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

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

7 Nitroimidazoles - Metronidazole,
Tinidazole
8 Imidazoles derivatives- ketoconazole,
9 Polypeptides Antibiotic Bacitracin
Polymyxin -B
10 Nicotinic acid derivatives
Isoniazid, Pyrazinamide

Common Antibiotic used in

PERIODONTCS
Tetracycline
Metronidazole
Amoxicillin
Clindamycin
Cephalosporin
Ciprofloxin

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
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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

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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

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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
ARESTIN
ATRIDIOX
PERIO CHIP

Elyzol

(Tetracyclines)
Tetracyclines
(Minocycline)
(Metronidazole )
(Chlor hexidine)

(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
Probing depth reduction

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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

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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.
Carranzas 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
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