Antibiotics for Periodontal Infections: Biological and Clinical Perspectives.

AIM: The review is to highlight the use of antibiotics in periodontal infections and prevent indiscriminate use of antibiotics. BACKGROUND: Periodontitis is the most common disease of the periodontal attachment apparatus, and its etiological factor can be related to the existence of virulent microorganisms in the dental plaque biofilm which harbors millions of microorganisms. In addition, the pathogenesis of this disease is greatly influenced by the host immune response that leads to the cyclic destruction and healing pattern. REVIEW RESULTS: Periodontitis is mostly treated through mechanical debridement using surgical and nonsurgical therapy. However, many times, this treatment does not render desired results due to poor patient compliance, altered immune response, or other host-related factors. This leads to the administration of antibiotics as an adjunct to mechanical debridement. Antibiotics are useful in eliminating periodontopathic microbes, but these agents should be cautiously used and prescribed only if indicated. CONCLUSION: Indiscriminate use of antibiotics can lead to unforeseen adverse effects as well as the development of resistant strains of microorganisms. CLINICAL SIGNIFICANCE: Hence, it is crucial for the dentists to know the indications, contraindications, undesirable effects, correct choice, and dosage of the antimicrobial agent before prescribing it to their patients thereby ensuring the success of periodontal therapy. Thus, the clinician should keep in mind that the antibiotics are merely adjuncts to mechanical therapy and not its replacement.

COVID-19 and Periodontitis: A Reality to Live with.

BACKGROUND: Coronavirus disease-19 (COVID-19) is a r ecent pandemic that is advancing at a r apid r ate. The future course of the disease includes severe r espiratory infection and also leads to death if unattended. Meticulous measures are necessary before attending any patient. The dental operatories and the clinic surroundings must be well sanitized so as to prevent the spread of pandemic. AIM AND OBJECTIVE: This r eview discusses in brief about the pathophysiology and course of COVID-19. Further, we discussed in detail the management aspects of patients in periodontal perspective and the sanitization procedures required for the dental clinic. REVIEW RESULTS: The SARS coronavirus enters the human circulation via the angiotensin-converting enzyme (ACE) receptors which are also found on the oral mucosal surfaces. Furin and Cathepsin L are the pro-inflammatory molecules released during pathogenesis of periodontitis and mediate the molecular pathways that help the virus invade into the host. The clinic set-up should be modified to best suit the pandemic conditions. This includes the three phases, i.e., phase I: preparatory phase; phase II: implementation phase; and phase III: follow-up. The patient management is explained based on the emergency needs of the patient based on the recent AAP classification of periodontal diseases and conditions 2017 as emergency, urgent, and elective treatment needs which have been explained in detail. CONCLUSION: It can be strongly concluded that there is direct relationship between oral health and systemic health. The treatment procedures and sanitization protocols must be definitely modified. Further consensus and systematic reviews help us arriving at a more standardized protocol. CLINICAL SIGNIFICANCE: This review would help clinicians modify the way they treat patients in the clinic and provide better services depending upon the emergency needs of the patient.