Text book Antibiotics and Antiseptics in Periodontal Therapy 2011 by Alexandrina L. Dumitrescu PDF

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Antibiotics and Antiseptics in Periodontal Therapy Alexandrina L. Dumitrescu Antibiotics and Antiseptics in Periodontal Therapy Author Dr. Alexandrina L. Dumitrescu University of Tromsø Institute of Clinical Dentistry Department of Periodontology 9037 Tromsø Norway [email protected]...

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Antibiotics and Antiseptics in Periodontal Therapy

Alexandrina L. Dumitrescu

Antibiotics and Antiseptics in Periodontal Therapy

Author Dr. Alexandrina L. Dumitrescu University of Tromsø Institute of Clinical Dentistry Department of Periodontology 9037 Tromsø Norway [email protected]

ISBN 978-3-642-13210-0 e-ISBN 978-3-642-13211-7 DOI 10.1007/978-3-642-13211-7 Springer Heidelberg Dordrecht London New York Library of Congress Control Number: 2010937957 © Springer-Verlag Berlin Heidelberg 2011 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the German Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: eStudio Calamar, Figueres/Berlin Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com)

Preface

Periodontitis is defined as an inflammatory disease of the periodontium characterized by inflammation of the gingival and adjacent attachment apparatus, illustrated by loss of clinical attachment due to destruction of the periodontal ligament and loss of the adjacent supporting bone. Periodontitis represents the major cause of tooth loss in adults leading to long-term disability and increased treatment needs. It is well established that the various periodontal diseases are caused by bacterial infection. Dental plaque was defined as “matrix-enclosed bacterial populations adherent to each other and/or to surfaces or interfaces”. Dental plaque is a microbial biofilm, a diverse microbial community found on the tooth surface embedded in a matrix of polymers of bacterial and salivary origin. This complex biofilm may offer some protection from the host’s immunologic mechanisms as well as chemotherapeutic agents used for treatment. It is therefore logical to do first the mechanical removal and disruption of the dental plaque biofilm itself. Antimicrobial agents are used extensively in both medicine and dentistry to eliminate infection. These drugs are also widely used as a prophylaxis to prevent infection in the “at risk” patient. This book is a collection of data from scientific papers and textbooks found to be important for the understanding of the antibiotics and antiseptics used in the periodontal therapy. This book is addressed to dentists, periodontologists, undergraduate and postgraduate dental students, dental hygienists, and other co-associated professionals. Alexandrina L. Dumitrescu

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Contents

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Antimicrobial Resistance of Dental Plaque Biofilm ............................... 1.1 Characteristics of Dental Plaque as a Bacterial Biofilm ....................... 1.1.1 Biofilm Formation ................................................................... 1.1.2 Architecture of Dental Plaque Biofilm .................................... 1.1.3 Microbial Composition of Dental Plaque ................................ 1.1.4 Importance of Biofilms in Human Diseases ............................ 1.2 Mechanisms of Biofilm Resistance Against Antimicrobials ................ 1.2.1 Biofilm Impermeability to Antimicrobial Agents .................... 1.2.2 Altered Growth Rates in Biofilm Organisms ........................... 1.2.3 The Biofilm Microenvironment Antagonizing Antimicrobial Activity ............................................................. 1.2.4 The Role of Horizontal Dissemination in the Biofilm ............. 1.2.5 Communications Systems (Quorum Sensing) ......................... 1.2.6 Antibiotic Susceptibility of Bacterial Species Residing in Biofilms ................................................................ 1.2.7 Role for Drug Delivery Systems for Combating Bacterial Resistance of Biofilm ....................... References..................................................................................................... The Prophylactic Use of Antibiotics in Periodontal Therapy ................ 2.1 Levels of Bacteremia Associated with Interventional Procedures and Everyday Activities ..................................................... 2.1.1 Frequency of Bacteremia Associated with Dental Procedures and Oral Activities............................. 2.1.2 Nature of Bacteremia Associated with Dental Procedures and Oral Activities ..................................... 2.1.3 Magnitude of Bacteremia Associated with Dental Procedures and Oral Activities............................. 2.1.4 Duration of Bacteremia Associated with Dental Procedures and Oral Activities............................. 2.1.5 Impact of Dental Disease on Bacteremia ................................. 2.1.6 Impact of Oral Hygiene on Bacteremia ................................... 2.1.7 Impact of Type of Dental Procedure on Bacteremia ................ 2.1.8 Impact of Antibiotic/Antiseptic Therapy on Bacteremia ......... 2.1.9 Cumulative Risk over Time of Bacteremias from Routine Daily Activities Compared with the Bacteremia from a Dental Procedure .........................

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2.2 Prophylaxis of Infective Endocarditis ................................................... 2.2.1 Pathogenesis of IE.................................................................... 2.2.2 Clinical Features of IE ............................................................. 2.2.3 Identification of At-Risk Patients for Occurrence or Mortality from Endocarditis ....................... 2.2.4 Identification of At-Risk Dental Procedures ............................ 2.2.5 Recommended Prophylactic Regimens for Dental Procedures .............................................................. 2.2.6 Discussion ................................................................................ 2.3 Antibiotic Prophylaxis before Invasive Dental Procedure in Patients with Joint Replacements .................................... 2.3.1 Existing Guidelines .................................................................. 2.4 The Prevention of Infection Following Dental Surgical Procedures..... 2.4.1 The Asplenic Patient ................................................................ 2.4.2 Transplantation Patients ........................................................... 2.4.3 Hematological Patients ............................................................ 2.4.4 HIV Infection ........................................................................... References..................................................................................................... 3

The Systemic Use of Antibiotics in Periodontal Therapy ...................... 3.1 Advantages of Systemic Antibiotic Therapy in Periodontics ............... 3.2 Disadvantages of Systemic Antibiotic Therapy in Periodontics ........................................................................ 3.3 Efficacy of Systemic Antibiotic Therapy in Periodontics ..................... 3.4 Microbiological Analysis ...................................................................... 3.5 Drug Interactions................................................................................... 3.6 Antibiotic Regimens in Periodontal Therapy ........................................ 3.6.1 Single Antibiotic Regimes ....................................................... 3.6.2 Combination Antimicrobial Therapy ....................................... 3.6.3 Sequencing of Antibiotic Therapy ........................................... 3.7 Adverse Effects ..................................................................................... 3.8 Discussions of Available Data Regarding Effectiveness of Systemic Antibiotics in Periodontal Therapy ............. 3.8.1 Plaque Index Change ............................................................... 3.8.2 Gingival Inflammation ............................................................. 3.8.3 PD and CAL Change ............................................................... 3.8.4 Alveolar Bone Loss.................................................................. 3.8.5 Gingival Crevicular Fluid Changes .......................................... 3.9 Limitations of Available Data ............................................................... 3.9.1 The Type of the Periodontal Disease ....................................... 3.9.2 The Number of Subjects .......................................................... 3.9.3 Characteristics of the Study Population ................................... 3.9.4 The Nature of the Clinical Measurements Performed in the Studies .......................................................... 3.9.5 The Prescribed Antibiotics and Their Dosage and Duration of Administration.................. 3.9.6 Characteristics of the Interventions.......................................... 3.9.7 The Study Design.....................................................................

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3.10 What Dosage to Use? ......................................................................... 3.11 Considering Systemic Antibiotics as Monotherapy in the Treatment of Periodontal Disease?........................................... 3.12 Implications of Systemic Antibiotics as an Adjunct to Nonsurgical and Surgical Therapy ................................... 3.13 Recommendations for Treating Periodontitis with Antibiotics .......... 3.14 Final Considerations ........................................................................... References..................................................................................................... 4

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The Topical Use of Antibiotics in Periodontal Pockets ........................... 4.1 Advantages and Disadvantages of Local Antimicrobial Agent Pocket Delivery ................................................... 4.2 Antibiotics for Topical Use in Periodontal Therapy ............................. 4.2.1 Tetracycline-HCl ...................................................................... 4.2.2 Minocycline ............................................................................. 4.2.3 Doxycycline ............................................................................. 4.2.4 Metronidazole .......................................................................... 4.3 Comparison of Treatment Methods....................................................... 4.4 Antimicrobial Effects of Local Delivery Agents .................................. 4.5 Appropriate Time to Employ Local Drug Delivery: Active Versus Maintenance Therapy..................................................... References..................................................................................................... The Use of Chemical Supragingival Plaque Control in Periodontal Therapy................................................................ 5.1 Delivery Methods Vehicles for Periodontal Health Benefits ................ 5.1.1 Mouth rinses............................................................................. 5.1.2 Gels .......................................................................................... 5.1.3 Dentifrices ................................................................................ 5.1.4 Chewing-Gums ........................................................................ 5.1.5 Varnishes .................................................................................. 5.1.6 Dental Floss, Toothpicks, and Other Interdental Aids ............. 5.2 Chemotherapeutic Agents ..................................................................... 5.2.1 Bisguanide Antiseptics............................................................. 5.2.2 Quaternary Ammonium Compounds ....................................... 5.2.3 Detergents ................................................................................ 5.2.4 Essential Oils ........................................................................... 5.2.5 Phenols ..................................................................................... 5.2.6 Metal Salts ............................................................................... 5.2.7 Enzymes ................................................................................... 5.2.8 Natural Products....................................................................... 5.2.9 Oxygenating Agents................................................................. 5.2.10 Fluorides .................................................................................. 5.2.11 Amino-Alcohols....................................................................... 5.2.12 Iodine ....................................................................................... 5.2.13 Chlorine Compounds ............................................................... 5.2.14 Other Antiseptics ..................................................................... References.....................................................................................................

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Nonsteroidal Anti-inflammatory Drugs ................................................... 6.1 Pathways of Arachidonic Acid Metabolism.......................................... 6.2 Arachidonic Acid Pathway and Periodontal Disease ............................ 6.3 Classification of NSAIDs ...................................................................... 6.4 Effect of NSAIDs on Periodontal and Peri-implant Disease Progression .............................................................................. 6.4.1 Animal Studies ......................................................................... 6.4.2 Human Studies ......................................................................... 6.5 Side Effects of NSAIDs ........................................................................ References.....................................................................................................

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Index .................................................................................................................... 285

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Antimicrobial Resistance of Dental Plaque Biofilm Alexandrina L. Dumitrescu and Masaru Ohara

For a decade, many microbiologists have been attracted to new emerging concepts such as polymicrobial diseases, heterogeneous biofilms, and multispecies communities. The recent advent of molecular technologies, namely the 16S rRNA gene clone library, fluorescence in situ hybridization, and checkerboard DNA–DNA hybridization, has shed new light on dental biofilm research. We now have a much clearer view of the diversity of oral bacteria present in the human oral cavity. Nevertheless, the available information on dental biofilms remains limited. These technologies have allowed for a fragmented observation of these communities, but a full picture of the bacterial interactions and their functions is still lacking. Furthermore, many bacterial species detected in dental biofilms remain uncultured. To further our understanding, a combination of multiple approaches, ranging from the investigation of pure cultures and in vitro biofilm model systems to animal models and human investigation studies, should be undertaken. The development of technologies that enable us to analyze putative functions and metabolisms of a complete dental biofilm may be necessary. Such efforts could contribute to the elucidation of ecological constraints that govern multispecies communities, and help develop novel methods of controlling dental biofilms [42]. Biofilms commonly form in a variety of environments including those relevant to public health. Organisms that grow in a biofilm have distinct advantages, including protection from the effects of antimicrobial agents.

Several mechanisms have been proposed to explain how biofilms convey antimicrobial resistance [19].

1.1 Characteristics of Dental Plaque as a Bacterial Biofilm A biofilm may be defined as a sessile community of cells, characterized by a stable, irreversible union to a substratum, interface, or to each other, embedded in a matrix of extracellular polymeric products which it has synthesized and exhibits a different phenotype with respect to growth rate and gene expression from that of planktonic organisms [78]. Organization of microorganisms within biofilms confers, on the component species, properties which are not evident with the individual species grown independently or as planktonic populations in liquid media [25]. The basic biofilm properties are [66]: •฀ Cooperating community of various types of microorganisms: Microorganisms are arranged in microcolonies. •฀ Microcolonies are surrounded by protective matrix. •฀ Within the microcolonies are differing environments. •฀ Microorganisms have primitive communication systems. •฀ Microorganisms in biofilm are resistant to antibiotics, antimicrobials, and host response.

1.1.1 Biofilm Formation M. Ohara Hiroshima University Hospital, Dental Clinic 1-1-2, Kagamiyama, Higashi-Hiroshima 739-0046, Japan e-mail: [email protected]

At present, we know that bacteria form biofilms in essentially the same way, irrespective of the ecosystem

A.L. Dumitrescu, Antibiotics and Antiseptics in Periodontal Therapy, DOI: 10.1007/978-3-642-13211-7_1, © Springer-Verlag Berlin Heidelberg 2011

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they inhabit. The process of forming a biofilm depends on different variables, such as the species of bacteria, the composition of the surface, environmental factors, and essential gene products, and is regulated, at least in part, by the quorum sensing system. In an oversimplified version, adhesion is mediated, in the first stage, by nonspecific interactions, followed, in the second stage by the production of specific molecular interactions (by lectin, adhesin, or ligand). In brief, it is possible to differentiate three phases: primary bacterial adhesion; surface conditioning; and secondary bacterial adhesion. Primary bacterial adhesion comprises a random meeting between a conditioned surface and a planktonic bacterium. This stage is reversible and depends on physicochemical variables. First, the organism must be brought into close approximation with the surface, either propelled randomly by a stream of fluid flowing over a surface, for example, or in directed fashion, via chemotaxis and motility. After that, electrostatic interactions, for example, tend to favor repulsion, because most bacteria and inert surfaces are negatively charged and it seems that this factor is important during primary adhesion. However, primary contact generally occurs between an organism and a conditioned surface and hydrophobic conditions can vary greatly. The second stage of adhesion is the anchoring phase, in which binding is mediated by specific molecular adhesi...