Systemic metronidazole in the treatment of periodontitis

The present study evaluated the effect of systemic metronidazole on advanced periodontitis in 10 patients with inadequate oral hygiene. Clinical and microbiological observations were made at a total of 173 bleeding pockets of 5 mm depth or more. The clinical observations comprised plaque index scores, dichotomous measurements of gingival redness and suppuration, pocket depths and attachment levels. The microbiological variables investigated were the % spirochaetes, % black-pigmented Bacteroides species, % facultative streptococci and presence of absence of Bacteroides gingivalis. At baseline, after clinical measurements and microbiological samples had been taken, each patient received a thorough scaling and root planing. After 3 months, the clinical measurements and microbiological sampling were repeated and a 5-day course of metronidazole was administered while one side of the mouth was scaled and root planed. After a further 3 months, the final measurements and samples were taken. In comparing pre- and post-treatment data, the following significant differences were observed: for debridement alone, a reduction in mean % spirochaetes from 11.5% to 4.9% and an increase in mean % streptococci from 4.7% to 8.8%; for metronidazole alone, a 0.3 mm gain in mean attachment level, a 0.4 mm reduction in mean pocket depth and a reduction in the frequency of suppurating sites from 32% to 16%; for debridement plus metronidazole, a 0.2 mm gain in mean attachment level, a 0.5 mm reduction in mean pocket depth and a reduction in mean % spirochaetes from 5.6% to 2.5%. Thus systemic metronidazole, either alone or accompanied by debridement, produced a modest clinical improvement after debridement alone had failed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Systemic antibiotics in the treatment of periodontitis

Despite the fact that several clinical studies have shown additional benefits when certain systemic antibiotics are used as adjuncts to periodontal treatment, clear guidelines for the use of these agents in the clinical practice are not yet available. Basic questions concerning the use of systemic antibiotics to treat periodontitis remain unanswered, such as: which drug(s) should be used; which patients would most benefit from treatment; which are the most effective protocols (i.e. doses and durations); and in which phase of the mechanical therapy should the drug(s) be administered? Although not all of those questions have been directly addressed by controlled randomized clinical trials, recent concepts related to the ecology of periodontal diseases, as well as the major advances in laboratory and clinical research methods that have occurred in the past decade, have significantly broadened our knowledge in this field. This article endeavored to provide a ‘state of the art’ overview on the use of systemic antibiotics in the treatment of periodontitis, based on the most recent literature on the topic as well as on a compilation of data from studies conducted at the Center of Clinical Trials at Guarulhos University (São Paulo, Brazil) from 2002 to 2012.     

Systemic antibiotic therapy in the treatment of periodontitis

Periodontitis is characterized by a general inflammation of the tooth-supporting tissues, which leads to apical migration of the junctional epithelium along the root surface and progressive destruction of the periodontal ligament and the alveolar bone. Although the bacteria present within the subgingival dental biofilm constitute the primary etiologic agents of periodontitis, the host"s immune response modulates development of the condition toward either destruction or healing. Given the infectious nature of periodontal diseases and the limited results with conventional mechanical therapies for the treatment of certain forms of periodontitis (aggressive and refractory), the use of antibiotics is warranted in certain cases. This article provides an update on systemic antibiotic therapy for the treatment of periodontitis.     

Systemic manifestations of periodontitis in the non-human primate

This report describes our findings regarding the potential contribution of periodontitis to atherosclerotic processes using a nonhuman primate model. The goal of the investigations was to target general mechanisms which could describe the association of these disease processes, including: (i) systemic translocation of bacteria/products during periodontitis; (ii) alterations in systemic inflammatory biomarkers during periodontitis; and (iii) the relationship of periodontitis to serum lipids/lipoproteins. Increases in serum endotoxin (e.g. LPS) during ligature-induced periodontitis were observed in these animals. We determined serum levels of various acute phase reactants and chemokines (e.g. CRP, alpha 1-antitrypsin, haptoglobin, fibrinogen, IL-8). A number of these host factors were significantly increased during gingivitis and/or periodontitis. Finally, we observed specific changes in serum lipid levels (cholesterol, triglycerides, HDL, LDL) and lipoproteins (apoA-I) during periodontitis, which were exacerbated by exposure of the animals to a diet with elevated fat content. Thus, we have described systemic manifestations of periodontitis that include detection of bacterial products, inflammatory biomarkers, and dyslipoproteinemia consistent with an increased atherogenic risk.     

Systemic antibiotics in the management of chronic periodontitis

Multiple research studies have investigated the use of systemic antibiotics as adjunctive treatments in the management of chronic periodontitis. However, the great heterogeneity of study designs and variable outcomes that have been reported have led to confusion among the profession as to whether or not there is any clinical benefit of using systemic antibiotics. In this review, the potential advantages and disadvantages of using systemic antibiotics are considered together with outcomes from published clinical studies. Few published studies are of adequate quality to be considered in systematic reviews, and the outcomes are very varied. Drawing definitive conclusions is difficult, but given the lack of reliable data available, systemic antibiotics cannot be indicated as adjuncts in the treatment of chronic periodontitis.     

Systemic amyloidosis manifesting as localized, severe periodontitis

BACKGROUND: Amyloidosis comprises a heterogenous group of disorders characterized by amyloid deposition in various organs. The authors document a case in which amyloidosis manifested as a localized, severe, periodontal disease. CASE DESCRIPTION: A 73-year-old woman visited her dentist because of pain and increased mobility of her mandibular bridge. Radiographic examination revealed severe vertical bone loss associated with tooth no. 27. One of the authors extracted the tooth, removed tissue with a curet from this site and submitted it for pathological examination. He made a diagnosis of amyloidosis on the basis of histological and immunohistochemical findings. CLINICAL IMPLICATIONS: Clinicians should consider periodontal involvement in amyloidosis as a possible cause of severe, localized, periodontal disease, particularly in patients with chronic inflammatory disorders or a history of amyloidosis.     

Systemic circulating inflammatory burden and periodontitis in adolescents

Clinical Oral Investigations - To analyze the association between systemic inflammatory burden of cardiovascular disease (CVD) risk and periodontitis in adolescents, including mediating pathways...     

Systemic effects of periodontitis: lessons learned from research on atherosclerotic vascular disease and adverse pregnancy outcomes

Studies conducted over the past 25 years have focussed on the role of periodontitis, an inflammatory condition of microbial aetiology that destroys the tooth‐supporting tissues, as a systemic inflammatory stressor that can act as an independent risk factor of atherosclerotic vascular disease (AVSD) and adverse pregnancy outcomes (APOs). It has been suggested that periodontitis‐associated bacteraemias and systemic dissemination of inflammatory mediators produced in the periodontal tissues may result in systemic inflammation and endothelial dysfunction, and that bacteria of oral origin may translocate into the feto‐placental unit. Epidemiological studies largely support an association between periodontitis and ASVD/APOs, independently of known confounders; indeed, periodontitis has been shown to confer statistically significantly elevated risk for clinical events associated with ASVD and APOs in multivariable adjustments. On the other hand, intervention studies demonstrate that although periodontal therapy reduces systemic inflammation and improves endothelial function, it has no positive effect on the incidence of APOs. Studies of the effects of periodontal interventions on ASVD‐related clinical events are lacking. This review summarises key findings from mechanistic, association and intervention studies and attempts to reconcile the seemingly contradictory evidence that originates from different lines of investigation.     

慢性牙周炎系统治疗一例

牙周炎患者经过彻底完善的系统治疗,再加上细致的牙周维护,可以获得牙周组织长久的健康,而健康的牙周组织是修复、正畸和种植治疗成功的基础.本文就一例重度慢性牙周炎患者的系统治疗做一报告.     

慢性牙周炎系统治疗一例

牙周炎患者经过彻底完善的系统治疗,再加上细致的牙周维护,可以获得牙周组织长久的健康,而健康的牙周组织是修复、正畸和种植治疗成功的基础.本文就一例重度慢性牙周炎患者的系统治疗做一报告.     

慢性牙周炎系统治疗一例

牙周炎患者经过彻底完善的系统治疗,再加上细致的牙周维护,可以获得牙周组织长久的健康,而健康的牙周组织是修复、正畸和种植治疗成功的基础.本文就一例重度慢性牙周炎患者的系统治疗做一报告.     

Systemic effects of periodontal diseases

A number of studies suggest an association between periodontal disease and cardiovascular disease, pulmonary disease, diabetes,and pregnancy complications. Presently, the data must be regarded as preliminary. Additional large-scale longitudinal epidemiologic and interventional studies are necessary to validate these associations and to determine whether the associations are causal. The goal of this article is to review the history of this concept, describe the biologically plausible circumstances that may underlie these potential associations, and provide a summary of the published literature that supports or refutes them.