Efficacy+of+Local+Delivery+of+Antibiotics

The use of antibiotics for the treatment of periodontal disease is used to help destroy the bacteria left behind from scaling and root planning. It can be especially useful when you have areas that do not respond to scaling and root planning even after several attempts. Some tooth anatomy is difficult to reach, so antibiotics may be able to help. Deep hard to reach pockets should be referred to a periodontist. There are many types of antibiotics for the treatment of periodontal disease. A well known antibiotic used in dentistry is called Arestin. Arestin contains the antibiotic minocycline, it can be used effectively in the oral cavity and it does not seem to affect the normal microbial bacteria of the GI tract as some systemic antibiotic can. It was also found that the body has not built resistant to it. Dental Health network. (2009). Periodontal treatment alternatives. Retrieved February 27, 2009 from [] Wilder, R. (2003). A new option for local delivery. Dimensions of Dental Hygiene, 1 (2), 24-27. Retrieved February 25, 2009, from htp://www.dimensionsofdentalhygiene.com _Marcia// Jackie Systemic Delivery of Antibiotics Systemic antibiotics should be adjuctive to adequate mechanical debridement, because there is not enough evidence to support their use to treat periodontal disease. Evidence shows that it should start on the day of debridement completion, and debridement should be completed I a short time. Herrera, D., Alonso, B., Leon, R., & Sanz, M. (2008). Antimicrobial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm. //Journal of Clinical// Periodontology, (35), 45-46. The use of both local and systemic antibiotics management to treat periodontal disease but their use has mainly empirical ground. The abuse of systemic antibiotics is attributed to the global emergence of antibiotic resistance organisms. It should only be use as an adjuntive to the treatment of periodontal disease on the patients who do not respond to adequate mechanical treatment alone. The systemic antibiotics attack the microorganism that evaded mechanical scaling, focal infection, or in localized recurrent disease. Antimicrobials enhance the effect of machanical scaling on aggressive peridontitis, in patients with generalised systemic disease that may affect host resistance. Mombelli, A., & Samaranayake, L. P. (2004). Topical and systemic antibiotics in the management of periodontal diseases. //International Dentistry Journal, 54 (1)//, 3-14. Reina: Antibacterial and chemotherapeutic agents are applied in periodontal therapy. Bacteria continue to enhance the inflammatory response in periodontitis by proteolytic destruction of specific antibodies or activation of the complement system. The object of this study was to monitor the proportion of vital bacteria present in subgingival plaque following a single subgingival irrigation with saline, chlorhexidine, or povidone iodine without any subgingival instrumentation. In each patient, 4 initially untreated pockets (5-11 mm of depth, one as a control, one with saline, one with chlorhexidine, and one with povidone iodine) associated with bleeding were selected for the irrigation (only performed once at 0 hours) as well as plaque sampling at the baseline of 0 hours and then again at 1 hour, 24 hours, 7 days, and 31 days. The control and the saline irrigation led to a decrease in the number of spirochetes but had no influence on the vitality of the flora (VF). Large variations in VF could be observed in short-term (1 hour and 24 hours) irrigation with chlorhexidine and povidone iodine. The reduction was still significant after 7 days, but only the povidone iodine persisted up to 31 days. All single subgingival irrigations resulted in a temporary change of the subgingival microflora while povidone iodine produced the longest lasting antimicrobial effect. von Ohler, C., Weiger, R., Decker, E., Schlagenhauf, U., & Brecx, M. (1998, June). The efficacy of a single pocket irrigation on subgingival microbial vitality. //Clinical Oral Investigations//, //2//(2), 84-90. Irrigation of periodontal pockets with fluoride solution after scaling and root planing is occasionally recommended to inhibit the growth of pathogenic bacteria in the periodontal pocket, but fluoride solution deposited in the periodontium may lead to tissue damage because of its toxicity. In this case, extensive periodontal tissue necrosis and permanent loss of alveolar bone after irrigation of periodontal pockets with stannous fluoride solution occurred. Reasons for limited use of fluorides include the increased risk of adverse effects on other body sites, e.g. gastric mucosa, the short duration of the antibacterial effect, the lack of any added clinical benefit to scaling and root planing, and the increased risk for toxic effects in the inflamed periodontium including the possibility of impeded healing of the periodontal tissue. Sjostrom, S., & Kalfas, S. (1999, April). Tissue necrosis after subgingival irrigation with fluoride solution. //Journal of Clinical Periodontology//, //26//(4), 257-260. ** Diem: ** Antimicrobial therapy is chemical agents that can kill or inhibit the growth of bacteria. The two most common antimicrobial therapy are antiseptic and antibiotic. Antiseptic therapy is local antibiotic therapy, which is inhibit the growth of bacteria. Local antibiotic cannot be used orally, but it can be placed directly to the disease areas and may have benefit during periodontal maintenance phase. One advantage of antiseptic is that it has fewer side effects than systemic antibiotics. It is easy to use and good patients’ acceptance. Finally, it has the best effect when combining with SRP. All in all, conventional SRP is the best treatment for periodontal disease. Systemic and local antibiotics are an adjunct to SRP and used to help patients who have immune compromised. Antimicrobial therapy for periodontal disease. (March, 2002). //Oral & Dental Health Basic.// Retrieved March 14, 2009, from [] Noo: Periodontal disease initiation and progression occurs as a consequence of the host immune inflammatory response to oral pathogens. Periodontal pathogens produce harmful by-products and enzymes that break down extracellular matrices. Many of the microbial surface protein and lipopolysaccharide molecules are responsible for eliciting a host immune response, resulting in local tissue inflammation. A variety of treatment strategies have been developed to target the host response to periodontal infection. Many studies have sought to provide chemotherapeutic applications on the use of host modulatory for periodontal disease management. Researchers have found matrix metalloproteinase inhibitors, such as low-dose formulations of doxycycline, for the use in combination with scaling and root planing or surgical therapy. They also mentioned high-risk populations, such as patients with diabetes or refractory periodontal disease, have benefited from systemic matrix metalloproteinase administration. Testing on primates has shown the use of lipoxins did show significant potential in the management of the host response to periodontitis. Other therapeutic strategies being explored are aimed at inhibiting signal transduction pathways involved in inflammation. Pharmacological inhibitors of NF-//κ//B and p38 MAPK pathways are actively being developed to manage rheumatoid arthritis and inflammatory bone diseases. There is a new study using inflammatory mediators, including pro-inflammatory cytokines (interleukin-1, tumor necrosis factor, interleukin-6), matrix metalloproteinases and others, would be inhibited at the level of cell-signaling pathways required for transcription factor activation necessary for inflammatory gene expression or mRNA stability. They believe these therapies may provide the next wave of disease-specific chemotherapeutics to manage chronic periodontitis. Kirkwood, K., Cirelli, J, Rogers, J., and Giannobile, W. (2000) Novel host response therapeutic approaches to treat periodontal diseases. //Journal of periodontology//. 43:294-315.      Caton JG, Ciancio SG, Blieden TM, Bradshaw M, Crout RJ, Hefti AF, Massaro JM, Polson AM, Thomas J, Walker C. Treatment with subantimicrobial dose doxycycline improves the efficacy of scaling and root planing in patients with adult periodontitis. //Journal of Periodontology.//71:521–532. Jennifer I read an article that did a survey comparing what dentist used most, the results indicated that the use of systemic antibiotics is "infrequent" as well as the use of local antibiotics, but most dentist felt that the use of a local antibiotic was superior to just scaling and root planning. I also read an interesting article which states that systemic antibiotics work best on young bio film, where locally applied antibiotics are of higher concentrations there for are able to kill more of the bacteria. The article stated that by using systemic antibiotics with mature biofilm will create resistant bacteria. To determin if a locally applied antibiotic would be the best treatment a microbial analysis should be done, This way we can be sure to use antibiotics responsably. Camacho, N., Resposo, S., Gollwitzed, B. Alafant,N., Walker, C., and Shaddoxe, L. (2009). Evaluation of Local vs. Systemic Antibiotic Administration in Dental Biofilms http://iadr.confex.com/iadr/2009miami/webprogram/Paper116472.html Choudhury,M., Needleman, I,.Gillam, D., Moles, D.(2001). Systemic and local antimicrobial use in periodontal therapy in England and Wales. Journal of Periodontology 36(3). Tawnya The use of systemic or locally delivered antibiotics is indicated after scaling and root planning if desired results are not met in patients with chronic or aggressive periodontal disease or NUP. Minocycline is a good choice of antibiotic either topically of systemically as it is a broad spectrum antimicrobial against Enterobacteria, Pseudomonas, Staphylococcus and Candida which as we know are found in a periodontal pocket. Systemic antibiotics may be indicated for patients with aggressive perio or NUP while individual perio pockets not responding may be treated with local antibiotics. Studies indicate an increase in CAL with both systemic and local antibiotics but the increase is insignificant around .5 mm of CAL increase. More research needs to be done with more promising results on the gain of CAL for the use of antibiotics to become part of our periodontal regimen. Akalin, F., Baltacioglu, E., Sengun, D., Hekimoglu, S., Taskin, M., Etikan, I., et. al. (2004). A comparative evaluation of the clinical effects of systemic and local doxycycline in the treatment of periodontal disease. Journal of Oral Science, 46(1): 25-35. Bogren, A., Teles, R., Torresyap, G., Haffajee, A., Socransky, S., & Wennström, J. (2008). Locally delivered doxycycline during supportive periodontal therapy: A 3-Year Study. Journal of Periodontology 79(5), 827-835. de Oliveira, L., Cardosa, A. and Santos, S. (2006). In vitro minocycline activity on superinfecting microorganisms isolated from chronic periodontitis patients. Brazalien Oral Research, 20(3): 202-206. Mombelli, A., and Samaranayake, L.P. (2004). Topical and systemic antibiotics in the management of periodontal disease. International Dental Journal, 54(1): 3-14. Dorinda Antimicrobial medication is used for periodontal disease. The antibiotic works by exceeding concentrations to kill the pathogens that cause the destructive periodontal disease. This is a great resource to turn to when a patient does not respond to previous treatment given such as SRP or surgical or non surgical procedures. Patients with current perio. or medical conditions predisposing them to a perio. condition are candidates for antibiotic therapy. An antibiotic delivered locally are much more accurate because systemic antibiotic delivery is unable to achieve high amounts in the gingival crevice fluid and has an increased risk of adverse drug reactions. This also causes an increased to antibiotic resistant microorganisms and uncertain patient compliance, whereas the locally delivered do not hold these disadvantages. In a study conducted on clinical and microbiological response of generalized aggressive perio patients. The results concluded that peio debridement in conjunction with antibiotic therapy led to reduction of probing depths and reduced the re-treatment time period versus SRP. Casarin, R., Del Peloso Ribeiro, E., Cruz, S., Sallum, E., Nociti-Jr., F., et al. Periodontal debridement and systemic amoxicilin/metronidazole: therapeutic approach for aggressive periodontitis. Retreived March 7, 2009, from http://iadr.confex.com/iadr/2009miami/webprogram/Paper114495.html Systemic antibiotics in periodontics. (2004, November). Journal of Periodontology, (75) 1553-1565.
 * Efficacy of Local Delivery of Antibiotics **

The use of antibiotics for the treatment of periodontal disease highly recommended as an adjunctive therapy to SRP. Antibiotics alone are not effective in the treatment of periodontal disease. The question is, what is more beneficial for the patient? Systemic antibiotic therapy or local delivery antibiotic therapy? Personally, I think it would depend on the patient. Are they on any other medications? This would definitely have an impact on which route to take. Medications can contraindicate other medications and have adverse reactions. In my research I found one study that showed there was no significant difference in either routes of administration with tetracycline, another words, they were both effective. Another study showed that amoxicillin was more efficacious than CHX as an adjunctive therapy. I believe this issue will be patient specific and medication specific. What microorganisms are we targeting, specifically, and does the medication target that species specifically? Would we need to do a microbial analysis on patients to be optimal in our treatment with antibiotic therapy?
 * Efficacy of Local Delivery of Antibiotics/Efficacy of Systemic Antibiotics - Stacy **

Reference:

Purucker, P., Mertes, H., Goodson, J.M., and Bernimoulin, J.P. (2001). Local versus systemic adjunctive antibiotic therapy in 28 patients with generalized aggressive periodontitis. //Journal of Periodontology, 72//(9): 1241-1245.

Kaner, D., Bernimoulin, J.P., Hopfenmuller, W., Kleber, B.M., and Friedmann, A. (2007). Controlled-delivery chlorhexidine chip versus amoxicillin/metronidazole as adjunctive antimicrobial therapy for generalized aggressive periodontitis: a randomized controlled clinical trial. //Journal of Clinical Periodontology, 34//(10): 880-891.

Mombelli, A., and Samaranayake, L.P. (2004). Topical and systemic antibiotics in the management of periodontal disease. //International//