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QUESTION : 1. Why metronidazole gel is considered effective to care periodontal diseases?
ANSWER   : Metronidazole is a specific antimicrobial for gram negative bacteria like Bacteroides gingivalis, Bacteroides forsythus and Treponema denticola as the main cause of periodontitis. Metronidazole has characteristic bactericidal (kill germ). The result of Suwandiís research (2003), application of metronidazole gel after scaling and root planing reduce pocketís depth and bleeding on probing, increase attachment, and minimize flap operation.
QUESTION : 2. What is the difference of contents between ties metronidazole gel and ties metronidazole gel plus?
ANSWER   :
a. Ties metronidazole gel contains 25% metronidazole
b. Ties metronidazole gel plus contains 25% metronidazole and mefenamic acid (analgesic and anti inflammation)
Ties metronidazole gel Ties metronidazole gel plus
QUESTION : 3. What is the indication of ties metronidazole gel and ties metronidazole gel plus?
ANSWER   :
Indication of ties metronidazole gel : chronic periodontitis with periodontal pocket 4-7mm.
Indication of ties metronidazole gel plus : heavy gingivitis or periodontitis with shallow pocket, periodontal abscess, abscess and bleeding gingival. Instead of that, it also can be used to cure periapical abscess with apply it into the root canal or pulp chamber as medicament rotation.
QUESTION : 4. Does application of ties metronidazole gel can be changed with metronidazole tablet peroral?
ANSWER   :
Basic of ties metronidazole gelís application is to avoid the side effect from metronidazole tablet, and to get biggest concentration in sulcus gingival.
Assumption in chronic periodontitis case (included 2-3 teeth), the doses of metronidazole oral which will be given is 15 tablets @ 500mg 3 times/day. It may cause side effects such as gastrointestinal problem, vomitting, nausea, etc. therefore patient usually doesnít want to take medicine regularly. It causes the result of care not suitable.
If we apply metronidazole gel, the doses which will given is only 25mg. Patient doesnít need to take medicine again. This condition can be repeated in 1 week control.
The result of research shows concentration of metronidazole in sulcus liquid is higher then concentration in blood.
QUESTION : 5. How to apply ties metronidazole gel?
ANSWER   :
After scaling and root planing, the operation area is isolated with cotton rolls. Ties metronidazole gel is applied with put the tip of needle into pocket with 2mm depth, and applied it until the gel come out from marginal gingival. Clean the gel in marginal gingival with cotton.
Application with tip in 2mm
QUESTION : 6. How to apply ties metronidazole gel plus to treat the periodontal pocket?
ANSWER   :
There are 2 ways :
1. For medium pocket 3-4mm, application is done after scaling and root planing, by put the tip of needle inside pocket with 2mm depth and applied it until the gel come out from marginal gingival. Clean the gel in marginal gingival with cotton.
2. For shallow pocket 2-3mm with infection and abscess gingival, more bleeding on probing. Applied it with plastic filling. Ties metronidazole gel is pushed little bit to glass plate, then use plastic filling, put it into pocket.
Application with tip in 2mm Application with plastic filling
QUESTION : 7. Does ties metronidazole gel can tighten tooth mobility?
ANSWER   :
a. There are several causes of tooth mobility. If it is mobile until 2 degree which is caused by inflammation, so application of ties metronidazole gel after scaling and root planning will solve the problem.
b. If the tooth mobility 2 degree which is caused by inflammation with trauma from occlusion, do occlusal adjustment first and then apply metronidazole gel after scaling and root planing.
c. If the tooth mobility case more than 2 degree which is caused by inflammation and trauma from occlusion, so the care is the same with the above, and is needed splinting periodontal.
The tooth mobility must be identified first
Metronidazole gel has function as antimicrobial (to kill any anaerob microorganism)
QUESTION : 8. What instruction that should we be given to patient after ties metronidazole gelís application?
ANSWER   : Patient should not rinse the mouth, eat or drink minimal 1 hour after application.
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