Dr. Mazood Ahamad
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Chemotherapeutic agent is a general term for chemical
substance that provide a clinical therapeutic benefits

Chemotherapeutic agent may be a necessary adjunct
in controlling bacterial infection.
Indications for Antibiotic Therapy
• Acute infections
• Aggressive (early onset) forms of periodontitis
• Recurrent (“refractory”) periodontitis
• Chronic infections
Periodontal Surgical therapy: Regenerative technique, Post
Surgical Infections Treatment And Prophylaxis
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Antibiotics Used in Periodontal
Therapy
• Penicillins (e.g., amoxicillin
• Tetracyclines (e.g., doxycycline)
• Metronidazole
• Fluoroquinolones (e.g., ciprofloxacin)
•Erythromycin
• Azithromycin
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
Widely used in treatment of periodontics , Broad spectrum
antibiotics
Effective aganist : gram+ ve, Bacteriostatics,
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MOA - inhibiting protein synthesis in bacteria

Dose 250 mg four times daily (qid).
Inexpensive but less patient compliance.
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
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This group includes Tetracycline Hydrochloride, Minocycline And
Doxycycline.
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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. Have anti collagenase effect inhibiting tissue destruction
5. Increase bone regeneration
1.
2.
Dental use: Localized aggressive periodontitis , Refractory
periodontitis.
Contra indication
Pregnancy & Feeding mother
Liver & Kidney disorder
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Used in the treatment of adult periodontitis
Dose 200 mg/day
Complication
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Less photo &renal toxicity, Cause reversible vertigo
Doxycycline
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Dose is 100mg bid the first day, then 100 mg od.
Given once daily so more patient compliance
To reduce gastro intestinal upset – 50mg bid

It is bactericidal to anaerobic organisms( gram +ve & gram –
ve)
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MOA – inhibiting the growth of bacteria by inhibit the
bacterial DNA synthesis
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DOSE :Orally - 250/500 mg tid For 7-10 day
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On set of action – 8 hours ,Duration of action - 24-48 hours

More effective against obligate anaerobic gram – ve bacteria
INDICATION
1.
Gingivitis
2.
ANUG
3.
Chronic Periodontitis
4.
Aggressive Periodontitis
5.
Refractory Periodontitis
Contra indication
1.
Patient having alcohol habit
2.
Patient taking anticoagulant therapy
3.
Blood disorder
4.
Cirrhosis of liver
5.
Renal disorder
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Most widely used antibiotic.
Amoxicillin is a semi synthetic antibiotic . Known as Broad
spectrum penicillin
Effective against gram+ and - ve bacteria
MOA: Inhibit bacterial cell wall production and are
bactericidal.
Induce allergic reactions and bacterial resistance.
DOSE: 250 / 500 tid for 8 days (Orally, IM, IV)
For Periodontal therapy : Given combined with clavulanate
Amoxicillin + Clavulanate = AUGMENTIN
It is against the penicillanase

Augmentin is used for management of LAP or refractory
periodontitis.
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Clindamycin is effective against anaerobic bacteria.“
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It is effective in situations in which the patient is allergic to
penicillin.
MOA – Inhibit protein synthesis in bacterial cell wall

As a nature - Bacteriostatic but in high dose Bactericidal

It has ability to penetration in deeper tissue like bone and deep

tissue

DOSES:150mg (qid) for 10 days.
300mg(bid) for 8 days.
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Effective against gram – ve bacteria including all facultative
bacteria &some anaerobic bacteria

Dose- 500 mg bid

MOA -Inhibit bacterial DNA synthesis
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Contra Indication
Hypersensitivity
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Antibiotic from the macrolide group.

it exerts bacteriostatic activity by blocking of bacterial proteins
synthesis.
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covers gram-negative bacteria
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Penetrates epithelial cells-can kill invasive bacteria

oral dosage of 500 mg once daily for three consecutive days.
It is to treat the host side of the host bacterial
interaction

it is Treatment concept that aims to
• reduce tissue destruction and stabilization
• even regenerate the periodontium by modifying
• down regulating destructive aspect of host response
• upregulating protective or regenerative response
BISPHOSHONATES
PERIOSTAT
NSAIDS
PERIOSTAT
Antimicrobials
Osteoclasts
Prostaglandins
BACTERIAL
PRODUCTS
Cytokines
HOST CELLS
BONE
RESORPTION
CONNECTIVE
TISSUE
BREAK DOWN
POCKET
AND
CAL
TOOTH
MOBILITY
AND
LOSS
MMPs
PERIOSTAT
CLINICAL SEQUELAE
BACTERIAL COMPONENTS
HOST RESPONSE COMPONENTS
SYSTEMICALLY ADMINISTERED AGENTS
 Subantimicrobial -dose doxycycline
 Nonsteroidal anti-inflammatory drugs
 Bisphosphonates
LOCALY ADMINISTERED AGENTS
Nonsteroidal anti-inflammatory drugs
Enamel matrix proteins
Growth factors
Bone morphogenetic proteins
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NSAIDs inhibit the formation of prostaglandins,(PGE2), and
therefore reduce tissue inflammation.
Indomethacin (Lasfargues and saffor 1983) 28% decrease bone
loss 55% decrease osteoclast activity.

Flurbiprofen: -50 mg BID over 20 months.
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Ibuprofen
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side effects, including gastrointestinal problems, hemorrhage, and
renal and hepatic impairment.
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The bisphosphonates are bone-seeking agents that inhibit bone
resorption by disrupting osteoclast activity.

And also possess anticollagenase properties
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1st Generation:

2nd Generation: eg. Alerdeonate and pamideonate
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3rd Generation: eg: risedeonate
eg : etideorate
SUBANTIMICROBIAL DOSE DOXYCYCLINE (SDD)
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Doxycycline Hyclate (Periostat):-
DOSAGE -20-mg capsule, twice daily for 3 to 9
months of continuous dosing..
Inhibition of enzyme,cytokine, and osteoclast
It acts by suppression of the activity of collagen,
particularly that produced by PNM’s.
At present, SDD (Periostat) is the only systemically administered
HMT specifically indicated for the treatment of chronic
periodontitis that is approved (FDA) and (ADA).