administration of drug during last half of pregnancy
Administration of drug in 1-st 6 years of life
• Teratogenicty
• Photosensitivity
• GIT disorder
Nausea, Vomiting,
Diarrhea
Epigastric distress
Drecress absortion of vitamin k
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 Tetracyclines.......

• Lethal hepatic toxicity

if tetracycline use in renal disorder
• Fancony type syndrome if outdated
tetracycline Use in in renal disorder

Now tetracycline less use in dental &

medical, replace by more effective
other combination antibiotic
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Tetracycline Staining

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 METRONIDAZOLE
1. It is effective against anaerobic
bacteria & anaerobic parasite
2. Anaerobic bacteria both gram +ve &
gram –ve
3. MOA – inhibiting the growth of bacteria
by inhibit the bacterial DNA synthesis
4. On set of action – 8 hours I
5. Duration of action - 24-48 hours

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METRONIDAZOLE .......
• More effective against obligate anaerobic
gram – ve bacteria

• DOSE
Orally - 200- 400 mg tid
For 7-10 day
Available as
Metrogyl 400 mg
Flagyl 400 mg

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 METRONIDAZOLE ........

INDICATION
1. Gingivitis
2. ANUG
3. Chronic Periodontitis
4. Aggressive Periodontitis
5. In Refractory Periodontitis
In combination with amoxicillin
6. After extraction
7. All mixed infection with anaerobic bacteria
8. In severe odontogenic infection
with other antibiotic

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 METRONIDAZOLE ..........

Contra indication
1. Patient having alcohol habit
2. Patient taking anticoagulant therapy
B/C it prolonge the pro thrombin
time
3. CNS disorder
4. Blood disorder
5. Cirrhosis of liver
6. Renal disorder

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 METRONIDAZOLE ..........

Adverse Effect
1. Abdominal problem
Severe cramp, Nausea, Vomiting,
Diarrhea
2. Metallic taste in mouth
3. Headache disorder
4. Dry mouth
Not use as mono therapy for treatment of
periodontal disease

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 Penicillins
• These are B lactam antibiotic
Types
Penicillin –G (Benzyl Penicillin )
acid labile destroyed by gastric acid
Penicillin- V acid stable ( given orally )
Penicillinase resistance penicillin
Methicillin , cloxicillin, Oxacillin
Extended spectrum Penicillin
amphicilin, amoxicillin, bacampicillin

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 AMOXICILLIN
• Amoxicillin is a semi synthetic antibiotic
• Known as Broad spectrum penicillin
• Effective against gram- ve bacteria
• MOA of action – Inhibit synthesis of
bacterial cell wall
• Onset of action - 1-2 hours
• Duration of action - 8 hours

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 Amoxicillin .......
• It show excellent absorption after orally
administration
• It susceptible to penicillanase
• (Beta lactamase) produced by bacteria
• For Periodontal therapy
Given combined with clavulanate
Amoxicillin + Clavulanate =
AUGMENTIN
It is against the penicillanase 24
 Amoxicillin .......
INDICATION
1 As prophylaxis therapy before any
periodontal surgery
2 Amoxicillin + Metronidazole
In localized juvenile periodontitis
3 Amoxicillin +clavulanate
In refractory periodontitis
4 In all other aerobic infection
Contra Indication
Hypersensitivity to penicillin

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 Amoxicillin .......

DOSE 250 – 500 tid

route of administration
Orally, IM, IV

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 Amoxicillin .......
ADVERSE EFFECT
• Amoxicillin is a safe drug un till it is
hypersensitive to patient
• Toxicity to amoxicillin is rare
• Diarrhea
• Super infection
• Nausea , Epigastric distress
• Bleeding disdorder
• Urticaria
• Allergic reaction
• Bacterial resistance
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 CLINDAMYCIN
• It is macrolide
• MOA – Inhibit protein synthesis in bacterial
cell wall
• As a nature - Bacterio static but in high
dose Bactericidal
• It has ability to penetration in deeper tissue
like bone and deep tissue ,
so has importance in treating periodontal
disease
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 Clindamycin ........

• After oral administration

Level in bone similar to level in blood
Level in GCF is more than MIC required

• Effective against anaerobic bacteria

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 Clindamycin ........

INDICATION
• Treatment of refractory peridontitis
alone or in combination with amoxicillin
Dose – 150 mg tid for 7-10 day
• ANUG
• In deep odontogenic infection
• Osteomyelitis

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Clindamycin ........
Contra Indication
Hypersensitivity
Liver disorder
Renal failure
Blood disorder

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 Clindamycin .......
ADVERSE EFFECT

1. Main side effcet is

Diarrhea ,gastric upset if taken in
empty stomach
2. Ulcerative colitis
3. Anorexia, metallic taste
4. Allergic reaction
5. Aplastic anemia
6. Insomnia 32
 CIPROFLOXACIN
• It is first generation fluoroquinolone
• Effective against gram – ve bacteria
including all facultative bacteria &some
anaerobic putative periodontal bacteria
• Dose- 500 mg bid
Dose should be change according to severity
of disease
• MOA Inhibit bacterial DNA synthesis
• Onset of action -1 hours
• Duration of action – 8 to 12 hours
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 Ciprofloxacin ......
INDICATION
1. In Refractory Periodontitis
2. In combination with Metronidazole effective
against A. actinomycetemcomitans

Non Dental Condition

Typhoid
Gonorrhea
Skin & Soft tissue infection
Urinary tract infection

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 Ciprofloxacin ......

• Contra Indication
Hypersensitivity
Special Precaution
Renal disorder
Epilepsy
Children

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 Ciprofloxacin .....
ADVERSE EFFECT

• Nausea vomiting Headache

• Abdominal discomfort
• Inhibiting metabolism of theophyllline, warfarin
&anticoagulant
• Photosensitivity , Hyper pigmentation,
• Hypersensitivity
• Insomnia
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Locally Delivered of Antibiotic
• Limitation of systemic therapy, mouth
rinse & irrigation have, promoted for
research for development of alternative
delivery system
• Requirement of treating periodontal disease
include
1. Controlled release of drug
2. Maintained localized concentration of
drug at infection site for optimum time
3. Minimal side effect
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 Various Locally Delivered of
Antibiotic

• ACTISITE (Tetracyclines)
Tetracyclines
• ARESTIN (Minocycline)
• ATRIDIOX (Metronidazole )
• PERIO CHIP (Chlor hexidine)
• Elyzol (Metronidazole )

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Powered irrigation device

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Tetracycline – Containing Fiber
(ACTISITE ))
First local delivery product for antibiotic
Feature
1. Ethylene or vinyl acetate copolymer fiber
2. Diameter 0.5 mm
3. Containing Tetracycline
12.7 mg/ 9 inch
4. When packed into periodontal pocket, it is
well tolerated by oral tissue
5. For 10 day it sustains tetracycline
concentration exceeding 1300 ug/ ml

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ACTISITE

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 Actisite.......

Effect
Reduction in probing depth
Reduction in Bleeding on probing
Increase in clinical attachment level
Normally no staining on teeth
Reduction in plaque micro organism

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Sub Gingival Delivery Of Doxycline
ATRIDIOX
• Atridox is gel system that incorporate the
antibiotic Doxycycline (10%) in syringe able
gel system
• It is a Biodegradable mixture
• Drug introduced Subgingivally
• Applied with or without
Scaling or Root planning
Effect
Increase in clinical attachment level
Reduction in plaque micro organism
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Probing depth reduction
ATRIDIOX

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 Sub Gingival Delivery For
Minocycline (ARESTIN)
1. Sub Gingival Delivery system contain
2% (w/w) Minocycline hydrochloride
2. Use as a adjuvant to Sub Gingival
debridement
3. Biodegradable mixture in syringe
Effect are
Reduction in Pocket depth
Reduction in gingival bleeding
Reduction in plaque microorganism

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 Sub Gingival Delivery Of
METRONIDAZOLE
ELYZOL
• ELYZOL Containing an oil based
Metronidazole 25% dental gel

• Applied in viscous consistency to the

pocket where is liquidized by body heat
and hard again contact with water

• Preparation contain Metronidazole benzoate,

which is converted into active substance by
esterase in GCF

• Effective after scaling &Root planning 46

 Local Delivery Of Antiseptic
Agent
• Chlorhexidine delivery system (Perio chip) It is a
resorbable delivery system periochip ,tested for
Chlorhexidine gluconate
• It is small chip 4 x 5 x .35 mm
• Composed of
Bio degradable hydrolyzed gelatin matrix
Cross linked with glutraldehyde
Glycerin with water
2.5 mg Chlorhexidine gluconate

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PERIO CHIP
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• It is rounded on one end so easily inserted
• Perio chip released Chlor hexidine and
maintain drug concentration in GCF
more than 1000 ug/ml for atr least 7 day
• Bio degradable in 7 to 10 day

Advantage
Reduction in probing depth
Reduction in Bleeding on probing
Increase in clinical attachment level
Normally no staining on teeth A

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 REFERENCES
 Jan Lindhe – Clinic Periodontology &
Implant Dentistry, Fourth Edition.
 Carranza’s Clinic Periodontology, Ninth
Edition.
 J D Manson & B M Eley – Outline of
Periodontics, Fourth Edition.
 Guru Raja Rao – Text Book Of
Periodontology, Second Edition.
 Periodontal Medicine, Rose, Genco, Cohen
Menley 50
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