Long-term evaluation of the antimicrobial susceptibility and microbial profile of subgingival biofilms in individuals with aggressive periodontitis

This study evaluates the antimicrobial susceptibility and composition of subgingival biofilms in generalized aggressive periodontitis (GAP) patients treated using mechanical/antimicrobial therapies, including chlorhexidine (CHX), amoxicillin (AMX) and metronidazole (MET). GAP patients allocated to the placebo (C, n = 15) or test group (T, n = 16) received full-mouth disinfection with CHX, scaling and root planning, and systemic AMX (500 mg)/MET (250 mg) or placebos. Subgingival plaque samples were obtained at baseline, 3, 6, 9 and 12 months post-therapy from 3–4 periodontal pockets, and the samples were pooled and cultivated under anaerobic conditions. The minimum inhibitory concentrations (MICs) of AMX, MET and CHX were assessed using the microdilution method. Bacterial species present in the cultivated biofilm were identified by checkerboard DNA-DNA hybridization. At baseline, no differences in the MICs between groups were observed for the 3 antimicrobials. In the T group, significant increases in the MICs of CHX (p < 0.05) and AMX (p < 0.01) were detected during the first 3 months; however, the MIC of MET decreased at 12 months (p < 0.05). For several species, the MICs significantly changed over time in both groups, i.e., Streptococci MICs tended to increase, while for several periodontal pathogens, the MICs diminished. A transitory increase in the MIC of the subgingival biofilm to AMX and CHX was observed in GAP patients treated using enhanced mechanical therapy with topical CHX and systemic AMX/MET. Both protocols presented limited effects on the cultivable subgingival microbiota.

Eficácia da azitromicina no tratamento da periodontite agressiva / Effectiveness of the azitromicin in the treatment of aggressive periodontitis

Foi feita uma revisão bibliográfica sobre o uso da azitromicina em Periodontia considerando algumas questões como: Pode este antibiótico aumentar o efeito da raspagem radicular, limitar seus efeitos adversos ou pode até mesmo ser um substituto em alguns casos? A azitromicina vem sendo associada, em alguns casos, à raspagem e ao alisamento radicular no tratamento de doenças periodontais agressivas, por ser eficaz no combate a bactérias periodontopatogênicas. No entanto, faltam estudos com conteúdo confiável para se confirmar o sucesso dessa nova terapia. Sendo assim, o tratamento principal para a periodontite agressiva continua sendo a raspagem e o alisamento radicular.

Qual o antibiótico para periodontite agressiva? / What antibiotic to aggressive periodontitis?

As doenças periodontais são um grupo de infecções que possuem como fator etiológico primário as bactérias presentes na cavidade bucal, especialmente as que colonizam as superfícies dos dentes, supra e subgengivalmente, organizadas num biofilme cuja presença acomete as estruturas de proteção e sustentação dos dentes, levando à perda de inserção, de tecido ósseo e, eventualmente, do elemento dentário1. Muitos avanços tecnológicos nas áreas da imunologia e biologia molecular, ocorridos principalmente nas duas últimas décadas, facilitaram sobremaneira o entendimento da etiopatogenia das periodontites, incluindo a microbiota patogênica relacionada a cada tipo de doença e o perfil do hospedeiro. Esses conhecimentos têm facilitado o direcionamento de terapias mais específicas para cada paciente, que, sendo fundamentadas nos fatores etiológicos da infecção, podem trazer melhores resultados clínicos e microbiológicos em longo prazo.

The use of ozonated water and 0.2% chlorhexidine in the treatment of periodontitis patients: A clinical and microbiologic study.

Background: The development of periodontal disease has been thought to be associated with several restricted members of the oral anaerobic species, such as black-pigmented Porphyromonas species and Actinobacillus actinomycetemcomitans (Aa), in the subgingival environment. Apart from bacteria, certain viruses and fungi that are associated with periodontal disease are also present in the subgingival plaque . Materials and Methods: A randomized, double-blind, crossover split-mouth design was performed. A total of 16 patients suffering from generalized chronic periodontitis were selected for the study. The study period of 18 days was divided into two time-intervals, i.e. baseline (0 days) to 7 th day, with a washout period of 4 days followed by a second time interval of 7 days. The use of ozone and chlorhexidine gluconate (CHX) irrigation was randomized. Both the patient and the clinician evaluating the clinical parameters were blinded regarding the type of irrigation used. Results: The interpretation of clinical and microbial data is from baseline to 7 th day. A higher percentage of plaque index (12%), gingival index (29%) and bleeding index (26%) reduction was observed using ozone irrigation as compared to chlorhexidine. The percentile reduction of Aa (25%) using ozone was appreciable as compared to no change in Aa occurrence using chlorhexidine. By using O 3 and chlorhexidine, there was no antibacterial effect on Porphyromonas gingivalis (Pg) and Tannerella forsythensis. The antifungal effect of ozone from baseline (37%) to 7 th day (12.5%) was pronounced during the study period, unlike CHX, which did not demonstrate any antifungal effect. Conclusion: Ozone may be considered as an alternative management strategy due to its powerful ability to inactivate microorganisms. Also, there is growing evidence that ozone can be employed as a useful therapeutic agent in both dentistry and medicine.

Tratamiento integrado ortoperiodontal en la periodontitis juvenil. Presentación de un caso / Orthoperiodontal integrated treatment in juvenile periodontitis. A case report

La periodontitis juvenil es un término que se usa para incluir diferentes tipos de periodontitis que afectan a jóvenes sanos. Esta entidad afecta a personas en la segunda década de la vida y se ha dividido en 2 formas: la localizada y la generalizada. Se presenta el caso de una paciente femenina de 13 años de edad, mestiza, estudiante de canto coral, la cual llevaba año y medio de tratamiento de ortodoncia, que después de instaurados los aparatos fijos, abandonó el seguimiento por consulta de la especialidad. Al examen físico se detecta una lesión de distribución márgino papilar, con pérdida de la morfología gingival, consistencia duroelástica, aspecto fibroedematoso y color rosado intenso con manchas melánicas aisladas, gingivorragia al sondeo, dolor y movilidad en dientes anterosuperiores y en menor escala en los anteroinferiores, bolsas periodontales de hasta 8 mm y pérdidas óseas horizontales y verticales localizadas en incisivos superiores e inferiores y en los primeros molares permanentes, constatada en las radiografías. Se presenta el tratamiento indicado y la evolución del caso mediante seguimiento imagenológico(AU)

Juvenile periodontitis is a term used to include different types of periodontitis affecting healthy young individuals. This entity affects persons on the second decade of life, and it has been divided into 2 forms: the localized and the generalized. The case of a 13-year-old black female student of choral singing, who had been under orthodontia treatment for a year and a half, and that after having the fixed appliances abandoned the follow-up, was presented. On the physical examination, it was detected a lesion of the marginal and papillary distribution with loss of gingival morphology, hardelastic consistency, fibroedematous aspect and dark pink colour with isolated melanic stains, gingivorrhagia, pain and mobility in the anterosuperior teeth, and in a less scale in the anteroinferior, periodontal pockets of up to 8 mm, and horizontal and vertical bone losses localized in superior and inferior incisors and in the first permanent molars, confirmed in the X-rays. The indicated treatment and the evolution of the case by imaging follow-up was presented(AU)

Clinical response of early onset periodontitis to periodontal therapy supported by adjunctive tetracycline and metronidazole: long term follow-up

Early onset periodontitis EOP is infected periodontal disease, affecting individuals younger than thirty-five years old. It is characterized by a rapid rate of bone loss and disease progression with defects in host response and specific etiological microbial flora. The purpose of the study is to evaluate the response of different types of EOP not associated with systemic diseases and with Papillion- Lefevre syndrome to periodontal therapy in long-term follow-up patients 9 from 6 families were studied, exhibiting localized EOP [LEOP] and generalized EOP [GEOP] aged from 3-21 years old. Clinical and radiographic examination were performed. Initial phase of treatment composed of oral hygiene instructions, hygiene instructions, scaling and root planning, subgingival irrigation with anti microbial agent and surgery. Adjunctive antibiotic tetracycline in LEOP or metronidazole + amoxycillin in GEOP. Scaling and root planning, antibiotics and the anti-inflammatory agent ibuprofen were administrated in phases of maintenance. More clinical and radiographic improvement was evident in LEOP. GEOP was characterized by an increased tendency of teeth loss during the temporary denture and acute phases. Adjunctive therapy with metronidazole gave more adequate response than tetracycline in GEOP, and acute phases of LEOP. Topical application of metronidazole was effective in resolution of persistent periodontal pockets. Puberty was associated with recurrence of inflammatory gingival overgrowth, that was controlled by ciproflex administration. lboprofen reduced dermatic hyperkeratosis of Papillon-Lefevre syndrome. Conclusion:. Periodic periodontal treatment changes the type of lesion and reduces number of infected teeth. Period of clinical improvement did not signify complete resolution of EOP. Antibiotic administration may introduce modification in periodontal environment and determine the type of response

Avaliaçäo clínica e microbiológica da utilizaçäo da doxiciclina no tratamento de pacientes com periodontite juvenil / Clinical and microbiological evaluation of the utilization of doxycycline in the treatment of patients with juvenile periodontitis

Esta pesquisa se propôs avaliar a resposta clínica e microbiológica frente a um tratamento periodontal sequenciado em dois grupos de pacientes, um submetido à raspagem e outro à raspagem e antibiótico. Observou-se a resposta frente à raspagem (análise 1-0), os resultados da manutençäo com e sem antibiótico (análise 2-1) e a terapia mais efetiva em retardar a recidiva clínica e microbiológica (análise 3-2). Os dados obtidos permitiram concluir que com o estabelecimento de terapias de manutençäo com raspagem näo houve diferenças clínicas significantes entre os grupos com e sem antibiótico. O antibiótico foi incapaz de eliminar totalmente o actinobacillus actinomycetemcomitans, sendo mais eficiente na eliminaçäo dos microrganismos BANA positivos nas bolsas periodontais com o passar do tempo

clinical evaluation of non-steroidal anti-inflammatory drugs [NSAIDS] as adjuncts in the management of periodontal disease

Several effectors and mediators of inflammation have been identified as principle factors in periodontal disease progression. It has been reported that topical and systemic application of flurbiprofen [non-steroidal anti-inflammatory drug] reduced the rate of alveolar bone loss as well as signs of gingival inflammation. Twenty rapidly progressive as well as juvenile periodontitis patients were included in the present study. Results of the present study showed a significant reduction in pocket, .depth and gingival index in the experimental group over the control group. Radiographs revealed more bone fill in the experimental group over the control group