I prescribed Amoxicillin+clavulanic acid 625mg TDS, Metronidazole 400mg TDS, Tramadol 37.5mg, Aceclofenac 100mg+serratiopeptidase. 5mg BD (to be used with caution) and a multivitamin and antacid.
Planned surgical intervention but patient did not turn up.
Please advise.
Dear Colleague,
Periodontal disease itself will lead to a buccal space infection. As can instrumenting, plaque/food debris trapped into the sulcus. The bone loss itself is secondary to the periodontal disease but is not a primary cause of infection. Does this make sense?
For periodontal bone loss in otherwise controlled periodontitis (i.e.no pockets or other signs of infection) the answer is no: the bone loss itself is not obviously infectious.
For periodontally compromised teeth with active periodontal disease, yes. If the periodontal infection turns acute, it usually spreads to the buccal or the submental spaces in patients I've seen, rarely sublingual, depending on pocket localization.
As a side note, I think you would have been well off empirically using only simple v-penicillin+metronidazole with NSAID + possible other pain medication such as Tramal depending on the patient's condition. However, I'm not sure about the resistance situation in your region (India tends to have higher levels than the Nordic countries) and it naturally has to be taken into account. Only very rarely (and only after sensitivity testing) do we need to prescribe Amoxycillin+clavulanic acid AND metronidazole here.
Also, surgical intervention is usually considered the first-line of treatment, antimicrobials second, so the first thing that needs doing is the I&D and treatment of the infectious focus. This is done usually under antimicrobial prophylaxis. Otherwise the patient tends to come back after the ab medication has ended. Often enough, the procedure heals the patient and antimicrobials simply support the process and prevent complications such as formation of a new abscess.
Finally, what was serratiopeptidase used for? I am unfamiliar with the drug. I only find old links showing no evidence for its use as a pain medication or as an anti-inflammatory ( for example, http://www.ncbi.nlm.nih.gov/pubmed/19168326 ).
However, seeing as the question is 1.5 years old the patient must be healed by now...
With Best Regards,
AT
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