tetracycline and Dental-Plaque

Refractory periodontitis appears to be a patient phenomenon with a clinical pattern that may be the result of different influences including genetic factors and exogenous factors that alter the host response to the bacterial challenge. Different patients may have different mechanisms involved in their disease and therefore may show different response patterns following therapy. Although localized non-responsive sites in otherwise responsive patients should not be considered refractory periodontitis, such sites do present substantial therapeutic problems. Initial evidence suggests that local delivery tetracycline provides significant advantages in the management of such sites. Although refractory periodontitis cases appear to be primarily the result of host alterations, the most predictable approach to therapy at present involves systemic antibiotics in conjunction with local therapy. The goal of antibiotic therapy should be to eliminate from detection the target bacteria that were present prior to therapy. Good plaque control, regular professional maintenance therapy, regular microbial monitoring, and control of risk factors are important aspects of the long term maintenance of these cases.

Topics: Anti-Bacterial Agents; Bacteria; Dental Plaque; Disease Susceptibility; Drug Delivery Systems; Humans; Periodontitis; Risk Factors; Tetracycline

Because bacterial plaque is composed chiefly of micro-organisms, use of chemotherapeutic agents directed against a susceptible flora would seem a conceptually valid therapeutic modality, in terms of inhibition of plaque, for the prevention and treatment of periodontal disease. The objective of treatment largely dictates the modality used. If, for example, the philosophy of treatment is elimination or reduction of pocket depth, chemotherapy against supragingival plaque may complement mechanical oral hygiene in the absence of a plaque-free environment. On the other hand, access to the subgingival flora can only be achieved through systemic administration of drugs or the use of controlled delivery systems. Notwithstanding their potential benefit as adjunctive therapy, in cases of refractory periodontitis and juvenile periodontitis in which elimination of Actinobacillus actinomycetemcomitans by mechanical debridement alone is extremely difficult, the potential for adverse reactions from the administration of antibiotics must be weighed and their use, in general, considered unwarranted. The dynamics of the inter-relationship between supragingival and subgingival plaque necessitates control of both for the successful treatment of periodontal disease. Although there are chemical agents that have been shown to be effective in the treatment of gingivitis, the evidence pertaining to their effectiveness in the treatment of periodontitis, either alone or in conjunction with conventional therapy, is inconclusive. If specific microbial floras are associated with different forms of periodontal disease, chemotherapeutic agents to which such micro-organisms are susceptible would have to be employed for their elimination. Until accurate predictors of disease activity--including definitive indicators of which particular sites are, at any one time, actively undergoing attachment loss--are available, the use of chemotherapeutic agents directed at the subgingival flora appears extremely limited and impractical. However, with the development of predictors of disease activity, including sophisticated methods of determining even small increments of attachment loss, new drugs, and a better understanding of subgingival ecologic systems, chemotherapy may yet play a significant role in the treatment of periodontal disease.

Topics: Dental Plaque; Humans; Metronidazole; Periodontal Diseases; Tetracycline

The present communication attempts to summarize some of the features of attachment loss which are of interest to the clinician and the statistician analyzing data from clinical trials. These include the measurements employed to detect changes in attachment level, the nature of the destructive disease process and the effects of therapy on the attachment level measurements. Although there are several difficulties associated with the attachment level measurement, at the present time it appears to be the best estimator of periodontal attachment available. The overall standard deviation of this measurement in greater than 46,000 replicate measurements at periodontal sites in 58 subjects was 0.78 mm (range 0.4 to 1.2 mm). In the periodontally healthy subject, the length of the attachment measured around 28 teeth is approximately 700 mm. Therefore, there are approximately 1400 adjacent points along the periodontal attachment where a measurement could be made using a periodontal probe with a 0.5 mm diameter tip. If 6 measurements were recorded per tooth, then approximately 12% of the possible probable points would be evaluated. Recent data indicate that destructive periodontal diseases progress with acute bursts of activity rather than as slowly progressive, continual processes. Such findings suggest new models of attachment loss progression. In one likely model, destructive periodontal diseases would progress by asynchronous bursts of activity at individual sites which occur with greater frequency during a finite period of time in an individual's life. 3 major patterns of attachment loss could be distinguished when frequency distributions of attachment level measurements were constructed for 61 destructive periodontal disease subjects. Pattern I (30 subjects) exhibited a bimodal distribution with localized destruction occurring at less than 34% of sites. Pattern II (14 subjects) exhibited more widespread disease (greater than 33% of sites affected) with a trimodal frequency distribution. Pattern III (17 subjects) exhibited a unimodal distribution in which virtually all sites were affected. The proportions of Fusobacterium nucleatum, Streptococcus intermedius and Eikenella corrodens in subgingival plaque samples were significantly elevated in sites of subjects with patterns II and III (the widespread disease groups). Bacteroides intermedius, Streptococcus uberis and Actinobacillus actinomycetemcomitans were elevated in sampled sites of localized disease subjects

Topics: Adult; Bacterial Physiological Phenomena; Dental Cementum; Dental Enamel; Dental Plaque; Epithelial Attachment; Humans; Models, Biological; Periodontal Diseases; Periodontal Pocket; Periodontium; Surgical Flaps; Tetracycline; Time Factors

Periodontal diseases are common oral diseases that afflict all humans to some degree. The major aetiological agent is dental plaque--the complex microflora which forms on teeth in the absence of effective oral hygiene. The interaction of the microbial flora and the periodontal tissues produces an inflammatory response and tissue breakdown. Recent information has categorized periodontal diseases on the basis of increased knowledge about the particular microorganisms associated with the different clinical conditions. In addition, the important role of host defences, in particular the phagocytic cellular elements, has allowed for a better understanding of the pathological processes. This knowledge is contributing towards the development of rational and effective therapy for all forms of periodontal diseases. Because of the widespread occurrence of periodontal diseases and their potential relationships to systemic conditions, it is important that medical practitioners should be able to recognize, and be conversant with methods of treatment of, these diseases.

Topics: Acute Disease; Adult; Child; Chronic Disease; Dental Plaque; Gingivitis; Gingivitis, Necrotizing Ulcerative; Humans; Metronidazole; Oral Hygiene; Periodontal Diseases; Periodontal Pocket; Periodontitis; Periodontium; Stomatitis, Herpetic; Tetracycline

Attempts to control plaque by chemical means using enzymes, antibiotics and antiseptics are reviewed. Enzymes such as mucinase, dehydrated pancreas, enzymes of fungal origin, dextranase and mutanase showed limited clinical success despite promising in vitro and animal studies. Side effects from the use of enzymes were observed. Many antibiotics have been used in attempts to control plaque and several have been successful. However, problems exist from the long-term use of such drugs which precludes their routine use as agents for controlling plaque. The biguanide chlorhexidine is the most widely used and investigated method of chemical plaque control. Many studies have been demonstrated that it will successfully control plaque. No toxic side effects have been reported from its long-term use but local side effects such as staining of the teeth do occur. The quaternary ammonium compounds have at present no advantages over the biguanides and require more frequent usage to achieve the same degree of plaque control as chlorhexidine.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Dental Plaque; Dextranase; Enzyme Therapy; Humans; Quaternary Ammonium Compounds; Tetracycline; Vancomycin

Of the plaque-control agents studied, it would appear that chlorhexidine is the most suitable agent to prevent plaque accumulation and the development of gingivitis. It also is attractive to speculate on the possibilities of a commercially available mouthwash. A trio of antibiotics--kanamycin, spiramycin, and vancomycin--may prove of value in the treatment of severe gingival and periodontal disease. The ultimate role of xylitol has yet to be determined. Regardless of the agent selected, access to the gingival sulcus region seems critical.

Topics: Anti-Bacterial Agents; Benzalkonium Compounds; Biguanides; Cetylpyridinium; Chlorhexidine; Dental Plaque; Dextranase; Drug Therapy; Erythromycin; Fluorides; Glycosides; Humans; Iodine; Kanamycin; Leucomycins; Pancreatin; Penicillins; Quaternary Ammonium Compounds; Tetracycline; Vancomycin; Xylitol

This clinical study evaluated the influence of scaling and root planning (SRP), with and without the use of tetracycline-loaded bovine absorbent membrane, in the reduction of periodontal pockets according to 3 parameters: probing pocket depth (PPD), bleeding on probing (BOP) and plaque index (PI). Twenty-four patients were selected totalizing 144 random teeth divided in 2 groups (n=72 teeth) - control (SRP) and experimental (SRP with tetracycline-loaded absorbent membrane). PPD, BOP and PI were determined before and 28 days after the treatment. In all patients, the PPD values at the end of the treatment were always lower than the baseline values. There was a reduction of the PI for both treatments, but it was more evident on the experimental group. In conclusion, the use of tetracycline-loaded absorbent membrane could result in a better prognosis compared to scaling and root planning after only 28 days of evaluation.

Topics: Adult; Animals; Anti-Bacterial Agents; Cattle; Dental Plaque; Dental Plaque Index; Dental Scaling; Drug Delivery Systems; Female; Humans; Male; Membranes, Artificial; Periodontal Index; Periodontal Pocket; Tetracycline

The aim of our study was to evaluate the clinical, radiological and microbiological response to the local delivery of tetracycline (TE) of sites with persistent periodontal lesions.. The study was conducted in a split-mouth design. Nineteen patients with at least four bilateral pockets 4-5 mm and bleeding on probing (BOP) were treated with scaling and root planing (SRP) plus TE fibres (test sites) or with SRP alone (control sites). Clinical and radiological measurements were taken at baseline, 6 months and 12 months post-operatively. Subgingival plaque samples were collected at baseline, at fibres removal, 6 and 12 months following treatment and analysed by polymerase chain reaction.. Both treatments yielded a statistically significant (p<0.05) reduction of probing depth (2.05 and 1.21 mm), gain of clinical attachment level (1.71 and 0.53 mm) and reduction of BOP scores (23.68% and 57.89%) for TE and SRP groups, respectively, when comparing 12-month data with baseline. The differences between two groups were significant. The prevalence of Treponema denticola and Bacteroides forsythus decreased after therapy in both groups but only in the test sites Actinobacillus actinomycetemcomitans and Prevotella intermedia were not yield detected. The pathogens could be eliminated from five periodontal pockets by SRP alone, while 21 TE sites were not recolonized at 12 months.. SRP plus TE fibres gave the greatest advantage in the treatment of periodontal persistent lesions at least 12 months following treatment.

Topics: Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Bacteroides; Cellulose; Dental Plaque; Dental Scaling; Drug Delivery Systems; Female; Follow-Up Studies; Gingival Hemorrhage; Humans; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Prevotella intermedia; Root Planing; Tetracycline; Treponema

Tetracyclines have been extensively used as adjunctives to conventional periodontal therapy. Emergence of resistant strains, however, has been reported. This study evaluated longitudinally the tetracycline resistance patterns of the subgingival microbiota of periodontitis subjects treated with systemic or local tetracycline therapy+scaling and root planing (SRP).. Thirty chronic periodontitis patients were randomly assigned to three groups: SRP+500 mg of systemic tetracycline twice/day for 14 days; SRP alone and SRP+tetracycline fibers (Actsite) at four selected sites for 10 days. Subgingival plaque samples were obtained from four sites with probing pocket depths (PPD)> or =6 mm in each patient at baseline, 1 week, 3, 6 and 12 months post-therapy. Samples were dispersed and diluted in pre-reduced anaerobically sterilized Ringer's solution, plated on Trypticase Soy Agar (TSA)+5% blood with or without 4 microg/ml of tetracycline and incubated anaerobically for 10 days. The percentage of resistant microorganisms were determined and the isolates identified by DNA probes and the checkerboard method. Significance of differences among and within groups over time was sought using the Kruskal-Wallis and Friedman tests, respectively.. The percentage of resistant microorganisms increased significantly at 1 week in the tetracycline groups, but dropped to baseline levels over time. The SRP+Actsite group presented the lowest proportions of resistant species at 6 and 12 months. No significant changes were observed in the SRP group. The predominant tetracycline-resistant species included Streptococcus spp., Veillonela parvula, Peptostreptococcus micros, Prevotella intermedia, Gemella morbillorum and Actinobacillus actinomycetemcomitans (Aa). A high percentage of sites with resistant Aa, Porphyromonas gingivalis and Tanerella forsythensis was observed in all groups at baseline. However, T. forsythensis was not detected in any group and P. gingivalis was not present in the SRP+Actsite group at 1 year post-therapy. Aa was still frequently detected in all groups after therapy. However, the greatest reduction was observed in the SRP+Actsite group.. Local or systemically administered tetracycline results in transitory selection of subgingival species intrinsically resistant to this drug. Although the percentage of sites harboring periodontal pathogens resistant to tetracycline were quite elevated in this population, both therapies were effective in reducing their prevalence over time.

Topics: Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Bacteroides; Cellulose; Dental Plaque; Dental Scaling; Drug Delivery Systems; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Middle Aged; Peptostreptococcus; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Root Planing; Streptococcus; Tetracycline; Tetracycline Resistance; Veillonella

Class II furcations present difficult treatment problems and historically several treatment approaches to obtain furcation fill have been used.. The response of mandibular Class II facial furcations to treatment with either bioactive glass (PG) bone replacement graft material or expanded polytetrafluoroethylene (ePTFE) barrier membrane was evaluated in 27 pairs of mandibular molars in 27 patients with moderate to advanced periodontitis. Following initial preparation, full thickness flaps were raised in the area being treated, the bone and furcation defects debrided of granulomatous tissue, and the involved root surfaces mechanically prepared and chemically conditioned. By random allocation, PG or ePTFE was placed into or fitted over the furcations, packed or secured in place, and the host flap replaced or coronally positioned with sutures. Postsurgical deplaquing was performed every 10 days leading up to ePTFE removal at about 6 weeks. Continuing periodontal maintenance therapy was provided until surgical reentry at 6 months for documentation and any further necessary treatment.. Direct clinical measurements demonstrated essentially similar clinical results with both treatments for bone and soft tissue changes. There were no statistically or clinically significant differences (e.g., mean horizontal furcation fill 1.4 mm PG, 1.3 mm ePTFE; mean percent horizontal furcation fill 31.6% PG, 31.1% ePTFE, both P>0.85). Seventeen of the PG treated and 18 of the ePTFE furcations became Class I clinically and 1 furcation completely closed clinically with each treatment. Intrapatient comparisons showed similar horizontal furcation responses with both treatments.. The findings of this study suggest essentially equal clinical results with PG bone replacement graft material and e-PTFE barriers in mandibular molar Class II furcations. PG use was associated with simpler application and required no additional material removal procedures.

Topics: Adult; Aged; Analysis of Variance; Anti-Bacterial Agents; Bone Substitutes; Ceramics; Debridement; Dental Plaque; Female; Follow-Up Studies; Furcation Defects; Gingival Recession; Humans; Male; Mandible; Membranes, Artificial; Middle Aged; Molar; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Polytetrafluoroethylene; Statistics, Nonparametric; Surgical Flaps; Tetracycline; Tooth Root; Treatment Outcome

Whether adjunctive tetracycline fibers can provide an additive effect to scaling and root planing in treating non-responsive sites in maintenance subjects is still controversial. Recolonization of the bacteria from untreated sites or from the extracrevicular region may explain the insignificant response to local therapy. The purpose of the present study was to evaluate the microbiological response of sites treated with tetracycline fibers combined with scaling and root planing.. The study was conducted in a split-mouth design. Thirty patients on maintenance therapy having at least 2 non-adjacent sites in separate quadrants with probing depths between 4 to 8 mm with bleeding on probing, or aspartate aminotransferase enzyme levels > 800 microIU in the gingival crevicular fluid, were treated with scaling and root planing plus tetracycline fibers or with scaling and root planing only. Subgingival plaque samples were collected at baseline, and 1, 3, and 6 months following treatment. A. actino-mycetemcomitans, C. rectus, B. forsythus, E. corrodens, F. nucleatum, P. gingivalis, and P. intermedia were detected by culture, immunofluorescence, or PCR technique.. There was a reduction of total bacterial cell count, as well as of certain periodontal pathogens, following treatment. The prevalence of A. actinomycetemcomitans, B. forsythus, and P. gingivalis and the mean proportions of C. rectus, P. intermedia, F. nucleatum, and P. gingivalis decreased after therapy, but there was no statistically significant difference between the 2 treatment groups with respect to bacterial proportions or the number of positive sites. Besides, the pathogens could not be eliminated from the periodontal pocket, and recolonization of the pocket was noted at 3 months post-treatment.. Bacteria located within the cheek, tongue mucosa, saliva, or untreated sites may contribute to reinfection of the pockets and explain the insignificant response to local tetracycline therapy.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Analysis of Variance; Anti-Bacterial Agents; Bacteria, Anaerobic; Bacteroides; Campylobacter; Colony Count, Microbial; Dental Plaque; Eikenella corrodens; Female; Fusobacterium nucleatum; Humans; Male; Microbial Sensitivity Tests; Multivariate Analysis; Periodontitis; Porphyromonas gingivalis; Prevotella intermedia; Secondary Prevention; Tetracycline

A biocompatible microporous composite of PMMA (poly-methyl-methacrylate), PHEMA (poly-hydroxy-ethyl-methacrylate) and calcium hydroxide bone replacement graft material (Bioplant HTR Synthetic Bone) was evaluated in 16 maxillary molar and 10 mandibular molar Grade II furcations in 13 patients. Following initial preparation, full thickness flaps were raised to gain access to the furcations; mechanical hand and ultrasonic root and defect debridement and chemical tetracycline root preparation were performed; furcation and adjacent osseous defects in each patient were grafted with HTR Synthetic Bone; and the host flaps replaced or slightly coronally positioned. Weekly, then monthly deplaquing was performed until surgical re-entry at 6-12 months. Patients were then followed on approximate 3-month recalls for > or = 6 yr. Evaluation of the primary clinical outcome of furcation grade change showed that in the maxilla 5/16 furcations were clinically closed, 9/16 were Grade I, and 2/16 remained Grade II; while in the mandible 3/10 were clinically closed, 5/10 were Grade I, and 2/10 remained Grade II. Other significant clinical changes included decrease in mean horizontal furcation probing attachment level from 4.4 mm at surgery to 2.2 mm at re-entry to 2.0 mm at 6 yr, decrease in probing pocket depth from 5.4 mm at surgery to 3.0 mm at re-entry to 3.2 mm at 6 yr, and improvement in vertical clinical probing attachment level from 5.4 mm at surgery to 4.2 mm at re-entry to 4.1 mm at 6 yr (all p < 0.05 from surgery to re-entry and surgery to 6 yr, n.s. from re-entry to 6 yr via ANOVA). These favorable results with HTR polymer are similar to several reports with other graft materials and with GTR barriers, and suggest that HTR polymer may have a beneficial effect in the clinical management of Grade II molar furcations.

Topics: Adult; Alveoloplasty; Analysis of Variance; Anti-Bacterial Agents; Biocompatible Materials; Bone Substitutes; Composite Resins; Debridement; Dental Plaque; Evaluation Studies as Topic; Female; Follow-Up Studies; Furcation Defects; Humans; Male; Mandible; Maxilla; Methylmethacrylates; Middle Aged; Molar; Periodontal Attachment Loss; Periodontal Pocket; Polyhydroxyethyl Methacrylate; Reoperation; Root Planing; Surgical Flaps; Tetracycline; Treatment Outcome; Ultrasonic Therapy

The purpose of this investigation was to evaluate the clinical efficacy of controlled-release tetracycline fiber therapy in adult periodontitis patients. One hundred-twenty-two (122) adult patients from 3 dental centers were enrolled at baseline for this study. each patient provided at least one site in each of four quadrants that was > or = 5 mm and bled on probing. One or two such sites were selected as test sites and were randomly assigned to receive one of four treatments: scaling and root planing (S), scaling and root planing plus tetracycline fiber for 10 days (SF), fiber therapy alone for 10 days (F), or two 10-day serial fiber applications (FF). After treatment, no periodontal maintenance or supportive care was provided until the end of this 12-month study. Probing depth (PD), clinical attachment level (CAL), plaque, and bleeding on probing (BOP) were measured at baseline and at 1, 3, 6, 9, and 12 months following treatment. Repeated PD and CAL measurements were taken at three locations within each site and averaged for each site. One hundred-sixteen (116) subjects completed the study. All treatments resulted in similar improvements in clinical parameters compared to baseline and were equally effective in the treatment of periodontitis as measured by probing depth reduction, clinical attachment level gain, and reduction of bleeding on probing. The clinical response, established primarily by 3 months following therapy, was generally sustained in all treatment groups for 12 months without the benefit of supportive maintenance therapy.

Topics: Adult; Aged; Anti-Bacterial Agents; Combined Modality Therapy; Delayed-Action Preparations; Dental Plaque; Dental Scaling; Drug Implants; Female; Follow-Up Studies; Gingival Hemorrhage; Humans; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Reproducibility of Results; Root Planing; Single-Blind Method; Tetracycline

The purpose of this investigation was to examine periodontal disease recurrence from 3 to 12 months following various treatments with scaling and root planing and controlled-release tetracycline fibers. One-hundred-twenty-two (122) adult volunteers with at least one bleeding pocket > or = 5 mm in each of four quadrants were enrolled in this study. One or two such sites in each quadrant were selected as test sites. Quadrants were randomly assigned to receive one of four treatments: scaling and root planing (S); scaling and root planing plus tetracycline fiber for 10 days (SF); fiber therapy alone for 10 days (F); or fiber therapy alone for 20 days (FF). After treatment, no supportive care was provided during the 12-month study period. Probing depth (PD), attachment loss (AL), plaque, and bleeding on probing were measured at baseline, and at 1, 3, 6, 9, and 12 months after treatment. PD and AL measures were taken at three locations within each site and averaged for each site. Disease recurrence was defined as > or = 1 mm mean attachment loss at a site during the 3- to 12-month period. One-hundred-sixteen (116) subjects completed the study. Sites treated with SF experienced significantly (P < 0.05) less disease recurrence (4%) than S, F, or FF (9%, 10%, and 12%, respectively). Results of this study suggest that, compared to S, F, or FF, scaling and root planing in conjunction with tetracycline fiber therapy for 10 days can significantly reduce disease recurrence 3 to 12 months following treatment in the absence of supportive care.

Topics: Adult; Anti-Bacterial Agents; Combined Modality Therapy; Delayed-Action Preparations; Dental Plaque; Dental Scaling; Drug Implants; Follow-Up Studies; Gingival Hemorrhage; Humans; Periodontal Attachment Loss; Periodontal Pocket; Periodontitis; Recurrence; Root Planing; Single-Blind Method; Tetracycline

The purpose of the present investigation was to assess the effects of periodontal surgery and 4 systemically administered agents, Augmentin, tetracycline, ibuprofen or a placebo on clinical and microbiological parameters of periodontal disease. 98 subjects were monitored at 2-month intervals at 6 sites per tooth for clinical parameters. Subgingival plaque samples were taken from the mesial surface of each tooth at each visit and evaluated for their content of 14 subgingival species using DNA probes and a colony lift method. 40 subjects who exhibited loss of attachment > 2.5 mm at 1 or more sites during longitudinal monitoring were treated using modified Widman flap surgery at sites with probing pocket depth > 4 mm, subgingival scaling at all other sites and were randomly assigned 1 of the 4 agents. Treatment was completed within 30 days during which time the subject took the assigned agent. Overall, subjects exhibited a mean attachment level "gain" of 0.34 +/- 0.10 mm (SEM) and a mean pocket depth reduction of 0.62 +/- 0.09 mm 10 +/- 4 months post-therapy. However, certain subjects in each treatment group showed a poor response. Subjects receiving antibiotics exhibited significantly more attachment level "gain" (0.57 +/- 0.15 mm, SEM) than subjects receiving either ibuprofen or a placebo (0.02 +/- 0.10). The differences between Augmentin and tetracycline groups were not significant, nor were the differences between ibuprofen and placebo. 10 months post-therapy, there was a reduction in the number of sites colonized in any subject group by detectable levels (10(3)) of P. gingivalis. Species showing similar reductions were B. forsythus, P. intermedia and P. micros. Subjects receiving systemically administered antibiotics had a significant increase in the proportion of sites colonized by C. ochracea coupled with a greater decrease in the number of sites colonized by P. gingivalis, B. forsythus, P. intermedia and P. micros post-therapy than subjects not receiving antibiotics. The results of this investigation indicate that adjunctive systemic antibiotics increase periodontal attachment "gain" and decrease the levels of some suspected periodontal pathogens in subjects with evidence of current disease progression.

Topics: Adolescent; Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Bacterial Infections; Bacteroidaceae; Chemotherapy, Adjuvant; Clavulanic Acids; Dental Plaque; Dental Scaling; Disease Progression; Drug Therapy, Combination; Female; Humans; Ibuprofen; Longitudinal Studies; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Placebos; Subgingival Curettage; Surgical Flaps; Tetracycline

In a study of the efficacy of modified Widman flap surgery and scaling and root planning accompanied by 1 of 4 systemic adjunctive agents, Augmentin, tetracycline, ibuprofen or placebo, it was observed that subjects differed in their response to therapy. The difference was only partially accounted for by the adjunctive agent employed. The purpose of the present investigation was to examine clinical and microbiological features in subjects who showed different levels of attachment change post-therapy. 40 subjects were subset into 3 groups based on mean attachment level change post-therapy. 10 poor response subjects showed mean attachment loss; 19 moderate response subjects showed mean attachment gain between 0.02-0.5 mm and 11 good response subjects showed a mean gain of attachment > 0.5 mm. Clinical parameters were measured at 6 sites per tooth both pre- and post-therapy. Microbiological samples were taken from the mesial aspect of each tooth and evaluated individually for their content of 14 subgingival taxa using a colony lift method and DNA probes. % of sites colonized by each species was computed for each subject both pre- and post-therapy. Significant differences were observed among treatment response groups for mean probing pocket depth, attachment level and % of sites with plaque pre-therapy. The poor response subjects had the lowest mean probing pocket depth and attachment level, but the highest plaque levels. Post-therapy, the poor response group exhibited the greatest degree of gingival inflammation as assessed by gingival redness and bleeding on probing.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Bacteria; Chemotherapy, Adjuvant; Clavulanic Acids; Combined Modality Therapy; Dental Plaque; Dental Scaling; Drug Therapy, Combination; Gingival Hemorrhage; Gingivitis; Humans; Ibuprofen; Middle Aged; Periodontal Attachment Loss; Periodontal Pocket; Placebos; Root Planing; Surgical Flaps; Tetracycline

The present study was conducted on 14 quadrants from seven solicited patients. After initial phase of plaque control, six different clinical parameters were recorded and scaling and root planning performed. In each of the seven patients two Modified Widman flaps were done. One served as a control and the other as experimental in which irrigation by Tetracycline-Hcl solution 100 mg/ml for 5 minutes was performed. On comparing the two treatment modalities the tetracycline-Hcl root conditioning showed a better improvement in all the clinical parameters tested. Tetracycline irrigation gave less bacterial counts than the control group right after irrigation, however after two weeks the bacterial counts increased again and were insignificantly different in the two groups.

Topics: Adult; Aged; Anti-Bacterial Agents; Chemotherapy, Adjuvant; Colony Count, Microbial; Dental Plaque; Dental Scaling; Humans; Middle Aged; Periodontitis; Surgical Flaps; Tetracycline; Tissue Conditioning, Dental

The purpose of this study was to assess the clinical and microbiological effects of a newly developed root conditioning gel system containing tetracycline or a mixture of tetracycline and citric acid on non-surgical periodontal therapy. Sixty-four (64) single-rooted teeth with a probing depth of 4 to 6 mm were randomly subjected to one of the following four treatments; 1) root planing alone (RP group); 2) tetracycline-containing gel alone (TCG group); 3) root planing plus tetracycline-containing gel (RP + TCG group); or 4) root planing plus a mixture of tetracycline and citric acid-containing gel (RP + TC-CAG group). Probing depth, attachment level, and tooth mobility were measured and the presence of dental plaque and gingival inflammation was recorded at baseline and after 2, 4, 8, and 12 weeks. Subgingival plaque samples from each site were collected at the same visits and examined with phase contrast microscopy for proportions of motile rods and spirochetes. Plaque index, gingival sulcus bleeding index (SBI), probing depth, and attachment level decreased significantly in all groups compared to the baseline values (P < 0.05). A significant decrease in probing pocket depth was noted after 12 weeks in RP + TC-CAG group compared to the other groups (P < 0.05). Significantly more gain in attachment was detected in the RP + TC-CAG group compared to the TCG group (P < 0.05). Tooth mobility scores also decreased later in the study. A significant decrease in the proportion of motile rods was found primarily in the RP + TC-CAG group.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Bacteria; Citrates; Citric Acid; Colony Count, Microbial; Combined Modality Therapy; Dental Plaque; Dental Plaque Index; Drug Combinations; Female; Gels; Gingival Hemorrhage; Gingivitis; Humans; Male; Middle Aged; Periodontal Diseases; Periodontal Index; Periodontal Pocket; Root Planing; Spirochaetales; Tetracycline; Tooth Mobility

Systemic metronidazole and tetracycline were compared as adjunctive agents in the treatment of localized juvenile periodontitis (LJP). 27 patients with Actinobacillus actinomycetemcomitans-positive (Aa) LJP were treated with scaling and rootplaning, control of oral hygiene and periodontal surgery if indicated. The patients were randomly divided into 3 equal groups: the 1st group had metronidazole 200 mg x 3 x 10 days, the 2nd tetracycline 250 mg x 4 x 12 days, the 3rd group received no medication and served as a control. 6 patients had periodontal surgery. 4 sites with the most advanced bone loss as determined on radiographs were selected in each subject for test sites. Gingival index, gingival bleeding after probing (GB), probing depth (PD), suppuration, and radiographic bone loss were registered, and subgingival Aa was selectively cultured. GB and PD > or = 4 mm were registered in the whole dentition as well. All parameters were monitored at baseline and at 6 and 18 months after treatment. By the end of the study, Aa was suppressed to below detection level at all test sites only in the metronidazole group, at 17/26 sites (4 patients) in the tetracycline group and at 19/26 sites (6 patients) in the control group. Clinically, all groups showed improvement. In conclusion, metronidazole was more effective than tetracycline in the suppression of Aa and the suppression of Aa appeared to produce better clinical results.

Topics: Adolescent; Adult; Aggregatibacter actinomycetemcomitans; Aggressive Periodontitis; Alveolar Bone Loss; Dental Plaque; Female; Gingival Hemorrhage; Humans; Male; Metronidazole; Periodontal Index; Periodontal Pocket; Radiography; Tetracycline

The purpose of this investigation was to inspect and characterize the subgingival root surface after a 10-day exposure in vivo to 25% tetracycline hydrochloride by weight in an ethylene vinyl acetate copolymer fiber matrix with and without root planing therapy. The root surfaces were examined by fluorescent-light microscopy (FLM), scanning electron microscopy (SEM), and energy dispersive spectroscopy (EDS). Thirty-two teeth were selected for study, 4 from each of 8 patients. The teeth of each patient were randomly assigned to one of four treatment groups: non-treated control (C), scaling and root planing only (RP), tetracycline-impregnated fiber only (F), and scaling and root planing with tetracycline-impregnated fiber application (RP/F). SEM revealed a visible reduction in the subgingival microbial flora in both the F and RP/F treatment groups in comparison with the C group specimens. Many of the residual bacteria observed in F and RP/F specimens appeared non-viable, exhibiting obvious loss of membrane integrity. In contrast, the RP specimens exhibited randomly distributed areas of residual subgingival plaque and calculus with newly developing plaque fronts; the plaque fronts undoubtedly having formed during the 10 days post-therapy. All RP/F specimens exhibited an incomplete removal of adsorbed root surface pellicle and demineralization of the subsequently exposed root surface. EDS analysis of large crystals adhering to root surfaces of F and RP/F specimens revealed high chloride peaks, suggesting the presence of residual tetracycline. FLM examination of F and RP/F treated specimens showed a superficial penetration of tetracycline into the root surface of about 10 microns. Areas of demineralized root showed slight tetracycline penetration into exposed dentinal tubules.

Topics: Adsorption; Adult; Bacteria; Dental Calculus; Dental Pellicle; Dental Plaque; Dental Scaling; Drug Implants; Electron Probe Microanalysis; Female; Humans; Male; Microscopy, Electron, Scanning; Microscopy, Fluorescence; Periodontitis; Polyvinyls; Root Planing; Tetracycline; Tooth Root

In vitro tests in our laboratory have shown that 40% tetracycline HCl in a white petrolatum carrier (TTC-WP) has potential as a sustained release, autodissipating system. The present study tested subgingival placement of TTC-WP via syringe in vivo. Quadrants (2 diseased sites in each) in 9 patients with moderate/severe periodontitis were randomly assigned to receive the following treatments: (1) TTC-WP; (2) WP only; (3) scaling and root planing; (4) untreated control. TTC release into gingival crevicular fluid (GCF) over time (baseline, 1, 8, 24, 72 and 168 h) was measured using an agar diffusion bioassay. Clinical parameters and subgingival bacterial morphotypes (darkfield analysis) were also evaluated over time (baseline, 2, 4, 8, 12 weeks). Results indicated that TTC-WP was easily placed into periodontal pockets and biologically effective TTC was released into GCF for at least 3 days (mean concentration = 115.8 +/- 43.1 micrograms/ml at 3 days). TTC-WP reduced probing pocket depths and bleeding on probing relative to baseline measurements for 8-12 weeks post-treatment, and reduced %s of motile rods and spirochetes, with an accompanying increase in cocci, for 2-8 weeks. Similar effects were noted in the scaled and root-planed sites, but for a longer duration. TTC-WP and WP were clinically dissipated after 2 weeks and no adverse tissue reactions were observed. From these findings, subgingival TTC-WP cannot replace scaling and root planing therapy, but has characteristics useful in subgingival plaque control.

Topics: Administration, Topical; Adult; Aged; Bacteria; Delayed-Action Preparations; Dental Plaque; Drug Carriers; Gingiva; Gingival Crevicular Fluid; Gingival Hemorrhage; Humans; Middle Aged; Periodontal Pocket; Periodontitis; Petrolatum; Tetracycline

The purpose of this study was to evaluate the duration of therapeutic effect after administration of the collagen film immobilized tetracycline (TC film). TC film or tetracycline non-immobilized placebo film was applied one time to the periodontal pocket (greater than or equal to 4 mm) of five periodontitis patients (20 teeth). The clinical and microbiological effects are summarized as follows: The group that received TC film continued to show significantly low values for bleeding upon probing the pocket depth for 3 and 4 weeks, respectively, after administration, but there was no significant difference in the plaque index or gingival index when compared with the group that received a placebo film. In the TC film group, the density of microorganisms and the proportion of motile rods and spirochetes were also significantly decreased 3 weeks after administration. These findings suggest that topically administered TC film remains both clinically and bacteriologically effective for 2 to 3 weeks.

Topics: Administration, Topical; Adult; Bacteria; Collagen; Delayed-Action Preparations; Dental Plaque; Dental Plaque Index; Female; Gingiva; Humans; Periodontal Index; Periodontal Pocket; Periodontitis; Placebos; Tetracycline

The aim of the present study was to analyze the effect of systemic antimicrobial therapy and mechanical plaque control in patients with recurrent periodontal disease. 9 patients volunteered for the combined therapy. At a baseline examination they were randomly distributed into 2 groups, one given tetracycline therapy for 2 weeks and the other metronidazole therapy for 1 week. A mechanical plaque control program comprising oral hygiene training, professional cleaning of all teeth and subgingival debridement at diseased sites was carried out at the baseline examination and at all recall visits, i.e. once every month during the first 6 months and then after 9, 12, and 18 months. The results demonstrated clinically and microbiologically that a combination of an initial antimicrobial and a continuous systematic mechanical plaque control program may be a valuable therapeutic approach in a strictly selected group of refractory patients. Recurrent periodontal lesions which still displayed severe inflammation despite renewed conventional therapy showed a marked reduction in probing depths, bleeding and suppuration from the pockets, and further, a reduced presence of spirochetes and motile rods during the trial. The results indicate that the level and longevity of success is also related to whether or not self-performed oral hygiene measures are sufficiently carried out. No superior effect of the combined program could be observed in cooperating patients receiving tetracycline as compared with those given metronidazole.

Topics: Adult; Aged; Bacteria; Combined Modality Therapy; Dental Plaque; Dental Prophylaxis; Female; Humans; Male; Metronidazole; Middle Aged; Periodontitis; Recurrence; Tetracycline

The objective of this study was to test the efficacy of scaling and root planing with or without adjunctive tetracycline therapy in the treatment of periodonitis in humans. The presence of plaque, gingival inflammation, probing depths and attachment levels was assessed for all teeth in 12 patients with chronic, advanced periodontitis. After an initial examination all patients were given detailed oral hygiene instructions. The teeth in one-half of each arch were then scaled and root planed. The teeth in the contralateral half were not treated. Six patients were given tetracycline (1 gm/day) during the first and second weeks and the seventh and eighth weeks of the trial. The study thus included four different treatment groups: 1) no treatment, 2) scaling and root planing alone, 3) tetracycline administration alone, and 4) scaling and root planing combined with tetracycline administration. All patients were reexamined at 8 and 25 weeks subsequent to the initiation of therapy. Both PlI and GI scores decreased significantly in all groups. The GI scores were significantly lower in the scaled and root planed areas as compared to the contralateral sides at both the 8- and 25-week examinations. The PlI score was lower in the scaled and root planed areas only at the 25-week interval. The gingival probing depths were reduced in all groups. A significantly greater decrease in probing depth, however, was noted in scaled and root planed areas. There was a trend to gain of attachment in the treated areas but the magnitude of the gain was very small. The findings of the trail also revealed that the administration of tetracycline had only a minor effect on the parameters examined.

Topics: Adult; Clinical Trials as Topic; Dental Plaque; Dental Prophylaxis; Dental Scaling; Female; Humans; Male; Oral Hygiene; Periodontal Index; Periodontitis; Root Canal Therapy; Tetracycline

Chlorhexidine (CHX) is used in oral care products to help control dental plaque. In this study dental plaque bacteria were grown on media containing 2 μg/ml chlorhexidine gluconate to screen for bacteria with reduced CHX susceptibility. The isolates were characterized by 16S rRNA gene sequencing and antibiotic resistance profiles were determined using the disc diffusion method.. The isolates were variably resistant to multiple drugs including ampicillin, kanamycin, gentamicin and tetracycline. Two species, Chryseobacterium culicis and Chryseobacterium indologenes were able to grow planktonically and form biofilms in the presence of 32 μg/ml CHX. In the CHX and multidrug resistant C. indologenes we demonstrated a 19-fold up-regulation of expression of the HlyD-like periplasmic adaptor protein of a tripartite efflux pump upon exposure to 16 μg/ml CHX suggesting that multidrug resistance may be mediated by this system. Exposure of biofilms of these resistant species to undiluted commercial CHX mouthwash for intervals from 5 to 60 s indicated that the mouthwash was unlikely to eliminate them from dental plaque in vivo.. The study highlights the requirement for increased vigilance of the presence of multidrug resistant bacteria in dental plaque and raises a potential risk of long-term use of oral care products containing antimicrobial agents for the control of dental plaque.

Topics: Ampicillin; Anti-Bacterial Agents; Bacteria; Bacterial Proteins; Base Sequence; Biofilms; Chlorhexidine; Chryseobacterium; Dental Plaque; Disk Diffusion Antimicrobial Tests; Drug Resistance, Microbial; Drug Resistance, Multiple, Bacterial; Gentamicins; Kanamycin; Microbial Sensitivity Tests; Microbial Viability; Mouthwashes; RNA, Ribosomal, 16S; Tetracycline; Up-Regulation

The purpose of this study was to utilize an in vitro biofilm model of subgingival plaque to investigate resistances in subgingival biofilm communities to antibiotics commonly used as adjuncts to periodontal therapy.. Biofilms were grown on saliva-coated hydroxyapatite supports in trypticase-soy broth for 4 h-10 days and then exposed for 48 h to either increasing twofold concentrations of tetracycline, amoxicillin, clindamycin, and erythromycin or therapeutically achievable concentrations of tetracycline, doxycycline, minocycline, amoxicillin, metronidazole, amoxicillin/clavulanate, and amoxicillin/metronidazole.. Concentrations necessary to inhibit bacterial strains in steady-state biofilms were up to 250 times greater than the concentrations needed to inhibit the same strains grown planktonically. In the presence of therapeutically available antibiotic concentrations, significantly higher proportions of the biofilms remained viable as the biofilms reached steady-state growth. The combinations of amoxicillin/clavulanate and amoxicillin/metronidazole were the most effective in suppressing growth. These combinations were particularly effective against biofilms up to and including 7 days of age and inhibited 90% or more of the bacteria present relative to untreated controls. As the biofilms approached steady state, these combinations were less effective with 50-60% of the bacteria retaining viability.. Most, but not all, species of subgingival bacteria are considerably more resistant in biofilms than in planktonic cultures. Resistance appeared to be age-related because biofilms demonstrated progressive antibiotic resistance as they matured with maximum resistance coinciding with the steady-state phase of biofilm growth.

Topics: Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Biofilms; Clindamycin; Dental Pellicle; Dental Plaque; Dose-Response Relationship, Drug; Doxycycline; Drug Resistance, Bacterial; Durapatite; Erythromycin; Gingiva; Gram-Negative Bacteria; Humans; Metronidazole; Middle Aged; Minocycline; Periodontitis; Tetracycline; Time Factors

To investigate the effect of triclosan exposure on the antimicrobial susceptibilities of numerically important dental bacteria.. A gradient plate technique was used to expose Fusobacterium nucleatum, Lactobacillus rhamnosus, Neisseria subflava, Porphyromonas gingivalis, Actinomyces naeslundii, Prevotella nigrescens, Streptococcus oralis, Streptococcus sanguis, Streptococcus mutans and Veillonella dispar repeatedly to escalating, sublethal concentrations of triclosan. Escherichia coli ATCC 8739 was included as an organism showing the triclosan resistance development trait. MIC values towards chlorhexidine, metronidazole and tetracycline were determined before and after biocide exposure.. N. subflava, Pr. nigrescens Po. gingivalis and E. coli were highly susceptible to triclosan (MIC range 0.1-3.9 mg/L), whereas the lactobacillus and S. mutans were less susceptible (MIC range 15.6-20.8 mg/L). Triclosan exposure resulted in a highly significant ( approximately 400-fold) reduction in triclosan susceptibility (P < 0.01) for the positive control E. coli, although its MICs towards chlorhexidine, metronidazole and tetracycline were not significantly altered. Minor ( approximately two-fold) decreases in triclosan susceptibility (MIC) occurred for Pr. nigrescens and in S. sanguis and S. oralis (MBC). Mean changes in susceptibilities (MIC and MBC) of the oral species to chlorhexidine, metronidazole and tetracycline did not exceed two-fold, although chlorhexidine MBCs for S. sanguis were markedly, but transiently, increased.. These data fail to demonstrate biologically significant drug resistance in triclosan-exposed bacteria and suggest that markedly decreased triclosan susceptibility, although confirmed for E. coli, is not a universal phenomenon. Other bacteria possibly possess more susceptible targets than FabI that are highly conserved, which may govern triclosan activity.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Bacteria; Chlorhexidine; Dental Plaque; Drug Resistance, Bacterial; Escherichia coli; Humans; Metronidazole; Microbial Sensitivity Tests; Mouth; Mouthwashes; Tetracycline; Triclosan

The hypothesis was tested that bacterial susceptibilities in aggressive periodontitis change upon administration of systemic antibiotics as adjuncts to periodontal therapy.. In 23 subjects (average age 38.9+/-6.7 years) with aggressive periodontitis, microbial parameters were assessed prior to and 1 year after completion of comprehensive mechanical/surgical and systemic antimicrobial therapy. Following identification of five selected pathogens with the Rapid ID 32 A system, their susceptibilities towards amoxicillin/clavulanate potassium, metronidazole, and tetracycline were examined with the E-test. Antibiotics were administered according to the test results, and the minimal inhibitory concentrations (MIC90) were reevaluated after 1 year. Statistical analysis was performed on a patient basis, with the site data used for evaluation of the MIC levels.. Bacterial MIC levels remained constant among the three antibiotic treatment groups compared with baseline. Mean MIC90 values ranged from <0.02 to 0.11 microg/ml (amoxicillin/clavulanate potassium), <0.02 to 0.27 microg/ml (metronidazole), and <0.02 to 0.11 microg/ml (tetracycline). Observed changes in susceptibility were attributed to the elimination of single bacterial taxa in the subgingival environment after antibiotic therapy. There were no statistically significant differences in clinical parameters among the treatment groups. Single tetracycline MICs were 1.5- to 6-fold enhanced compared to amoxicillin/clavulanate potassium and metronidazole.. The periodontal pathogens investigated prior to and 1 year after periodontal therapy are tested sensitive to the antimicrobial agents. In aggressive periodontitis, changes in bacterial susceptibility upon the administration of systemic antibiotics are associated with the limited number of isolates tested following therapy.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Combined Modality Therapy; Dental Plaque; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Follow-Up Studies; Gram-Negative Bacteria; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Periodontal Diseases; Periodontitis; Pilot Projects; Statistics, Nonparametric; Tetracycline

Dental plaque from 76 children without amalgam restorations was screened for bacteria resistant to mercuric chloride. Seventy-one per cent of the children harboured mercury-resistant oral bacteria and the median percentage of the total oral microflora resistant to mercuric chloride was 0.007% (range 0-5.3%). Eighty-seven mercury-resistant bacteria were isolated and 86% of these were streptococci with Streptococcus mitis predominating. Sixty per cent of the mercury-resistant isolates were also resistant to at least one of the four antibiotics tested (penicillin, ampicillin, erythromycin and tetracycline) with resistance to tetracycline (40% of isolates) most frequently encountered.

Topics: Anti-Bacterial Agents; Child, Preschool; Dental Amalgam; Dental Plaque; Disinfectants; Drug Resistance, Bacterial; Erythromycin; Humans; Mercuric Chloride; Prevalence; Streptococcal Infections; Tetracycline; Tetracyclines; Viridans Streptococci

Topics: Adult; Alveolar Bone Loss; Anti-Bacterial Agents; Arthritis, Rheumatoid; Chemotaxis, Leukocyte; Dental Plaque; Dental Scaling; Disease Progression; Disease Susceptibility; Female; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Male; Middle Aged; Neutrophils; Occlusal Adjustment; Oral Hygiene; Periodontal Attachment Loss; Periodontal Diseases; Root Planing; Tetracycline; Toothbrushing

The aim of this study was to investigate the effects of tetracycline administration on the viability and antibiotic resistance profiles of microcosm dental plaques. A constant depth film fermenter was used to generate multi-species biofilms, which were grown for 216 h before tetracycline was added. The composition of the microcosm plaques was determined by viable counting on selective and non-selective media. The prevalence of antibiotic-resistant organisms was determined on antibiotic-containing media. Before administration of tetracycline, the biofilms had a total viable anaerobic count of 7 x 10(7) cfu per biofilm. They contained 7% lactobacilli, 19% streptococci and 2% Actinomyces spp. Immediately after pulsing with tetracycline, the composition of the biofilms changed and they consisted of 30% lactobacilli, 1.5% streptococci and 3% Actinomyces spp., with a total anaerobic count of 1 x 10(7) cfu per biofilm. The pre-valence and composition of the antibiotic-resistant microflora changed dramatically after the addition of tetracycline, with the proportion of the microflora displaying resistance to tetracycline increasing from 6% to 45%. Corresponding changes in the proportions of the microflora displaying resistance to other antibiotics were as follows: 5-28% for erythromycin, 1-5% for vancomycin and 0.4-3% for ampicillin. The results of this study have shown that the addition of tetracycline to microcosm dental plaques alters their composition and enriches for bacteria resistant to tetracycline and other unrelated agents.

Topics: Actinomyces; Animals; Anti-Bacterial Agents; Biofilms; Cattle; Colony Count, Microbial; Dental Plaque; Drug Resistance; Humans; Lactobacillus; Microbial Sensitivity Tests; Models, Biological; Saliva; Streptococcus; Tetracycline; Tetracycline Resistance

To longitudinally determine if early therapeutic intervention, based on a positive neutral protease activity (NPA) assay score could effectively arrest the progress of periodontal disease destruction.. 63 periodontal sites which had previously undergone probing attachment loss were identified from among 31 previously treated adult periodontitis patients who were monitored during periodontal maintenance for an average of 3 yrs. Clinical levels of gingival inflammation and attachment levels and NPA assay data were collected at the beginning of each maintenance visit. When a site tested negative with the assay, routine Supportive Periodontal Therapy (SPT) was followed during the same appointment, while sites exhibiting a positive NPA score received more aggressive periodontal treatment.. During the study period, 51 of 63 sites displayed at least one positive NPA score. Our protocol of administering periodontal treatment rendered at the visit showing a positive NPA score revealed that only 1 of the 51 sites lost > or = 1 mm attachment during the study period. The remaining 50 positive assay sites showed an overall gain of > or = 1 mm of probing attachment over the course of the study. 12 of 63 sites consistently tested negative for neutral protease enzyme activity and remained stable, although 9 of these sites exhibited bleeding on probing (BOP) at least once during this study. Initial group mean probing attachment measurements were 5.6 mm for NPA negative and 5.7 mm for NPA positive sites.

Topics: Adult; Aged; Analysis of Variance; Anti-Bacterial Agents; Anti-Infective Agents, Local; Biocompatible Materials; Cellulose; Chlorhexidine; Dental Plaque; Dental Scaling; Drug Delivery Systems; Endopeptidases; Female; Follow-Up Studies; Gingival Crevicular Fluid; Gingival Hemorrhage; Gingivitis; Humans; Longitudinal Studies; Male; Middle Aged; Periodontal Attachment Loss; Periodontal Diseases; Periodontitis; Reproducibility of Results; Root Planing; Subgingival Curettage; Tetracycline

The selection of antibiotic resistance genes during antibiotic therapy is a critical problem complicated by the transmission of resistance genes to previously sensitive strains via conjugative plasmids and transposons and by the transfer of resistance genes between gram-positive and gram-negative bacteria. The purpose of this investigation was to monitor the presence of selected tetracycline resistance genes in subgingival plaque during site specific tetracycline fiber therapy in 10 patients with adult periodontitis.. The polymerase chain reaction (PCR) was used in separate tests for the presence of 3 tetracycline resistance genes (tetM, tetO and tetQ) in DNA purified from subgingival plaque samples. Samples were collected at baseline, i.e., immediately prior to treatment, and at 2 weeks, and 1, 3, and 6 months post-fiber placement. The baseline and 6-month samples were also subjected to DNA hybridization tests for the presence of 8 putative periodontal pathogenic bacteria.. PCR analysis for the tetM resistance gene showed little or no change in 5 patients and a decrease in detectability in the remaining 5 patients over the 6 months following tetracycline fiber placement. The results for tetO and tetQ were variable showing either no change in detectability from baseline through the 6-month sampling interval or a slight increase in detectability over time in 4 of the 10 patients. DNA hybridization analysis showed reductions to unmeasurable levels of the putative periodontal pathogenic bacteria in all but 2 of the 10 patients.. These results complement earlier studies of tet resistance and demonstrate the efficacy of PCR monitoring for the appearance of specific resistance genes during and after antibiotic therapy.

Topics: Adult; Base Sequence; Cellulose; Dental Plaque; DNA Probes; DNA, Bacterial; Drug Delivery Systems; Female; Genes, Bacterial; Gingiva; Humans; Male; Molecular Sequence Data; Periodontitis; Polymerase Chain Reaction; Sequence Analysis, DNA; Tetracycline; Tetracycline Resistance; Time Factors

In the present study, the antibiotic susceptibility of most prevalent micro-organisms in advanced periodontitis patients was evaluated. In 56 patients, pooled subgingival plaque samples were taken from the deepest site of each quadrant and were cultivated anaerobically. From each patient, the 4 most frequently encountered types of bacterial colonies were subcultured and identified (Rapid ID 32 A). From all bacterial species identified in the 224 subcultures, the 4 most prevalent were used for susceptibility testing to tetracycline, metronidazole and amoxicillin/clavulanate using the E Test. The most prevalent microorganisms were Fusobacterium nucleatum (38/214), Peptostreptococcus micros (33/214), Prevotella oralis (33/214) and Porphyromonas gingivalis (32/214). Regarding antibiotic susceptibility it could be shown that minimal inhibitory concentration (MIC) in all cases was below antibiotic concentrations achievable in gingival crevicular fluid. However, antibiotic resistance was seen in 3 to 29% of the investigated microorganisms.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteria, Anaerobic; Biofilms; Dental Plaque; Drug Resistance, Microbial; Female; Fusobacterium nucleatum; Gingival Crevicular Fluid; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Peptostreptococcus; Periodontal Index; Periodontitis; Porphyromonas gingivalis; Prevotella; Tetracycline; Tetracycline Resistance

The purpose of the present investigation was to use baseline clinical and laboratory parameters to distinguish subjects refractory to conventional periodontal therapy. Baseline clinical, microbial and host parameters were compared in 61 successfully-treated and 27 refractory subjects. Refractory subjects showed mean full-mouth attachment level (AL) loss and/or >3 sites with new AL loss >2.5 mm within 1 year after both scaling and root planing and surgery with systemic tetracycline. Successfully-treated subjects showed mean AL gain and no sites with new AL loss >2.5 mm after either regimen. Gingival redness, bleeding on probing, suppuration, supragingival plaque accumulation, pocket depth and AL were measured at 6 sites per tooth in each subject. The levels of 40 subgingival taxa were determined in subgingival plaque samples from up to 28 sites in each subject using checkerboard DNA-DNA hybridization. Serum antibody (Ab) to 85 subgingival species was determined using checkerboard immunoblotting. Levels of serum IgG2 and Gm23 allotype were measured using radial immunodiffusion; FcgammaRIIa and FcgammaRIIIb receptor haplotypes were determined using PCR and allele specific oligonucleotide probes. Odds ratios of a subject being refractory were determined by comparing measured parameters in the 2 subject groups using univariate and multivariate techniques. 17 of 151 clinical, microbial and immunological variables were significant using chi2 analysis after adjusting for multiple comparisons. For example, the odds ratios of a subject being refractory were 12.2, 5.4 and 6.9 if the subject had Ab >50 microg/ml to >9 species; S. constellatus counts >2.4% of the total DNA probe count or >2.1% of sites with AL >6 mm. The 17 significant predictor variables were used in logistic regression and discriminant analyses. Similar variables were selected using both analyses including the number of serum Ab to subgingival species >50 microg/ml, % S. constellatus in plaque samples and % sites with attachment loss >6 mm. In the logistic regression analysis model, the odds ratios associated with >9 species exhibiting >Ab 50 microg/ml, >2.1% of sites with AL >6 mm and >2.4% S. constellatus in plaque were 8.7, 6.8 and 2.4, respectively, after adjusting for other variables in the model. Discriminant analysis using these variables provided sensitivity, specificity, positive and negative predictive values of 0.66, 0.92, 0.80 and 0.85 respectively. Refractory periodontitis subjects coul

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Chi-Square Distribution; Dental Plaque; Dental Scaling; Discriminant Analysis; DNA, Bacterial; Female; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Periodontal Attachment Loss; Periodontitis; Predictive Value of Tests; Sensitivity and Specificity; Tetracycline; Treatment Failure

The ecosystem of the dental plaque in periodontal diseases is very complex: the study of such micro-organisms, which are mostly strict anaerobes, requires the use of specific techniques under conditions of strict anaerobiosis. The aim of the present study was to design a rapid method to evaluate the activity of antimicrobials on mixed bacterial plaque of subjects with periodontal diseases. The study was carried out using a computerised instrument generally used for simultaneous diagnostic tests with aerobic bacteria. Operative and methodological modifications were made to obtain conditions of strict anaerobiosis and the balanced growth of all the microbial forms present in the mixed cultures of the plaque. Penicillins and cephalosporins were active on all the samples, whereas colistin, gentamicin, kanamycin and nalidixic acid showed no activity. Clindamycin, tetracycline, erythromycin and penicillin G were effective only against some samples. The activity of the antimicrobials towards isolated strains was analogous to that towards the corresponding mixed culture.

Topics: Adult; Anaerobiosis; Anti-Bacterial Agents; Anti-Infective Agents; Bacteria, Anaerobic; Cephalosporins; Clindamycin; Colistin; Dental Plaque; Drug Resistance, Microbial; Ecology; Erythromycin; Female; Gentamicins; Gingivitis; Humans; Kanamycin; Kanamycin Resistance; Male; Microbial Sensitivity Tests; Middle Aged; Nalidixic Acid; Penicillin G; Penicillin Resistance; Penicillins; Periodontitis; Tetracycline; Tetracycline Resistance

The occurrence of creeping attachment has been documented with epithelialized autogenous masticatory mucosa grafts (free gingival grafts) and suggested in other root coverage techniques. The purpose of this study was to examine whether or not creeping attachment occurred after a connective tissue with partial-thickness double pedicle graft had been performed. This study examined 22 defects, in 19 patients, treated where less than complete root coverage was obtained at 4 weeks postoperative. Creeping attachment occurred in 21 of the 22 defects (95.5%), in 18 of the 19 patients (94.7%). Complete root coverage occurred in 17 of the 22 defects (77.3%), in 15 of 19 patients (78.9%). The mean creeping attachment obtained was 0.8 mm. Additionally, it was the goal of this study to see if any factor could be associated with creeping attachment. This study did not find any factors that could be associated with the amount of creeping attachment seen. Creeping attachment seems to occur commonly, but complete root coverage is not predictable.

Topics: Adult; Age Factors; Anti-Bacterial Agents; Bucrylate; Connective Tissue; Dental Plaque; Dentin Sensitivity; Epithelial Attachment; Female; Follow-Up Studies; Forecasting; Gingiva; Gingival Pocket; Gingival Recession; Humans; Keratins; Labial Frenum; Male; Periodontal Dressings; Root Planing; Smoking; Surgical Flaps; Tetracycline; Tissue Adhesives; Tooth Cervix; Tooth Root; Transplantation, Autologous; Wound Healing

Subgingival plaque samples were collected from 68 patients with a history of moderate to severe adult periodontitis and enumerated on Trypticase-soy blood agar plates, with and without tetracycline at 4 micrograms/ml. Each different colony morphotype was enumerated, and a representative colony was subcultured for identification and examined for the tetracycline resistance gene tet(Q) by polymerase chain reaction (PCR) amplification and DNA hybridization, using a fragment of tetA(Q)2 from Bacteroides fragilis 1126. PCR primers (5'-GGCTTCTACGACATCTATTA-3' and 5'-CATCAACATTTATCTCTCTG-3') were chosen to amplify a 755 bp region of tet(Q). The subgingival plaque samples were also tested by PCR. Approximately 12% of the total cultivable flora was resistant to tetracycline, and the percentage of the tetracycline-resistant cultivable flora with the tet(Q) gene varied greatly from one patient to another with a range from 0.0 to 67%. Half of the 68 subgingival plaque samples were positive or weakly positive for tet(Q) by PCR. Approximately 15% of the 210 isolates subcultured with resistance to tetracycline, (> or = 4 micrograms/ml) contained tet(Q), and 60% contained tet(M). All of the tet(Q)-resistant isolates were gram-negative anaerobic bacilli and included all of the Prevotella and Bacteroides isolates.

Topics: Adult; Anti-Bacterial Agents; Bacteria, Anaerobic; Bacterial Proteins; Bacteroides; Base Sequence; Dental Plaque; DNA Primers; DNA Probes; DNA, Bacterial; Doxycycline; Genes, Bacterial; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Microbial Sensitivity Tests; Minocycline; Molecular Sequence Data; Periodontitis; Polymerase Chain Reaction; Prevotella; Sensitivity and Specificity; Tetracycline; Tetracycline Resistance

Tetracycline in combination with scaling and root planing is frequently used to treat refractory periodontal disease. This study examined tetracycline resistance in bacteria recovered from periodontal pockets of patients with refractory periodontitis. Bacterial isolates resistant to 10 micrograms/ml of tetracycline were isolated from plaque samples of 17 patients, of whom 6 had received tetracycline within 8 weeks prior to sampling. Minimal inhibitory concentrations (MICs) of tetracycline and minocycline were determined by agar dilution. In the 6 patients who had received tetracycline, a mean of 22.9% (+/- 38.2) of the total cultivable subgingival flora were resistant to tetracycline, compared with a mean of 7.2% (+/- 8.5) in the untreated group. Although various organisms were isolated, in most patients, the tetracycline-resistant organisms were dominated by Streptococcus spp. Overgrowth of Candida was found in one patient, and of Enterobacteriaceae in another patient, while small numbers of yeast or Staphylococcus spp. were isolated from the plaque samples of 9 others. 3 out of 4 patients who did not respond to tetracycline treatment had a variety of tetracycline-resistant anaerobic Gram-negative rods present. No correlation was found between increased proportions of tetracycline resistance in the whole bacterial sample and the presence of resistant periodontal pathogens.

Topics: Adult; Chronic Disease; Colony Count, Microbial; Dental Plaque; Enterobacteriaceae; Gram-Negative Anaerobic Bacteria; Humans; Microbial Sensitivity Tests; Middle Aged; Minocycline; Periodontal Pocket; Periodontitis; Streptococcus; Tetracycline; Tetracycline Resistance

Eighty isolates of Actinobacillus actinomycetemcomitans from 30 Brazilian periodontitis patients were examined to determine the distribution of biotypes and in vitro antimicrobial susceptibility. Seventy-seven percent of the isolates belonged to biotype X. All A. actinomycetemcomitans isolates were susceptible to cefoxitin, imipenem and tetracycline.

Topics: Adolescent; Adult; Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Antitrichomonal Agents; Bacterial Typing Techniques; Cefoxitin; Cephamycins; Clindamycin; Dental Plaque; Drug Resistance, Microbial; Erythromycin; Female; Humans; Imipenem; Lincomycin; Male; Metronidazole; Microbial Sensitivity Tests; Penicillin G; Penicillins; Periodontitis; Tetracycline; Thienamycins

Inflammatory periodontal diseases are related to dental plaque formation. Increase in the perfusion of the inflamed tissue results in increased oxygen supply. Although oxygen has healing effects, it is bound to be a mediator of peroxidation in biological membranes. Chemotherapeutic agents such as chlorhexidine, listerine, sanguinarine, and cetylpridinium chloride and oral antibiotics such as tetracycline HCl and doxycyline were tested for their antioxidative activities. While doxycycline has the highest antioxidant activity in lower volumes (0.1 ml), sanguinarine, listerine and a pace after them, tetracycline HCl, had similar effects in higher volumes (0.3 and 0.4 ml). The results showed that in addition to their antiseptic or antimicrobial effects, these preparations have an antioxidative activity against spontaneous oxidation.

Topics: Alkaloids; Animals; Anti-Infective Agents, Local; Antioxidants; Benzophenanthridines; Brain; Cattle; Cetylpyridinium; Chlorhexidine; Dental Plaque; Doxycycline; Drug Combinations; Gingivitis; Isoquinolines; Malondialdehyde; Membranes; Mouthwashes; Oxidation-Reduction; Peroxides; Salicylates; Terpenes; Tetracycline

Topics: Anti-Bacterial Agents; Cellulose; Dental Plaque; Drug Carriers; Drug Implants; Humans; Periodontal Pocket; Polyvinyls; Tetracycline

Previous in vitro studies have suggested that tetracycline-HCl (TTC-HCl) is adsorbed and actively released from root dentin. The aim of the current study was to evaluate the binding to and release of TTC-HCl from human root dentin surfaces in vivo, and to evaluate the clinical utility of TTC-HCl irrigation as an adjunct to scaling and root planing. Experiment I utilized two contralateral mandibular single-rooted teeth which were examined in four adults with severe generalized periodontitis. One tooth in each patient was carefully scaled and root planed, under local anesthesia, and the other used as an unscaled control. Each subgingival root surface was irrigated for 5 min with an aqueous TTC-HCl solution at a concentration of 100 mg/ml. Gingival crevicular fluid samples were collected on paper strips for the next three weeks. The TTC-HCl concentrations in each sample were determined by the inhibition zone of B. cereus cultured on agar plates. The TTC-HCl concentrations in gingival crevicular fluid collected 15 min after irrigation were 3100 +/- 670 micrograms/ml from the scaled lesions and 4700 +/- 1300 micrograms/ml from the unscaled root surfaces. The antibiotic concentrations decreased logarithmically over the next 7 days; 1500 +/- 270 micrograms/ml and 1100 +/- 330 micrograms/ml at 2 h, 880 +/- 350 micrograms/ml and 1300 +/- 360 micrograms/ml at 6 h and 19 +/- 5 micrograms/ml and 31 +/- 26 micrograms/ml at 1 week for scaled and unscaled root surfaces, respectively. Results for week two and three indicated an average of over 8 micrograms/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Topical; Adult; Combined Modality Therapy; Dental Plaque; Dental Plaque Index; Dental Scaling; Dentin; Epithelial Attachment; Female; Gingival Crevicular Fluid; Gingivitis; Humans; Male; Middle Aged; Periodontal Index; Periodontal Pocket; Periodontitis; Root Planing; Tetracycline; Therapeutic Irrigation; Tooth Root

The purpose of the study was to validate the Epsilometer test (E-test) method for antimicrobial susceptibility testing of selected periodontopathic microorganisms using the agar dilution method as a standard. The E-test has been developed to provide a direct quantification of antimicrobial susceptibility of microorganisms. The device consists of a predefined, continuous, and exponential gradient of antibiotic concentrations immobilized along a rectangular plastic test strip. After 48 hours incubation a drop-shaped inhibition zone intersects the graded test strip at the inhibitory concentration (IC) of the antibiotic. Twenty-two subgingival plaque samples from periodontitis sites were plated on trypticase soy agar supplemented with 5% rabbit blood or 5% sheep blood and trypticase soy agar supplemented with vancomycin and bacitracin. A total of 60 strains of key periodontal pathogens (Prevotella intermedia, Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Eikenella corrodens, Campylobacter rectus, and Capnocytophaga) isolated from 22 sites of 12 patients were studied. The antibiotics tested were clindamycin, metronidazole, tetracycline, ciprofloxacin, cefoxitin, and ampicillin at concentrations above and below the achieved blood or gingival crevicular fluid levels. As a standard reference the minimal inhibitory concentrations (MICs) were determined using the agar dilution method. MICs were compared with ICs determined using the E-test method. The results showed an agreement ranging from 67% to 100%; sensitivity ranging from 75% to 100%; predictability ranging from 56% to 100% and specificity ranging from 33% to 96%. The E-test ICs for ampicillin, cefoxitin, and metronidazole against the Gram-negative capnophilic and microaerophilic rods and the black-pigmented anaerobic rods ICs for ampicillin, clindamycin, metronidazole, and tetracycline showed a high percentage of agreement with the agar dilution MICS.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aggregatibacter actinomycetemcomitans; Ampicillin; Anti-Bacterial Agents; Bacteria; Bacteroides; Bacteroides fragilis; Campylobacter; Capnocytophaga; Cefoxitin; Ciprofloxacin; Clindamycin; Clostridium perfringens; Dental Plaque; Eikenella corrodens; Female; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Peptostreptococcus; Periodontal Diseases; Periodontitis; Porphyromonas gingivalis; Tetracycline

Topics: Adult; Aggregatibacter actinomycetemcomitans; Dental Plaque; Dental Plaque Index; Female; Humans; Minocycline; Periodontal Diseases; Periodontal Index; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Tetracycline

The purpose of the present study was to evaluate the effects of subgingival irrigations with tetracycline as a supplement to mechanical plaque control and root debridement on clinical conditions of periodontal furcation pockets. 20 subjects with molar teeth having furcation pockets of varying depths and different grades of furcation involvement served for the study. Following oral hygiene instruction and root debridement at baseline, test teeth were irrigated subgingivally by a professional with a solution of 50 mg/ml of tetracycline, and control teeth with saline every 2nd week for 3 months. Records of dental plaque, bleeding on probing, probing depth and probing attachment level were obtained at 0, 1, 2, 3, 6, 9 and 12 months. The results failed to demonstrate any significant differences between test and control teeth for any of the subgroups of furcation sites at any observation interval. It is suggested that future studies may need to be performed over longer periods of time, and that the antimicrobial agents may need to be administered in vehicles, which provide prolonged periods of active subgingival concentrations.

Topics: Debridement; Dental Plaque; Humans; Molar; Oral Hygiene; Periodontal Index; Periodontal Pocket; Periodontitis; Tetracycline; Therapeutic Irrigation; Tooth Root

Local and systemic administrations of tetracycline have been used in human periodontal treatment for conditions including juvenile periodontitis and rapidly progressive periodontitis, although microbiological effects of the treatment have not been clear. The effect of systemic oral administration of tetracycline on subgingival bacteria in experimental periodontal disease in hamsters as an animal model has not yet been reported. The aim of this study was to investigate changes in subgingival bacteria and bone resorption at the lower left first molar, and supragingival plaque formation on the lower right first molar in animals with (TC group) or without (Diet-2000 group) systemic oral administration of tetracycline hydrochloride 25 mg/kg/day in 20-day-old golden hamsters that mere fed a high sucrose diet (Diet-2000). Experimental periods were established as 15, 29, 43, 57, and 71 days. Supragingival plaque formation on the lingual surface on the lower right first molar in the Diet-2000 group gradually increased with time; that in the TC group was scarce and was not increased with time. Bone resorption at the lower left first molar in the Diet-2000 group proceeded rapidly with time, while that in the TC group was scarce. Total number of bacteria from subgingival plaque on the lower left first molar in the Diet-2000 group increased rapidly with time, but that in the TC group did not vary at all with time. Actinomyces (Actinomyces naeslundii and Actinomyces viscosus) and Bacteroides (Bacteroides capillosus and Bacteroides ruminicola subsp. ruminicola) in the Diet-2000 group increased with time; those in the TC group decreased with time. A remarkable difference in IgG titers to Bacteroides asaccharolyticus was not observed in the Diet-2000 and the TC groups. These results suggest that systemic oral administration of tetracycline hydrochloride on experimental gingivitis in golden hamsters causes the total number of subgingival bacteria to be confined, and to be decreased species of Actinomyces (Actinomyces naeslundii and Acinomyces viscosus) and Bacteroides (Bacteroides capillosus and Bacteroides ruminicola subsp. ruminicola), leading to the inhibition of bone resorption and supragingival plaque formation. It is suggested that Bacteroides asaccharolyticus is not a pathogen concerned in experimental periodontal disease in hamsters, because the antibody titer was not elevated in the Diet-2000 group.

Topics: Administration, Oral; Animals; Bone Resorption; Cricetinae; Dental Plaque; Gingivitis; Mesocricetus; Tetracycline

Strips containing tetracycline hydrochloride or metronidazole 25% in polyhydroxybutyric acid as a biodegradable polymer matrix, showed sustained release in simulated gingival fluid pH 6.6 at 37 degrees C. When evaluated in patients suffering from advanced periodontal disease, the greatest response to therapy was observed with tetracycline hydrochloride strips inserted into periodontal pockets at four-day intervals for 16 days, compared with an untreated control group. A reduction in plaque index, gingival index and pocket depth was observed. A favourable alteration occurred in the microbial flora of treated pockets with an increase in the proportion of cocci and decrease in gram-negative rods, fusiforms and spirochetes. Metronidazole strips or root-planning tended not to be as effective. The clinical improvement produced by each treatment was not maintained when treatment was terminated.

Topics: Administration, Topical; Calorimetry, Differential Scanning; Dental Plaque; Gingiva; Humans; Metronidazole; Periodontal Diseases; Periodontitis; Solubility; Tetracycline

33 subjects with evidence of active destructive periodontal disease were treated by modified Widman flap surgery and systemic tetracycline (1 g/day for 21 days). Subgingival plaque samples were taken from 41 sites in 12 of these subjects before and 6 months after therapy for predominant cultivable microbiota studies. Mean pocket depth and attachment levels in the 41 sampled sites were 7.1 +/- 2.9 mm and 7.7 +/- 3.2 mm prior to therapy and 4.8 +/- 2.3 mm and 6.2 +/- 3.4 mm after therapy. B. melaninogenicus and V. parvula were more frequently detected in samples taken after therapy, while S. intermedius, S. morbillorum, S. uberis and W. recta were less frequently detected after therapy. A. actinomycetemcomitans were detected in 7 sites pretherapy and 1 site post therapy. The frequency of detection of B. gingivalis and B. intermedius was virtually unchanged. The mean levels of the Actinomyces sp., A. actinomycetemcomitans, B. gingivalis, B. intermedius, S. morbillorum, S. uberis and W. recta were decreased after therapy, while the mean levels of B. melaninogenicus, S. mitis, S. sanguis II and V. parvula were increased after therapy. V. parvula showed the greatest increase to 8.2% of the microbiota. In the second phase of the study, subgingival plaque samples from 94 sites in the 33 treated subjects were analyzed by predominant cultivable techniques. As a result of therapy, 24 sites exhibited attachment loss greater than 2 mm, 23 sites exhibited "gain" greater than 2 mm and the remaining 47 sites were considered to be unchanging.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Bacteria; Dental Plaque; Female; Humans; Male; Periodontal Diseases; Surgical Flaps; Tetracycline

27 subjects with active destructive periodontal diseases were treated by modified Widman flap surgery and systemic tetracycline and divided into 4 groups based on pre- and post-therapy hazard rates (% of sites losing greater than 3 mm of attachment in 1 year). Pre- and post-therapy hazard rates were respectively: group I (3 subjects) less than 4 and less than 4; group II (8 subjects) greater than 4 and less than 4; group III (3 subjects) less than 4 and greater than 4; group IV (refractory group of 13 subjects) greater than 4 and greater than 4. Baseline mean pocket depths and attachment loss of groups I and II subjects were less than groups III and IV subjects and exhibited less suppuration. 6 group IV subjects lost a total of 38 teeth after therapy, in contrast to no tooth loss in subjects in the other 3 groups. Redness, bleeding on probing, plaque levels and age did not differ among groups. Subjects in the 4 groups differed in the subgingival species to which they showed elevated serum antibody responses. Group IV subjects showed elevated responses to a select range of gram-negative species, including A. actinomycetemcomitans strains Y4 or ATCC 29523, F. nucleatum and B. intermedius. No subject in any of the other groups exhibited an elevated response to B. intermedius. The mean % of each species in all sampled sites, both before and after therapy, was computed for each subject. Subjects in groups III and IV (high post-therapy hazard rates) exhibited elevated mean levels of B. forsythus, F. nucleatum, S. intermedius, E. corrodens, and B. gingivalis.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Antibodies, Bacterial; Bacteria; Child; Combined Modality Therapy; Dental Plaque; Humans; Middle Aged; Periodontal Diseases; Surgical Flaps; Tetracycline

Niridazole, metronidazole and tetracycline were compared for their activity against subgingival bacteria from patients with chronic periodontitis. Niridazole was consistently more effective than the other drugs against obligate anaerobes and exhibited some activity against facultative organisms. It was concluded that niridazole has potential for topical use in chronic periodontitis.

Topics: Bacteria, Anaerobic; Dental Plaque; Humans; Metronidazole; Niridazole; Periodontal Pocket; Periodontitis; Tetracycline

A 9-year-old girl was treated for the periodontal component of Papillon-Lefèvre syndrome, an autosomal recessive disease characterized by palmarplantar hyperkeratosis and premature loss of teeth. Initially, the patient was found to have a polymorphonuclear leukocyte chemotactic dysfunction, defective leukocyte adherence, and deep periodontal pockets harboring presumptive periodontopathic bacteria. After unsuccessful treatment with combined mechanical therapy and 2 different antibiotics, all of the patient's erupted teeth were extracted in an attempt to minimize the chance of infection of teeth yet to erupt. At age 16 years, the now-erupted teeth have normal gingiva and crevice depths, radiographs show no evidence of periodontal pathology, no periodontopathic bacteria are detected in gingival crevices, and leukocyte function is normal.

Topics: Bacteria; Child; Dental Plaque; Erythromycin; Female; Humans; Keratoderma, Palmoplantar; Papillon-Lefevre Disease; Periodontal Diseases; Tetracycline; Tooth Extraction

The correction of malocclusions in juvenile periodontitis (JP) patients completing periodontal therapy is a problem of increasing clinical concern to orthodontists, since many teeth with severe alveolar bone loss in these patients can now be successfully treated without extraction. In this report, fixed edgewise orthodontic therapy was carried out after the completion of periodontal therapy on four JP patients. The orthodontic therapy included extensive intrusion of teeth severely affected by JP. Phase-contrast microscopic analysis of subgingival plaque from orthodontically treated teeth was used to monitor longitudinally the effects of fixed orthodontic bands on the subgingival flora and also to monitor the efficacy of topical and systemic antimicrobial therapy aimed at suppression of suspected periodontopathic bacteria. Orthodontic movement was completed on most periodontally compromised teeth without significant evidence of additional deterioration in periodontal status. However, within the first 6 months of orthodontic band placement, all patients had significant increases in the number of spirochetes and motile rods in their subgingival flora. Three of the patients also developed high levels of crevicular polymorphonuclear leukocytes around orthodontically treated teeth, indicating significant subgingival inflammation. Intensive antimicrobial measures, including topical inorganic salt applications and systemic tetracycline, were helpful in limiting clinical inflammation and subgingival colonization by periodontopathogens during orthodontic therapy. The results demonstrate that successful orthodontic repositioning can be carried out in treated JP patients. In addition, bacteriologic monitoring and chemotherapeutic suppression of periodontal pathogens may be valuable in the prevention of further destructive periodontal disease activity in periodontitis patients undergoing orthodontic therapy.

Topics: Adolescent; Adult; Aggressive Periodontitis; Bacteria; Bicarbonates; Dental Plaque; Female; Humans; Hydrogen Peroxide; Male; Malocclusion; Microscopy, Phase-Contrast; Neutrophils; Orthodontic Appliances; Periodontal Diseases; Sodium; Sodium Bicarbonate; Spirochaetales; Tetracycline; Tooth Movement Techniques

Topics: Adult; Aged; Bacteria; Bicarbonates; Dental Plaque; Dental Scaling; Female; Humans; Hydrogen Peroxide; Long-Term Care; Male; Middle Aged; Periodontal Pocket; Periodontitis; Sodium; Sodium Bicarbonate; Sodium Chloride; Tetracycline; Tooth Root

The present investigation was performed to study the effect on localized juvenile periodontitis (LJP) of a treatment program which included tetracycline administration, surgical elimination of inflamed tissues, scaling and root planing, and careful plaque control during healing. Treatment of LJP lesions was carried out on 16 individuals aged 14 to 18 years (JP group). Lesions in first molars and incisors in a group of patients with adult periodontal disease (AP) were treated in an identical manner and served as controls. The presence of angular bony defects adjacent to first molars and incisors was first documented in all patients. Thereafter, a clinical examination was carried out, including assessments of oral hygiene status, gingival conditions, probing depths and attachment levels. The patients were subjected to a treatment program involving administration of tetracycline (250 mg 4 times per day for 2 weeks), removal of granulation tissue after flap elevation, and root curettage. After surgery, the patients were instructed to rinse the mouth with 0.2% chlorhexidine for 2 min twice a day during the first 2 postsurgical weeks. Professional tooth cleaning was carried out once every 3 months during a 5-year period. At 6, 12, 24 and 60 months after surgical treatment, the patients were re-examined regarding oral hygiene, gingival conditions, probing depths and attachment levels. Treatment of LJP lesions resulted in resolution of gingival inflammation, gain of clinical attachment, and refill of bone in angular bony defects. The healing of the lesions of this patient sample was similar to healing observed in patients with AP.

Topics: Adolescent; Adult; Aggressive Periodontitis; Dental Plaque; Dental Prophylaxis; Dental Scaling; Evaluation Studies as Topic; Follow-Up Studies; Humans; Middle Aged; Oral Hygiene; Periodontal Diseases; Periodontal Index; Tetracycline; Tooth Root

A total of 65 bacterial strains originating mostly from subgingival plaque were tested for their susceptibilities to metronidazole, spiramycin, and their combination, ornidazole, erythromycin and tetracycline by means of an agar dilution technique. All agents were active against all anaerobic Gram-negative rods. Bacteroides gingivalis and Fusobacterium nucleatum showed marked susceptibility to metronidazole (MIC less than or equal to 0.06 microgram/ml) whereas 4-64 micrograms/ml were required to inhibit the capnophilic Actinobacillus actinomycetemcomitans and Capnocytophaga. Gram-positive facultatives were resistant to nitro-imidazoles but were inhibited at macrolide concentrations less than or equal to 0.5 microgram/ml. Except for F. nucleatum and Veillonella strains (2 less than or equal to MIC less than or equal to 128 micrograms/ml) macrolides were active against all other anaerobic bacteria tested. At concentrations less than or equal to 2 micrograms/ml the combination of spiramycin and metronidazole (2 : 1) was active against virtually all bacteria tested but our results failed to show a synergistic effect.

Topics: Bacteria; Bacteroides; Dental Plaque; Drug Combinations; Erythromycin; Humans; Leucomycins; Metronidazole; Microbial Sensitivity Tests; Ornidazole; Periodontal Diseases; Tetracycline

In the management of chronic periodontitis, there has been a renewed interest in the local delivery of antimicrobial drugs into periodontal pockets. This study assessed the effects of the acrylic strip delivery system containing chlorhexidine, metronidazole or tetracycline on subgingival microflora assessed by dark field microscopy. Strips containing 40% chlorhexidine, metronidazole or tetracycline were placed for 2 to 3 days into pockets greater than 6 mm which bled on probing. Plaque samples were obtained before and after treatment and counts of morphological and motile groups of organisms were made by dark field microscopy. Prior to treatment, the dark field microscopic counts were similar to those previously reported for diseased sites with motile bacteria, in particular spirochaetes, present in high numbers. Following treatment, all 3 antimicrobial drugs produced a significant increase in the proportion of cocci and significant decreases in all other types of organisms. Motile organisms, in particular, were markedly reduced and spirochaetes could not be recovered from some sites treated with metronidazole and tetracycline. Metronidazole was significantly more effective than tetracycline or chlorhexidine on spirochaetes. The results indicate that acrylic strips may be useful in the management of chronic periodontitis as an adjunct to routine mechanical methods.

Topics: Acrylic Resins; Administration, Topical; Bacteria; Chlorhexidine; Dental Plaque; Humans; Metronidazole; Periodontal Pocket; Periodontitis; Tetracycline

Actinobacillus actinomycetemcomitans is an oral bacterium which is being encountered with increasing frequency in infective endocarditis. This organism occurs in high numbers in periodontitis lesions of patients with localized juvenile periodontitis (periodontosis). It is present infrequently, and only in low numbers in most other individuals. Its common resistance to penicillin, erythromycin and vancomycin represents a clinical problem in patients at risk of developing endocarditis after dental treatment. However, the high activity of tetracyclines against A. actinomycetemcomitans may be useful in prophylactic endocarditis considerations by allowing a suppression of the organism prior to the institution of recommended prophylactic protocols. In this study, we determined the effect of systemic tetracycline-HCl therapy (1 gm/day) on the oral A. actinomycetemcomitans population in five localized juvenile periodontitis patients who were heavily infected with the organism. A. actinomycetemcomitans could not be detected in samples of subgingival and supragingival dental plaque and cheek mucosal surfaces following 14 days of administration of systemic tetracycline. The organism was still undetectable 3 weeks after therapy but it reappeared at a few oral sites at week 8 post-treatment. On the basis of this data, it is proposed that the prophylactic endocarditis therapy of patients with high numbers of penicillin-resistant A. actinomycetemcomitans include a two-stage approach: first, the systemic administration of tetracycline for 14 days, and second, institution of a conventional prophylactic protocol during the time of dental treatment.

Topics: Actinobacillus; Actinobacillus Infections; Adolescent; Dental Plaque; Endocarditis, Bacterial; Female; Humans; Male; Mouth Diseases; Periodontitis; Tetracycline

The in vitro inhibitory effect of several antimicrobial agents was determined against dispensed dental plaque samples taken from periodontally diseased sites as an aid in the selection of antibiotics for adjunctive use in periodontal therapy. 2 groups of patients were sampled. 1 group of 10 patients with severely advanced disease had received periodontal treatment which included the frequent adjunctive use of an antibiotic. The second group consisted of 15 individuals with less severe periodontal disease; only 4 individuals had been previously treated with antibiotics for their periodontal disease. Bacterial samples of subgingival plaque were taken from each patient and tested against a battery of antibiotics to determine which agent was the most effective in suppressing bacterial growth. Each antibiotic was incorporated into Trypticase-soy blood agar at a concentration equivalent to that achieved in either gingival fluid or blood following recommended oral dosages. The inhibitory effect was determined by comparing the number of bacterial recovered on the antibiotic-containing medium to the total number of bacteria recovered on the basal medium. Penicillins, with the exception of cloxacillin, were the most effective in inhibiting bacterial growth. Benzylpenicillin consistently inhibited the growth of 90% of the isolates recovered on media free of antibiotics while ampicillin and amoxicillin frequently inhibited 99% or more of the bacteria recovered. Tetracycline was generally inhibitory for at least 90% of the isolates if the patients had not been previously treated with this agent. However, resistance to this drug was common in samples taken from patients previously treated with tetracycline. Doxycycline, a tetracycline derivative, did not inhibit significantly more isolates than tetracycline. Clindamycin was inhibitory for 90% or more of the organisms in most of the samples; and, was usually effective in inhibiting isolates in samples which exhibited large numbers of isolates resistant to tetracycline. Erythromycin was relatively ineffective against the isolates recovered from samples from the severely diseased group but was inhibitory to isolates in some samples taken from the more moderately diseased group. Metronidazole, at the concentration tested, was largely ineffective against the isolates in bacterial samples from both groups. No single antimicrobial agent was found to be inhibitory for greater than 90% of the bacteria recovered from all of the

Topics: Adolescent; Anti-Bacterial Agents; Bacteria; Child; Clindamycin; Dental Plaque; Gingiva; Humans; Microbial Sensitivity Tests; Penicillins; Periodontal Diseases; Tetracycline

Several antibiotics were found to adsorb to saliva-coated enamel and to inhibit in vitro plaque formation by pure cultures of oral bacteria: Actinomyces viscosus, Actinomyces naeslundii and Streptococcus mutans. Tetracycline, minocycline and oxytetracycline adsorbed to the greatest degree, showing 100-fold higher adsorption than spiramycin, the test antibiotics with least adsorption. Inhibition of in vitro plaque formation was found to require both drug substantivity (capacity for adsorption) and antimicrobial activity. Inhibition of plaque formation in the in vitro assay employed correlated well with clinical efficacy.

Topics: Actinomyces; Adsorption; Dental Enamel; Dental Plaque; Humans; Saliva; Streptococcus mutans; Tetracycline; Tetracyclines

Topics: Cellulose; Chlorhexidine; Delayed-Action Preparations; Dental Plaque; Humans; Tetracycline

This study was designed to evaluate the effect of mechanical stimulation on the keratinization of the sulcular epithelium in four adult Rhesus monkeys. Each animal received a thorough prophylaxis. One week later, each monkey received one of the following modalities of plaque control: (a) daily intravenous tetracycline and rubber cup prophylaxis, (b) daily rubber cup prophylaxis, (c) daily intravenous tetracycline injections; (d) no treatment, as a control. After sacrifice and tissue processing the histologic sections were evaluated for the presence of sulcular keratinization. The keratin width and length were measured, and an Inflammatory Index determined. It was found that all treatment modalities reduced inflammation significantly, when compared to the control. No differences among the three procedures tested were found. Although all permitted keratinization to develop, sulcular keratinization was significantly increased when daily prophylaxes were performed. It was concluded that mechanical stimulation of the sulcular epithelium, seemingly plays a role in promoting its keratinization.

Topics: Animals; Dental Plaque; Dental Prophylaxis; Epithelium; Gingiva; Injections, Intravenous; Keratins; Macaca mulatta; Male; Tetracycline

Twenty patients were selected for antibiotic treatment due to poor response to conventional therapy. Ten patients were evaluated after taking 250 mg/day of tetracycline for 2 to 7 years. Ten other patients who had been on tetracycline for at least 2 years were evaluated 6 months to 2 years after stopping the antibiotic. Subgingival plaque was cultured anaerobically on nonselective media (ETSA) and ETSA with 1 microgram/ml of tetracycline HCl. Pocket depth, plaque and gingivitis were scored. Those patients on tetracycline had no bleeding on probing despite residual pockets ranging from 3 to 7 mm. Gram-negative anaerobic rods made up to 49.8% of the microflora of these patients, with Fusobacterium nucleatum dominating. B. melaninogenicus, and B. gingivalis were not detected in the samples. Five of ten patients off tetracycline bled on probing and had pocket depths in the same range as those on tetracycline. The microflora of tetracycline-off sites was predominately Gram-negative rods (63.1% with B. gingivalis and F. nucleatum 7.3% and 3.1% of the flora respectively). In tetracycline-on samples 76.6% of the isolates were resistant to 1 microgram/ml of tetracycline compared to 25.9% in the patients off tetracycline and 7.1% resistant organisms in 14 untreated control samples from periodontitis patients not exposed to any long-term tetracycline therapy. Long-term, low-dose tetracycline was associated with a healthy clinical condition and diverse Gram-negative anaerobic flora resistant to the antibiotic. After discontinuing tetracycline the clinical and bacterial status was more characteristic of disease.

Topics: Adult; Bacteria; Dental Plaque; Follow-Up Studies; Humans; Periodontitis; Tetracycline; Time Factors

The changes induced in the bacteriology of the gingival sulcus were evaluated as part of a study considering the keratinizing potential of the sulcular epithelium when bacterial plaque was essentially eliminated. Two Rhesus monkeys were scaled and placed on a daily therapeutic regimen which included a prophylaxis, systemic tetracycline, and topical chlorhexidine. Over the 40 day experimental period and 74 days post-therapy, subgingival plaque samples were taken periodically. The plaque samples were cultured anaerobically and aerobically to determine the predominant bacterial flora. The total cultivable bacterial flora decreased from initial levels by greater than 99.9% with the antibacterial therapy. The flora shifted with therapy from one dominated by anaerobic organisms, including Bacteroides melaninogenicus (18%) and Fusobacterium species (13.9%), to a flora dominated by organisms growing aerobically. During treatment B. melaninogenicus and Fusobacterium species were not detected in any sample. After cessation of all therapy the anaerobes increased to dominance again, but B. melaninogenicus remained undetectable through 74 days post-therapy.

Topics: Actinomyces; Animals; Bacteria; Chlorhexidine; Dental Plaque; Fusobacterium; Gingiva; Haplorhini; Macaca mulatta; Male; Prevotella melaninogenica; Streptococcus sanguis; Tetracycline

Topics: Administration, Oral; Animals; Dental Plaque; Dogs; Gingivitis; Metronidazole; Tetracycline

Topics: Adult; Aged; Anti-Bacterial Agents; Dental Plaque; Diabetes Mellitus; Erythromycin; Female; Humans; Hypoglycemic Agents; Insulin; Male; Microbial Sensitivity Tests; Middle Aged; Periodontal Pocket; Periodontitis; Staphylococcus; Tetracycline

Selected anaerobic, capnophilic and facultative bacteria isolated from patients with various forms of periodontal health and disease were tested for their susceptibility to antibiotics and antimicrobial agents. Specific bactericidal and minimum inhibitory concentrations were compared to disc zone diameters, thereby generating new standards for the potential selection of antimicrobial agents.

Topics: Ampicillin; Anti-Bacterial Agents; Bacteria; Chlorhexidine; Dental Plaque; Eugenol; Microbial Sensitivity Tests; Penicillin Resistance; Penicillins; Periodontal Diseases; Periodontium; Sodium Fluoride; Tetracycline

Topics: Adult; Bacteria; Bacteroides; Dental Plaque; Female; Fusobacterium; Gingiva; Gingival Pocket; Gram-Negative Anaerobic Bacteria; Humans; Peptostreptococcus; Periodontal Diseases; Periodontal Index; Spirochaetales; Tetracycline; Time Factors

Samples of subgingival plaque were collected from periodontal patients receiving two different tetracycline treatment regimens following conventional periodontal therapy. Four patients had received an oral dose of 1000 mg/day for 2 weeks and nine had received 1000 mg/day for 1 week followed by 250 mg/day for extended time periods. The latter regimen is similar so that commonly prescribed for the chronic skin disease, acne vulgaris. Taxonomic characterization of plaque isolates indicated that the predominant organisms cultured from both treatment groups were species of Streptococcus and the branching, filamentous Gram-positive rods, Actinomyces and Rothia. A much greater microbial complexity was observed among the flora isolated from patients taking 250 mg/day. The latter group harbored many of the fastidious Gram-negative organisms presently implicated in the etiology of periodontal disease. All bacterial strains isolated were tested for resistance to tetracycline by replica-plating cultures on an agar medium containing two-fold dilutions of the antibiotic. Streptococcus, Veillonella and Neisseria were the bacterial genera found to be consistently resistant to tetracycline, with minimum inhibitory concentrations as high as 128 micrograms/ml. Among the Actinomyces, selection for antibiotic resistance was common only within a single species, A. odontolyticus. However, A viscosus strains isolated at 54% of the subgingival flora from one patient did demonstrate an intermediate resistance level, growing on concentrations up to 8 micrograms/ml. Tetracycline resistance was shown by a variety of Gram-negative rods isolated from the low dosage group. Although a minimum number of patients were studied, extensive microbial analyses of the predominating subgingival bacteria indicated that the goal of tetracycline therapy was achieved during the 2-week therapy period at 1000 mg/day.

Topics: Actinomyces; Bacteria; Dental Plaque; Gingiva; Humans; Microbial Sensitivity Tests; Periodontal Index; Periodontitis; Streptococcus; Tetracycline; Time Factors

The present investigation was undertaken to determine the influence of systemically administered tetracycline on periodontitis in the rat. Thirty Sprague-Dawley rats were arranged into two groups, one group received 21 mg of tetracycline hydrochloride each day for 10 weeks in the drinking water. Periodontitis was induced in the maxillary left segment with a 0.008 inch stainless steel ligature wire and by modifying the normal diet with sucrose. The direct microscopic and histometric measurements obtained were analyzed for statistical significance, which revealed the following: 1. Tetracycline-treated animals demonstrated significantly less resorption of the buccal alveolar bone. There were no statistical differences however, in the amount of alveolar bone resorption palatally or interdentally. 2. Tetracycline-treated animals demonstrated significantly less apical migration of the junctional epithelium on the distal root of the maxillary first molar tooth. 3. Tetracycline-treated animals demonstrated significantly fewer inflammatory cells. In conclusion, long term systemic administration of tetracycline in the rat may be of value in reducing the amount of tissue destruction in experimentally induced periodontitis.

Topics: Administration, Oral; Alveolar Process; Animals; Dental Plaque; Epithelial Attachment; Gingiva; Male; Periodontitis; Rats; Tetracycline

Topics: Administration, Topical; Bacteria; Dental Plaque; Dental Scaling; Dosage Forms; Gingiva; Humans; Oral Hygiene; Periodontal Index; Periodontal Pocket; Periodontitis; Subgingival Curettage; Tetracycline

Topics: Dental Calculus; Dental Caries; Dental Deposits; Dental Plaque; Diagnosis, Oral; Fluoresceins; Humans; Tetracycline; Tooth Discoloration; Ultraviolet Rays

Topics: Animals; Cariogenic Agents; Dental Caries; Dental Caries Susceptibility; Dental Plaque; Dietary Carbohydrates; Erythromycin; Male; Mouth; Rats; Tetracycline