牙周病药物治疗解析.pptVIP

中药的应用Traditional Chinese Medicine 肾虚则齿衰, 肾固则齿坚 补肾固齿丸(古方六味地黄丸) * 21 牙周病的药物治疗 Chemotherapy of Periodontal Disease 21-4 药物治疗的目的和原则 Objective and Principles for Chemotherapy 目的 辅助机械治疗 杀灭或控制 微生物 预防或减少 菌斑形成 控制急性感染 伴有全身疾病 的术后预防性 应用 伴有全身疾病 的术后预防性 应用 特异性致病菌的问题未解决-用药的盲目性。弊端：1，形成耐药菌；2，破坏口腔微生态平衡；3，对宿主的副作用等。 ? PRINCIPLES FOR ANTIBIOTICTHERAPY 原则 基础治疗为主 效果不佳时 可用药 去除结石 扰乱菌斑结构 后用药 尽量局部给药 尽量细菌学 检查和药敏 不应将抑菌和 杀菌药物 共同使用 The treatment of periodontal diseases by antimicrobial agents alone will probably not suffice and indicate that mechanical instrumentation to disrupt the biofilm and to remove the bulk of bacterial deposits must precede antimicrobial therapy. The limitations of mechanical therapy. Can antimicrobial agents help? Antimicrobial agents may be delivered by direct placement into the periodontal pocket or via the systemic route. Each method of delivery has specific advantages and disadvantages An antimicrobial gel is applied with a syringe inserted into a residual pocket (a). For retention of the agent in the site, the viscosity of the carrier should change immediately. A large portion of the product may other-wise be expelled from the pocket quickly (b). 影响药物疗效的因素 Factors Influencing the Outcomes of Antimicrobial Therapy 药物在组织中的吸收分布 感染类型 耐药性 菌斑生物膜 药代动力学 药物配伍 Comparison of local and systemic antimicrobial therapy Issue Systemic administration Local administration Drug distribution Wide distribution Narrow effective range Drug concentration Variable levels in different body High dose at treated compartments site, low levels elsewhere Therapeutic potential May reach widely distributed May act better microorganisms better locally on biofilm