tetracycline and Periodontal-Diseases

Topics: Animals; Anti-Infective Agents, Local; Bacterial Infections; Cytokines; Humans; Inflammation Mediators; Neutrophils; Periodontal Diseases; Smoking; Tetracycline

Among the aging U.S. population, patients are taking significantly more medications than in the past. In view of this, dentists should take careful medical histories, including use of herbal agents, and be aware of medication-related problems and their potential effect on the diagnosis and treatment of periodontal disease. This review highlights major concerns about medications as a risk factor for periodontal therapy. Medications and their impact on periodontal disease can be categorized as those which affect oral hygiene, diagnosis, gingival and oral mucosa, and alveolar bone.

Topics: Adrenal Cortex Hormones; Alveolar Bone Loss; Anti-Bacterial Agents; Anti-Inflammatory Agents; Bone Density Conservation Agents; Drug Utilization; Drug-Related Side Effects and Adverse Reactions; Gingival Overgrowth; Humans; Mouth Mucosa; Periodontal Diseases; Pigmentation Disorders; Polypharmacy; Risk Factors; Tetracycline; Xerostomia

Root surface biomodification has been used to treat periodontitis and gingival recession. The rationale for this procedure is that removing the smear layer from the root surfaces exposes collagen fibers, which leads to improved healing. Although animal studies have shown promising results, human studies have been disappointing. Some experts claim that the use of low-pH biomodification agents may cause necrotizing effects, and the use of neutral-pH agents does not. However, clinical investigations generally have failed to find any improvement in clinical parameters when using such agents.

Topics: Acid Etching, Dental; Animals; Anti-Bacterial Agents; Cell Adhesion; Chelating Agents; Citric Acid; Collagen; Dental Scaling; Edetic Acid; Endotoxins; Gingival Recession; Humans; Hydrogen-Ion Concentration; Necrosis; Periodontal Diseases; Root Planing; Smear Layer; Tetracycline; Tooth Root; Wound Healing

Antimicrobial agents, systemic and/or local, are thought by some to be effective agents for treating periodontal infections. Here the authors determine the costs and benefits of local delivery agents for treating periodontal disease. Applying this cost-benefit analysis to patient care, however, will depend upon a clinician's expertise and a patient's value system.

Topics: Administration, Topical; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Infective Agents, Local; Cellulose; Chlorhexidine; Cost-Benefit Analysis; Doxycycline; Drug Approval; Drug Costs; Drug Delivery Systems; Gels; Glycerides; Humans; Metronidazole; Microspheres; Minocycline; Periodontal Diseases; Randomized Controlled Trials as Topic; Research Design; Risk Assessment; Sesame Oil; Tetracycline; Treatment Outcome

Periodontal therapy has the primary aim of halting periodontal disease progression. Clinical trials over the years have indicated that meticulous scaling and root planing in conjunction with a patient's proper plaque control can arrest periodontitis, but this therapy is not always completely effective and thus adjunctive therapies need to be considered. Local delivery of antibacterial agents into periodontal pockets has been extensively developed and investigated since the late 1970s and many systems have been designed to maintain high levels of antimicrobial agents in the crevicular fluid with minimal systemic uptake. More recently subgingival antimicrobial delivery systems have become available to the practising periodontist for clinical use. These systems, employ different antimicrobial agents but also different delivery systems which influence the concentration of available drug over time. The dental profession is confused by the wide variety of available slow release subgingival antimicrobial devices on the market and clearly comparative independent assessment of these therapies is needed. This review will summarise the findings of a comparative study on three commonly available periodontal local delivery antimicrobial systems on sites with previously unsuccessful mechanical therapy. The slow release devices studied adjunctively with root planing were: Actisite, Dentomycin and Elyzol, compared to root planing alone. Substantivity of an antimicrobial system is the ability of the system to maintain an effective concentration of drug over time which may be the most significant difference between the three delivery systems rather than the type of antimicrobial drug used. Although all three locally applied antimicrobial systems seem to offer some benefit over scaling and root planing alone, a treatment regime of scaling and root planing plus tetracycline fibre placement gave the greatest reduction in probing pocket depth over the six months after treatment.

Topics: Administration, Topical; Anti-Bacterial Agents; Anti-Infective Agents; Biocompatible Materials; Cellulose; Delayed-Action Preparations; Dental Scaling; Disease Progression; Drug Delivery Systems; Gingival Crevicular Fluid; Glycerides; Humans; Metronidazole; Minocycline; Periodontal Diseases; Periodontal Pocket; Root Planing; Sesame Oil; Tetracycline

This article discusses the use of tetracyclines in the clinical management of periodontal infections. A review of the drugs pharmacology, pharmacokinetics, and potential adverse effects shows that they are relatively safe if used in appropriate dosages and under controlled conditions. Current data suggest that the routine use of tetracyclines in conjunction with the treatment of periodontitis is unnecessary. However, their distinctive characteristics can be utilized in different delivery systems as an adjunctive aid to conventional treatment of juvenile and refractory forms of periodontitis.

Topics: Adult; Aggressive Periodontitis; Anti-Bacterial Agents; Drug Delivery Systems; Humans; Periodontal Diseases; Periodontitis; Tetracycline; Tetracycline Resistance

This article addresses the use of tetracycline-impregnated fibers in the treatment of periodontal diseases. Clinical and microbiologic data are reviewed to provide pragmatic guidelines for fiber use. In addition, controversial issues associated with the labeling of Actisite, the potential of developing antibiotic-resistant strains, and the benefits of systemic vs local drug delivery are discussed. Ultimately, the article concludes that tetracycline-impregnated fibers can be used as an adjunct to scaling and root planing in certain patients at sites that do not respond to conventional therapy.

Topics: Aggregatibacter actinomycetemcomitans; Drug Delivery Systems; Evaluation Studies as Topic; Humans; Periodontal Diseases; Periodontal Pocket; Periodontitis; Tetracycline; Tetracycline Resistance; Tetracyclines; Time Factors

A new therapeutic approach involves the discovery by the "Stony Brook group," that tetracyclines, but not other antibiotics, can inhibit host-derived collagen-destructive enzymes. This newly discovered property of tetracyclines is unrelated to the antimicrobial activity of these drugs. Examples support the hypothesis that this unexpected property of tetracyclines provides a new approach to treating periodontal diseases as well as a variety of medical disorders.

Topics: Gingival Crevicular Fluid; Matrix Metalloproteinase Inhibitors; Metalloendopeptidases; Periodontal Diseases; Periodontal Pocket; Tetracycline; Tetracyclines

Antimicrobial agents are used in combination with debridement to eliminate putative periodontal pathogens, including Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans, from diseased tissues. The most frequently used antimicrobial agents are the tetracyclines. However, these agents are not effective in some patients. This lack of efficacy may be due to antimicrobial resistance. As many as 75% of the bacteria in the subgingival flora may be resistant to tetracycline after long-term, low-dose treatment. Tetracycline resistance is mediated by the tet(M) determinant in some isolates of Veillonella species and Fusobacterium nucleatum, while a DNA probe to the tet(Q) determinant hybridizes to isolates of Prevotella denticola and P. intermedia. The mechanism of tetracycline resistance for most periodontal organisms, however, has yet to be determined. Before tetracycline is used as adjunctive therapy for refractory periodontitis, the subgingival bacterial flora should be tested for susceptibility.

Topics: Bacteria; Bacterial Infections; Humans; Periodontal Diseases; Tetracycline; Tetracycline Resistance

Adjunctive treatment with various chemotherapeutic regimens in implant dentistry are reviewed along with the indications for specific approaches. The use of systemic antibiotics, topical antimicrobials, and various mechanical modalities are discussed in relation to patient maintenance and the repair of ailing implants.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Dental Implants; Equipment Contamination; Humans; Periodontal Diseases; Premedication; Prosthesis-Related Infections; Tetracycline; Therapeutic Irrigation

Tetracyclines have recently been shown to inhibit the activity of some but not all mammalian matrix metalloproteinases believed to mediate periodontal destruction. However, the specificity of this effect, which could have significant therapeutic implications for different periodontal diseases, has not been examined in detail. Doxycycline and 4-de-dimethylaminotetracycline (CMT-1) have been tested in vitro for their ability to inhibit human neutrophil and fibroblast interstitial collagenases and collagenase in human gingival crevicular fluid (GCF). The GCF samples were obtained from systemically healthy and insulin-dependent diabetic adult periodontitis patients and from localized juvenile periodontitis (LJP) patients. The concentrations of these 2 tetracyclines required to inhibit 50% of the collagenase activity (IC50) were found to be 15 to 30 microM for human neutrophil collagenase and for collagenase in GCF of systemically healthy and diabetic adult periodontitis patients. These concentrations approximate the tetracycline levels observed in vivo during treatment with these drugs. In contrast, human fibroblast collagenase and GCF collagenase from LJP patients were both relatively resistant to tetracycline inhibition; the IC50 for doxycycline and CMT-1 for these 2 sources of collagenase were 280 and 500 microM, respectively. Based on these and other findings, we propose the following: 1) that systemic levels of tetracycline may inhibit connective tissue breakdown by inhibiting neutrophil collagenase; 2) that tetracyclines do not inhibit fibroblast-type collagenase, which may help explain their lack of effect on normal connective tissue remodeling; 3) that tetracycline inhibition of collagenases may serve to identify the cellular origin of the enzyme; and 4) that tetracyclines can also prevent the oxidative activation of latent human procollagenases.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Collagenases; Doxycycline; Fibroblasts; Gingival Crevicular Fluid; Humans; Inflammation; Matrix Metalloproteinase Inhibitors; Neutrophils; Periodontal Diseases; Periodontitis; Tetracycline; Tetracyclines

Topics: Anti-Bacterial Agents; Benzoates; Clinical Trials as Topic; Dental Research; Meta-Analysis as Topic; Mouthwashes; Outcome Assessment, Health Care; Periodontal Diseases; Periodontitis; Research Design; Sodium Dodecyl Sulfate; Tetracycline

Controlled drug release formulations are rapidly gaining importance in drug therapy as replacements for conventional systemic dosages. Examples include skin patches for treatment of angina pectoris and motion sickness, eye inserts for glaucoma and implants for prolonged release of contraceptives. This paper will review the current status of periodontal controlled release devices and look at their potential role in periodontal treatment.

Topics: Anti-Bacterial Agents; Chlorhexidine; Delayed-Action Preparations; Gels; Humans; Periodontal Diseases; Tetracycline

This case involves a 14-year-old female patient affected with localized juvenile periodontitis. Treatment consisted of periodontal flap surgery in conjunction with tetracycline therapy. A successful result was obtained and maintained. The case depicts the fact that in many instances localized juvenile periodontitis can be treated with confidence and a high degree of predictability. It should also be noted that, like all treatment modalities, the treatment of this disease as discussed in this case is not the panacea and will undergo considerable changes in the future; however, in light of current knowledge, this combined treatment approach appears to be effective in LJP patients.

Topics: Adolescent; Aggressive Periodontitis; Female; Humans; Periodontal Diseases; Surgical Flaps; 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

Increasing evidence for the involvement of specific microorganisms in the etiology of human periodontal diseases has appeared during the last few years. The microorganisms most likely to cause periodontal disease are Actinobacillus actinomycetemcomitans, Bacteroides gingivalis, Bacteroides intermedius and Capnocytophaga species. Many of the strains are resistant to tetracycline and doxycycline. Recently penicillin-resistant B. gingivalis and B. intermedius have also been described. A. actinomycetemcomitans strains and capnocytophaga strains are sensitive to tetracycline and doxycycline. This has raised the question if periodontal diseases are possible to treat with antimicrobial agents alone or in combination with scaling of the teeth and surgery. Although numerous studies with different antimicrobial agents have been published it is still controversial if antimicrobials agents have a role in the treatment of human periodontal diseases. Comparative randomized long term studies are still needed to answer this question.

Topics: Anti-Bacterial Agents; Clinical Trials as Topic; Double-Blind Method; Doxycycline; Humans; Periodontal Diseases; Random Allocation; 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

Topics: Aggressive Periodontitis; Anti-Bacterial Agents; Chlorhexidine; Gingivitis; Gingivitis, Necrotizing Ulcerative; Humans; Periodontal Diseases; Periodontitis; Periodontium; Tetracycline

Topics: Bacterial Physiological Phenomena; Humans; Periodontal Diseases; Tetracycline

Topics: Anti-Bacterial Agents; Bacteria; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Periodontal Diseases; Tetracycline

For many years, tetracycline has been prescribed in the treatment of periodontal disease with little research data supporting such use. Current data suggest that most patients with periodontal disease are best treated by conventional techniques of subgingival debridement.

Topics: Adult; Child; Clinical Trials as Topic; Dental Scaling; Gram-Negative Anaerobic Bacteria; Humans; Oral Hygiene; Periodontal Diseases; Tetracycline; Tooth Root

To compare the treatment outcome of scaling and root planing (SRP) in combination with systemic antibiotics, local antibiotic therapy and/or periodontal surgery.. One hundred and eighty-seven patients were assigned to eight groups treated by SRP plus none, one, two or three adjunctive treatments and monitored for 24 months in a randomized controlled clinical trial using a 2 × 2 × 2 factorial design. Systemic amoxicillin + metronidazole (SMA), local tetracycline delivery (LTC) and periodontal surgery (SURG) were evaluated as adjuncts. Changes in clinical attachment level (CAL) and probing pocket depth (PPD) were statistically evaluated by ancova of main effects.. Effects of adjunctive therapy to SRP were minimal at 3 months. Between 3 and 6 months PPD reduction occurred particularly in patients receiving periodontal surgery. After 6 months, both CAL gain and PPD reduction reached a plateau that was maintained at 24 months in all groups. The 24-month CAL gain was improved by SMA (0.50 mm) while PPD was reduced by SMA (0.51 mm) and SURG (0.36 mm). Smoking reduced CAL gain and PPD reduction.. Patients receiving adjunctive therapies generally exhibited improved CAL gain and/or PPD reduction when compared with the outcome of SRP alone. Only additive, not synergistic effects of the various adjunctive therapies were observed.

Topics: Amoxicillin; Analysis of Variance; Anti-Infective Agents; Cellulose; Chemotherapy, Adjuvant; Chlorhexidine; Dental Scaling; Drug Combinations; Drug Delivery Systems; Female; Humans; Male; Metronidazole; Middle Aged; Oral Surgical Procedures; Periodontal Attachment Loss; Periodontal Diseases; Periodontal Index; Periodontal Pocket; Smoking; Tetracycline; Treatment Outcome

The aim of this study was to evaluate the clinical and radiographic results of intentional replantation of periodontally involved teeth after conditioning of root surfaces with tetracycline-HCl. Thirteen patients (seven female, six male; age range: 35-52 years) with 15 periodontally involved hopeless teeth were included in this study. During the replantation procedure, the affected teeth were gently extracted, then the granulation tissues, calculus, remaining periodontal ligament and necrotic cementum on the root surfaces were removed. Tetracycline-HCl, at a concentration of 100 mg ml(-1), was applied for 5 min to the root surfaces. The teeth were then replaced into the socket and splinted. Patients were clinically and radiographically evaluated at baseline (time of surgery) and 6 months after the surgery. The following measurements were recorded: probing depth (PD), gingival recession (R), the amount of bone loss (BL) and bone gain (BG). Results indicated a reduction in PD and in the amount of bone loss and healthy gingiva. Mean PD was decreased from 5.25 to 2.36 mm, gingival recession was increased from 3.73 to 4.0 mm, and BL was reduced from 73.20 to 56.86%. At the end of 6 months, no root resorption or ankylosis was observed radiographically. Even during the short period of evaluation, it may be suggested that intentional replantation can be an alternative approach to extraction in cases where advanced periodontal destruction is present and no other treatments could be considered.

Topics: Adult; Alveolar Bone Loss; Anti-Bacterial Agents; Curettage; Dental Scaling; Female; Gingival Recession; Humans; Male; Middle Aged; Periodontal Diseases; Protease Inhibitors; Radiography; Root Canal Therapy; Tetracycline; Tooth Extraction; Tooth Replantation; Tooth Root; Tooth Socket; Treatment Outcome

This study evaluated, in vitro, fibroblast attachment to periodontally involved root surfaces which were either root planed or acid/chelated by different agents. Specimens were divided into 3 groups of 12 specimens each. The root surfaces were root planed with a Gracey 7/8 curette, an EMS or an Amdent piezo-electric scaler and treated with saline, citric acid, tetracycline hydrochloride or EDTA to produce different surface textures. They were then cultured with fibroblasts for 72 h and examined by scanning electron microscopy. There was a significantly greater number of fibroblasts attached to specimens treated with citric acid, tetracycline and EDTA than to those root planed only. Furthermore, fibroblasts were more likely to attach to rough-surfaced than to smooth-surfaced specimens.

Topics: Acid Etching, Dental; Cell Adhesion; Cells, Cultured; Chelating Agents; Citric Acid; Collagen; Curettage; Dental Scaling; Dentin; Edetic Acid; Fibroblasts; Gingiva; Humans; Microscopy, Electron, Scanning; Periodontal Diseases; Root Planing; Sodium Chloride; Tetracycline; Tooth Root

This study describes the formulation, characterisation and preliminary clinical evaluation of mucoadhesive, semi-solid formulations containing hydroxyethylcellulose (HEC, 1-5%, w/w), polyvinylpyrrolidine (PVP, 2 or 3%, w/w), polycarbophil (PC, 1 or 3%, w/w) and tetracycline (5%, w/w, as the hydrochloride). Each formulation was characterised in terms of drug release, hardness, compressibility, adhesiveness (using a texture analyser in texture profile analysis mode), syringeability (using a texture analyser in compression mode) and adhesion to a mucin disc (measured as a detachment force using the texture analyser in tensile mode). The release exponent for the formulations ranged from 0.78+/-0.02 to 1. 27+/-0.07, indicating that drug release was non-diffusion controlled. Increasing the concentrations of each polymeric component significantly increased the time required for 10 and 30% release of the original mass of tetracycline, due to both increased viscosity and, additionally, the unique swelling properties of the formulations. Increasing concentrations of each polymeric component also increased the hardness, compressibility, adhesiveness, syringeability and mucoadhesion of the formulations. The effects on product hardness, compressibility and syringeability may be due to increased product viscosity and, hence, increased resistance to compression. Similarly, the effects of these polymers on adhesiveness/mucoadhesion highlight their mucoadhesive nature and, importantly, the effects of polymer state (particularly PC) on these properties. Thus, in formulations where the neutralisation of PC was maximally suppressed, adhesiveness and mucoadhesion were also maximal. Interestingly, statistical interactions were primarily observed between the effects of HEC and PC on drug release, mechanical and mucoadhesive properties. These were explained by the effects of HEC on the physical state of PC, namely swollen or unswollen. In the preliminary clinical evaluation, a formulation was selected that offered an appropriate balance of the above physical properties and contained 3% HEC, 3% PVP and 1% PC, in addition to tetracycline 5% (as the hydrochloride). The clinical efficacy of this (test) formulation was compared to an identical tetracycline-devoid (control) formulation in nine periodontal pockets (>/=5 mm depth). One week following administration of the test formulation, there was a significant improvement in periodontal health as identified by reduced numbers of sub-

Topics: Acrylic Resins; Algorithms; Anti-Bacterial Agents; Cellulose; Chemistry, Pharmaceutical; Drug Carriers; Excipients; Gels; Humans; Mouth Mucosa; Periodontal Diseases; Povidone; Syringes; Tetracycline; Tissue Adhesives

The purpose of this study was to evaluate and compare the clinical effectiveness of 2 surgical techniques in treating periodontal defects. Both techniques involved tetracycline treatment of a root planed root, grafting the osseous defect with a bone graft, and placement of a bioabsorbable membrane. In group A, the bone graft was a mix of demineralized freeze-dried allograft, tetracycline, and porous hydroxyapatite and in group B, the bone graft was a mix of demineralized freeze-dried allograft and tetracycline. There was a statistically significant increase in recession (group A, 0.7 mm; group B, 0.6 mm), decreases in probing depth (group A, 6.1 mm; group B, 5.6 mm), and gains in attachment levels (group A, 5.4 mm; group B, 5.0 mm). There were no statistically significant differences between the results for either group. The defects associated with furcations and those that were not associated with furcations had similar results, except for the percent attachment gain. Smoking and age (> or =60 years old) could not be associated with results. Defects with > or =10 mm probing depths (PD) had greater PD reductions (group A, 7.7 mm; group B, 7.1) and attachment gains (group A, 6.6 mm; group B, 6.4 mm) than the defects with probing depths less than 10 mm (probing reduction group A, 4.8 mm; group B, 4.5 mm; attachment gain group A, 4.4 mm; group B, 4.0 mm). Both surgical procedures improved the clinical situation. However, neither technique seemed to offer a statistical advantage over the other. The inclusion of porous hydroxyapatite did not improve or diminish the results.

Topics: Adult; Age Factors; Aged; Alveolar Bone Loss; Analysis of Variance; Anti-Bacterial Agents; Biodegradation, Environmental; Bone Regeneration; Bone Transplantation; Decalcification Technique; Durapatite; Female; Freeze Drying; Furcation Defects; Gingival Recession; Guided Tissue Regeneration, Periodontal; Humans; Male; Membranes, Artificial; Middle Aged; Outcome Assessment, Health Care; Periodontal Attachment Loss; Periodontal Diseases; Periodontal Index; Smoking; Tetracycline; Tooth Root; Transplantation, Autologous; Transplantation, Homologous

This paper presents 5-year data pertaining to a subgroup of patients from a previous investigation who were treated with scaling and root planing plus tetracycline fibers. The parent study demonstrated that 6 months after therapy, scaling and root planing plus tetracycline fiber therapy was significantly better at reducing probing depth and gaining clinical attachment than scaling and root planing alone. However, the long-term data presented here show a regression from the original gains in clinical attachment levels in the fiber group. Ultimately, the use of fibers provided no significant advantage with regards to probing depth reduction or clinical attachment gain. Within the power of this study, which would have required 1.78 mm of change in clinical attachment to show a difference, there was no significant difference between the treatments at 5 years. This study underscores the need for additional long-term evaluation of this mode of therapy.

Topics: Analysis of Variance; Anti-Bacterial Agents; Combined Modality Therapy; Dental Scaling; Drug Implants; Evaluation Studies as Topic; Follow-Up Studies; Gingival Hemorrhage; Gingival Recession; Humans; Longitudinal Studies; Periodontal Attachment Loss; Periodontal Diseases; Periodontal Pocket; Recurrence; Root Planing; Single-Blind Method; Tetracycline; Wound Healing

In a previous study, subjects receiving either adjunctive tetracycline or Augmentin showed, on average, more attachment level gain 10 months post-therapy than subjects receiving either Ibuprofen or a placebo, although some subjects in each treatment group showed loss of attachment post-therapy. Since differences in treatment response might have been due to differences in the subgingival microbiota, the response to different therapies in subjects with different pre-therapy subgingival microbiotas was evaluated. 29 subjects exhibiting loss of attachment > 2.5 mm at 1 or more sites during longitudinal monitoring were treated by modified Widman flap surgery at deep sites, subgingival scaling at all other sites and were randomly assigned one of the following agents: Augmentin, tetracycline, ibuprofen or a placebo. Treatment was completed within 30 days, during which time the subject took the assigned agent. Subgingival plaque samples were taken from the mesial surface of each tooth at each visit and evaluated for their content of 14 subgingival species including P. gingivalis, P. nigrescens, P. intermedia and B. forsythus using DNA probes. 18 subjects with mean counts > 10(5) of 2 or more of these 4 species comprised the high test species group; 11 subjects with mean counts > 10(5) of 0 or 1 of the species, the low test species group. Because this was a post-hoc analysis, the number of subjects in some of the treatment/test species groups was small. However, the 8 high test species subjects who received tetracycline showed the most attachment level gain (0.83 +/- 0.20 mm), while the 3 tetracycline-treated, low test species subjects showed minimal gain (0.05 +/- 0.28 mm) 10 months post-therapy. Low test species subjects receiving Augmentin (n = 2) showed a mean gain in attachment of 0.67 (+/- 0.59) mm. The mean % of sites showing either attachment gain or loss > or = 2 mm was computed for each treatment/test species group. High test species subjects receiving tetracycline exhibited the best ratio of gaining to losing sites (16.2), followed by low test species subjects receiving Augmentin (14.1). Periodontal pockets < 7 mm pre-therapy in low test species subjects treated with Augmentin and high test species subjects treated with tetracycline showed attachment gain more frequently than attachment loss. The greatest proportion of gaining sites was seen at pockets > 6 mm, particularly in subjects receiving adjunctive tetracycline. Overall, the data indicated that a

Topics: Adolescent; Adult; Aged; Aggregatibacter actinomycetemcomitans; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Bacteroides; Campylobacter; Clavulanic Acids; Cluster Analysis; Colony Count, Microbial; Double-Blind Method; Drug Therapy, Combination; Female; Fusobacterium nucleatum; Humans; Ibuprofen; Male; Middle Aged; Peptostreptococcus; Periodontal Attachment Loss; Periodontal Diseases; Periodontal Pocket; Porphyromonas gingivalis; Prevotella; Prevotella intermedia; Statistics, Nonparametric; Streptococcus; Tetracycline; Treatment Outcome

This study evaluated the 6-month clinical response to sustained-release tetracycline fibers used alone or with scaling and root planing in 25 adult periodontal maintenance patients. All subjects had at least one pocket > or = 4.0 mm that bled on probing and required therapy. Thirty-six teeth were treated with tetracycline fibers for 7 to 12 days; twelve of the 36 teeth also received scaling and root planing. The selection of teeth for scaling and root planing was based on the condition of the teeth. Therapeutic results were evaluated by changes in probing depth and frequency of bleeding on probing. Use of tetracycline fibers and fibers with scaling produced 1.8- and 1.7-mm reductions in probing depth, respectively, 1 month after treatment; reductions declined to 1.3 and 0.8 mm at 3 months, but rebounded to 1.5 and 1.3 mm at 6 months. The percentage of teeth exhibiting bleeding on probing decreased from 100% at baseline to 68% and 50% in the fiber and fiber plus scaling groups, respectively, at 6 months. None of the differences was statistically significant. Tetracycline fibers clearly decreased clinical signs of periodontal inflammation. Addition of scaling and root planing at the time of fiber placement further decreased, although not significantly, the degree of inflammation.

Topics: Adult; Anti-Bacterial Agents; Delayed-Action Preparations; Dental Scaling; Humans; Periodontal Diseases; Periodontal Index; Periodontal Pocket; Polyvinyls; Root Planing; Tetracycline

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

The purpose of this clinical trial was to evaluate the effect of tetracycline root preparation on guided tissue regeneration in the treatment of Class II furcation defects. Nine pairs of defects with horizontal clinical attachment level value > or = 5 mm comprised the study group. Measurements were made to determine presence of plaque, gingival condition, probing depth, and vertical and horizontal clinical attachment level. Defects from each pair were randomly assigned for treatment with an expanded polytetrafluoroethylene membrane (e-PTFE) and tetracycline root conditioning (100 mg/ml) or the membrane alone. The membranes were removed 4 to 6 weeks postsurgery. Patients were then seen monthly for the duration of the study. Six months postsurgery, all clinical measurements were repeated. Following either treatment, improvement was observed in all clinical parameters, particularly in horizontal clinical attachment level. However, there was not a statistically significant difference in the improvement observed between sites treated with guided tissue regeneration in conjunction with tetracycline as compared to membrane placement alone. Further studies are needed to fully evaluate tetracycline root preparation in conjunction with regenerative therapy.

Topics: Administration, Topical; Adult; Analysis of Variance; Dental Plaque Index; Guided Tissue Regeneration, Periodontal; Humans; Membranes, Artificial; Middle Aged; Molar; Multivariate Analysis; Periodontal Diseases; Periodontal Index; Polytetrafluoroethylene; Tetracycline; Tooth Root

Substantivity of tetracycline HCl and chlorhexidine digluconate was assessed in extracted teeth. Fifty periodontally compromised teeth scheduled for extraction with probing depths ranging between 6 and 12 mm were root planed and then irrigated in situ with 1 of 4 solutions: tetracycline HCl at concentrations of 10 or 50 mg/ml, 0.12% chlorhexidine digluconate, or 0.9% sterile saline. Each tooth was exposed to 150 ml of the respective irrigation solution. Following extractions, the teeth were transferred to tris buffered saline and incubated at room temperature for 22 days. Incubation solutions were replaced at 24-hour intervals. Removed solutions were examined for desorbed antimicrobial activity using a microtiter assay in which bacterial growth was evaluated by optical density readings. Tetracycline HCl 50 mg/ml exhibited significantly greater antimicrobial activity than chlorhexidine digluconate for 12 days and greater than saline for 16 days. Tetracycline HCl 10 mg/ml exhibited significantly greater antimicrobial activity than chlorhexidine digluconate and saline for 4 days. Chlorhexidine digluconate did not exhibit any significant antimicrobial activity at any time point. Our findings demonstrate long-lasting substantivity of tetracycline HCl, but not chlorhexidine digluconate, by teeth exposed to a single episode of pocket irrigation of their periodontally-exposed roots. The amount of antimicrobial activity retained is proportional to the concentration of tetracycline HCl used for irrigation.

Topics: Adsorption; Adult; Analysis of Variance; Biological Availability; Chlorhexidine; Colony Count, Microbial; Humans; Microbial Sensitivity Tests; Middle Aged; Periodontal Diseases; Regression Analysis; Streptococcus mutans; Tetracycline; Therapeutic Irrigation; Time Factors; Tooth Root

The primary objective of this study was to evaluate the concentration and location of tetracycline hydrochloride in tissue adjacent to periodontal pockets treated with a tetracycline impregnated fiber. A secondary objective was to determine if the presurgical placement of fibers had any adverse effects on healing following periodontal surgery. The study population consisted of 10 patients with at least 2 pockets in both maxillary quadrants of > or = 5 mm in depth and exhibiting bleeding on probing. After an initial scaling and root planing, placebo or tetracycline fibers were randomly assigned by quadrant to 2 non-adjacent pockets. Fibers were removed at the time of surgery; i.e., day 8, and periodontal surgery was performed utilizing a flap incision that allowed biopsy of 1 interdental papilla from each of the 2 test sites in each quadrant. One biopsy was analyzed for tetracycline concentrations by high performance liquid chromatography (HPLC). The second biopsy was examined by both light and ultraviolet fluorescence microscopy to determine the location of residual tetracycline and the intensity of inflammatory cell infiltrates. Results showed that the tissue concentration of the antibiotic in tetracycline treated sites was 64.4 +/- 7.01 ng/mg (ng of tetracycline/mg tissue weight) which corresponds to 43 micrograms of tetracycline and was below levels of accurate measurement in placebo treated sites. Tetracycline tissue concentrations corresponded to the ultraviolet fluorescence microscopy with a Pearson correlation coefficient of r = 0.92. Tetracycline fluorescence was noted in the soft tissue wall ranging from 1 to 20 microns.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Chemotherapy, Adjuvant; Drug Implants; Epithelium; Gingiva; Gingival Hemorrhage; Humans; Periodontal Diseases; Periodontal Pocket; Periodontium; Placebos; Surgical Flaps; Tetracycline; Time Factors; Tissue Distribution; Wound Healing

The study design and baseline characteristics of a multicenter trial to test the effectiveness and safety of locally delivered tetracycline for treatment of adult periodontitis are described. Local delivery was provided by 0.5 mm diameter ethylene vinyl acetate copolymer fibers loaded 25% with tetracycline hydrochloride which were placed into periodontal pockets and maintained by an adhesive for 10 (+/- 2) days. A total of 113 subjects (56 male and 57 female; mean age 49.3 yr) at five centers participated in the study. Subjects were selected who had 4 nonadjacent teeth with 6-10 mm pockets that bled on probing. The selected sites in each subject were randomly assigned to 4 test groups: tetracycline fiber, control fiber, scaling with root planing, or untreated. A balanced experimental design was thereby established in which each subject contributed equally by providing 4 clinically comparable sites for evaluation. To provide a more specific model for testing periodontitis therapy, gingivitis was treated prior to the initiation of the study by prophylaxis with supragingival calculus removal and home care instruction. Clinical response variables measured were pocket depth reduction, attachment level gain and bleeding on controlled-force probing measured at baseline, 30 d, and 60 d. Levels of 6 bacterial species selected as probable periodontal pathogens were measured by DNA probe analysis of plaque samples. The design of this study provided several unique analytical opportunities. Controls included a comparison with conventional treatment, analysis of vehicle effects, and effects at untreated sites. Comparison of the test group with controls permitted evaluation of the principal variables that could effect interpretation of results.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Boston; Dental Plaque Index; Female; Georgia; Humans; Male; Middle Aged; Missouri; Multicenter Studies as Topic; New York City; Periodontal Diseases; Periodontal Pocket; Polyvinyls; Random Allocation; Research Design; San Francisco; Tetracycline

The safety and efficacy of periodontal disease treatment by intrapocket placement of tetracycline (TC) fibers was investigated in a 60-day multicenter study conducted by selecting 4 sites in each subject with 6-10 mm pockets that bled on probing. Sites were randomly assigned to 1 of 4 test groups: TC fiber therapy, scaling, control fiber (fibers without drug), or untreated. TC fibers and control fibers were placed to fill the pocket and were maintained with a cyanoacrylate adhesive for 10(+/- 2) d. Scaling was performed for a minimum of 5 min under local anesthesia. Following initial tooth cleaning procedures, pocket depth, attachment level and bleeding on controlled-force probing were measured at baseline and at 30 d, and 60 d following therapy. Analysis of data from 107 subjects who had complete clinical data sets indicated that TC fiber therapy significantly decreased pocket depth, increased attachment level, and decreased bleeding on controlled-force probing to a greater extent than observed in all other test groups including scaling. These effects were greater than, and in addition to, effects that occurred due to prophylaxis and improved home care. No serious adverse side-effects attributed to TC fiber therapy were observed. No TC fiber-treated sites abscessed and superinfection was not noted. A transient redness at fiber removal was seen at 21% of the sites. Although fibers were placed without anesthesia, mild pain on initial placement was infrequent (19%) and abated rapidly. The results indicate that TC fiber placement provides a safe and effective means for treatment of periodontal infections.

Topics: Adult; Analysis of Variance; Chi-Square Distribution; Epithelial Attachment; Female; Humans; Least-Squares Analysis; Linear Models; Male; Middle Aged; Periodontal Diseases; Periodontal Index; Periodontal Pocket; Random Allocation; Tetracycline

In a multicenter study of the effects of tetracycline (TC) fiber therapy, subgingival plaque samples were tested for 6 probable periodontal pathogens by DNA probe analysis. Levels of Actinobacillus actinomycetemcomitans, Eikenella corrodens, Fusobacterium nucleatum, Porphyromonas (Bacteroides) gingivalis, Prevotella intermedia (Bacteroides intermedius), and Wolinella recta were quantitatively determined in samples taken at baseline, and immediately after TC fiber removal, control fiber removal, and scaling and root planing. At untreated sites, samples were taken at baseline and 10 d later. Specificity of the DNA probe method was evaluated by testing the hybridization to 83 reference cultures. Interaction of the F. nucleatum probe with Fusobacterium periodonticum, and of the W. recta probe with Wolinella curva were the only cross-hybridizations noted. Species were detected at an average sensitivity of 2.9 x 10(4) organisms per sample. Approximately 70% of sites were initially infected with P. gingivalis and F. nucleatum; 50% with P. intermedia and E. corrodens; infections with W. recta and A. actinomycetemcomitans were less common (36% and 11% respectively). The average numbers of organisms found in the plaque samples were highest for F. nucleatum, P. gingivalis, and P. intermedia (ca. 10(6)). E. corrodens, W. recta, and A. actinomycetemcomitans occurred at 10-fold lower levels. Bacterial numbers and proportions of species in subgingival sites from the five centers did not differ appreciably. Both TC fiber therapy and scaling decreased the number of sites infected with all the monitored species. The bacterial composition at untreated sites and at sites where control fibers were placed was not significantly altered. The percentage reduction of the number of sites with detectable infection varied with each species: from 86% with W. recta to approximately 40% with P. gingivalis. Significant reduction of pocket depth and bleeding occurred at TC fiber-treated sites infected with each of the species. Significant attachment level gain occurred only at sites initially infected with P. gingivalis and treated with TC fibers.

Topics: Actinobacillus; Bacteria, Anaerobic; Bacteroides; DNA Probes; DNA, Bacterial; Eikenella corrodens; Fusobacterium; Gram-Negative Bacteria; Humans; Microbial Sensitivity Tests; Periodontal Diseases; Polyvinyls; Tetracycline

Oligonucleotide DNA probe and selective cultural methods were compared in their ability to monitor 6 putative periodontal pathogens in a study evaluating local tetracycline fiber therapy. Subgingival plaque was sampled from 4 sites in each of 20 subjects. Samples were taken before and after therapy from sites assigned to the following test groups: tetracycline (TC) fiber, scaling and root planing, control fiber, and untreated. Each sample was analyzed by both DNA probe and cultural methods. Total anaerobic cultivable counts, Porphyromonas (Bacteroides) gingivalis and Prevotella intermedia (Bacteroides intermedius) were enumerated on nonselective blood agar. Actinobacillus actinomycetemcomitans, Eikenella corrodens, Fusobacterium nucleatum and Wolinella recta were isolated on selective media. TC fiber therapy and scaling reduced total cultivable counts from an initial value of 1 x 10(7) to approximately 2 x 10(5) following therapy. Total counts at untreated sites and at sites with control fibers did not change from baseline. A. actinomycetemcomitans and E. corrodens were detected more frequently by the cultural method; the other monitored species were detected more frequently by DNA probes than by the cultural methods. Agreements between methods were: 77.2% for A. actinomycetemcomitans; 72.2% for P. intermedia; 75.6% for E. corrodens; 39.4% for F. nucleatum; 35.6% for P. gingivalis; and 68.9% for W. recta. Limitations of the selective cultural methods used probably contributed to the discrepancies for P. gingivalis and F. nucleatum. DNA probe and cultural methods indicated comparable levels of suppression of the monitored species following TC fiber therapy and scaling. The microbiota of control fiber and untreated sites did not appear to be significantly altered by either method.

Topics: Actinobacillus; Bacteria, Anaerobic; Bacteroides; Cells, Cultured; Colony Count, Microbial; DNA Probes; DNA, Bacterial; Eikenella corrodens; Fusobacterium; Gram-Negative Bacteria; Humans; Microbial Sensitivity Tests; Periodontal Diseases; Polyvinyls; Sensitivity and Specificity; Tetracycline

The present study describes results on selected clinical and microbiological parameters obtained by periodontal treatment with ethylene vinyl acetate fibers containing 25% by weight tetracycline hydrochloride placed into the periodontal pocket alone or in combination with scaling. Supragingival plaque control was maintained throughout the study by weekly professional cleaning and 0.2% chlorhexidine mouthrinses. Controls included untreated sites and sites treated by conventional scaling alone in a 4-quadrant split-mouth design. The experiment was conducted on 95 teeth from 10 subjects with periodontal pockets greater than or equal to 6 mm which initially bled on probing. All treatments resulted in changes indicative of effective therapy. Pocket depth was reduced, bleeding on probing decreased and gingival index scores decreased. Parallel to the clinical changes, all treatments reduced total bacterial numbers, % black-pigmented Bacteroides, motile bacteria, non-motile rods, and produced a proportionate increase in cocci. Fiber therapy with or without scaling reduced bacterial counts by approximately 2 orders of magnitude when evaluated at 62 days post-therapy. The combination of fiber therapy with scaling was particularly effective, suggesting a possible synergy between these forms of therapy. The combined therapy eliminated bleeding on probing, and black-pigmented Bacteroides, and produced the greatest mean reduction in pocket depth.

Topics: Adult; Aged; Bacteria; Colony Count, Microbial; Delayed-Action Preparations; Dental Scaling; Drug Implants; Female; Gingival Hemorrhage; Humans; Male; Middle Aged; Oral Hygiene; Periodontal Diseases; Periodontal Pocket; Polyvinyls; Tetracycline

Ten patients with bilateral, posterior osseous defects associated with localized juvenile periodontitis (LJP) completed the study. Following the initial therapy, osseous defects were surgically debrided and grafted with a 4:1 volume ratio combination of either Synthograft/tetracycline (b-TCP/TTC), Periograf/tetracycline (HA/TTC) or freeze-dried bone allograft/tetracycline (FDBA/TTC). Graft materials were selected randomly for each half mouth following defect debridement, with a different material used on the opposite side for that patient. Immediately following each surgery, patients were placed on doxycycline 100 mg/day for 10 days. Direct re-entry evaluation of 51 osseous defects demonstrated no significant differences among the graft materials regarding hard tissue or soft tissue changes, except for greater percent defect fill for HA/TTC compared to b-TCP/TTC. Significant decreases in defect depth and pocket depth were achieved with each graft material. No adverse reactions to the use of any of the graft materials in combination with local and systemic tetracycline were found. The results indicate all three graft materials used in conjunction with TTC are acceptable and beneficial for the treatment and repair of osseous defects associated with localized juvenile periodontitis.

Topics: Adolescent; Adult; Aggressive Periodontitis; Alveolar Process; Alveoloplasty; Biocompatible Materials; Bone Transplantation; Calcium Phosphates; Ceramics; Durapatite; Female; Gingiva; Humans; Hydroxyapatites; Male; Periodontal Diseases; Periodontal Pocket; Prostheses and Implants; Surgical Flaps; Tetracycline

Increasing evidence for the involvement of specific microorganisms in the etiology of human periodontal diseases has appeared during the last few years. The microorganisms most likely to cause periodontal disease are Actinobacillus actinomycetemcomitans, Bacteroides gingivalis, Bacteroides intermedius and Capnocytophaga species. Many of the strains are resistant to tetracycline and doxycycline. Recently penicillin-resistant B. gingivalis and B. intermedius have also been described. A. actinomycetemcomitans strains and capnocytophaga strains are sensitive to tetracycline and doxycycline. This has raised the question if periodontal diseases are possible to treat with antimicrobial agents alone or in combination with scaling of the teeth and surgery. Although numerous studies with different antimicrobial agents have been published it is still controversial if antimicrobials agents have a role in the treatment of human periodontal diseases. Comparative randomized long term studies are still needed to answer this question.

Topics: Anti-Bacterial Agents; Clinical Trials as Topic; Double-Blind Method; Doxycycline; Humans; Periodontal Diseases; Random Allocation; Tetracycline

Local antimicrobial therapy has been considered for use in the treatment of chronic periodontal disease. This study evaluated chlorhexidine, metronidazole, and tetracycline delivered into periodontal pockets in an acrylic resin vehicle and compared the results with root planed and untreated sites over a three-month follow-up period. One site per patient where pocketing greater than or equal to 6 mm associated with a single rooted tooth was randomly allocated to one of the five possible regimens. Baseline and follow-up measurements included probing depth, loss of attachment, bleeding on probing, crevicular fluid flow, and dark-field microscopy of a subgingival plaque sample. Intratreatment evaluations revealed no significant changes in any parameter for untreated sites. Significant improvements in many parameters occurred with all four therapies although the magnitude and duration were greater in metronidazole and root planing groups. The more important intertreatment comparisons indicated that most treatments produced significant benefits compared with the control group; however, again these were greater with metronidazole and root planing. Furthermore, significantly greater effects were noted for metronidazole and root planing compared with tetracycline and more particularly chlorhexidine. It is concluded that some locally delivered antimicrobials alone may be useful in the treatment of chronic periodontal disease. However, at this time local antimicrobial therapy should be considered as adjunctive to conventional debridement techniques.

Topics: Adult; Aged; Chlorhexidine; Chronic Disease; Dental Scaling; Drug Implants; Female; Follow-Up Studies; Humans; Male; Methylmethacrylates; Metronidazole; Middle Aged; Periodontal Diseases; Periodontal Pocket; Tetracycline; Tooth Root

Sixteen patients diagnosed as having juvenile periodontitis were randomly placed into one of two treatment groups. Group I received local and systemic tetracycline (TTC), while Group II received no antibiotics. Osseous defects were grafted with allogeneic freeze-dried bone (FDBA) mixed with TTC powder (Group Ia) or FDBA alone (Group IIa). Contralateral defects were debrided only in both Groups (Ib and IIb). Direct reentry evaluation of 104 measurement sites demonstrated significantly greater bone fill (mean = 2.8 mm) and resolution of osseous defects (mean = 72.7%) in the TTC/FDBA-treated group (Ia) as compared to the TTC plus debridement only (Ib) or no TTC-treated groups (IIa and IIb). The results of this study indicate that of the modes of treatment investigated, the combination of local and systemic tetracycline coupled with freeze-dried bone allografts was the treatment of choice for defects associated with juvenile periodontitis.

Topics: Adolescent; Adult; Aggressive Periodontitis; Alveolar Process; Bone Transplantation; Debridement; Drug Implants; Female; Freeze Drying; Humans; Male; Periodontal Diseases; Random Allocation; Tetracycline

Microbiologic criteria obtained with phase-contrast microscopy were used in a short-term, double-blind study to measure the effects of systemic tetracycline HCl on subgingival bacterial populations in advanced periodontal pockets refractory to local therapy (repeated scaling, root planing, and the subgingival administration of chemotherapeutic agents [H2O2, NaHCO3, NaCl, MgSO4]). Twenty-one subjects, selected for study, had at least one of the following conditions present after local therapy: spirochetes, motile rods, or crevicular leukocytes greater than or equal to 125 per phase-contrast microscopic field. Tetracycline HCl (1 gm/day for 14 days) was randomly distributed to 11 subjects and a placebo to ten subjects, so that neither the subjects nor investigators were aware of the prescription contents. Evaluations after two weeks disclosed that tetracycline HCl significantly reduced elevated levels of spirochetes, motile rods, and crevicular leukocytes to low or undetectable levels, whereas levels in the placebo subjects remained generally unchanged. The results clearly demonstrate the value of tetracycline HCl as an adjunct to periodontal therapy in reducing remaining suspected periodontopathic bacterial populations in advanced lesions after local therapy of scaling, root planing, and topically applied chemotherapy.

Topics: Adult; Bacteria; Double-Blind Method; Female; Gingival Crevicular Fluid; Humans; Leukocytes; Male; Microscopy, Phase-Contrast; Middle Aged; Periodontal Diseases; Placebos; Tetracycline

The present investigation was performed to study the effect of long-term, low dosage tetracycline therapy on advanced periodontal disease in humans. 14 volunteers participated in the trial. Each of the participants had at least 4 pairs of diseased sites around contralateral premolars and incisors with deep pockets and advanced bone loss. The trial extended over a 50-week period and was designed as a double-blind split-mouth study. A Baseline examination included assessments of oral hygiene, gingival conditions, probing depth, attachment level and analysis of the composition of the subgingival microbiota in samples obtained from 8 selected diseased sites. All participants received oral hygiene instruction. In each patient 2 quadrants of the mouth, chosen at random, were treated by scaling and root planing. The 2 remaining quadrants were left unscaled. Following the Baseline examination the patients were randomly distributed into 2 groups of 7 members each. In one of the groups the patients received tetracycline on a daily basis during a 50-week period. The participants of the control group received placebo. Reexaminations were performed 2, 10, 20, 30 and 50 weeks after the Baseline examination. The findings demonstrated that in patients with advanced periodontal disease long-term tetracycline therapy in the absence of scaling resulted in the establishment of a subgingival microbiota almost devoid of motile bacteria and in markedly reduced signs of gingivitis, probing depth and attachment loss. In fact, the alterations observed as a result of tetracycline administration to patients with excellent self-performed plaque control were similar to those obtained by conventional scaling and root planing in the control group.

Topics: Adult; Bacteria; Double-Blind Method; Female; Humans; Male; Middle Aged; Oral Hygiene; Periodontal Diseases; Periodontal Index; Tetracycline; Time Factors

A random double blind crossover study of patients on the effects of tetracycline therapy over a 3-month period revealed that there were no significant differences between the placebo group and tetracycline-treated groups in relation to (1) Gingival Index, (2) Debris Index and (3) Papillary Bleeding. A marked improvement in the Gingival Index occurred after 3 months of treatment in each group resulting from curettage and home care. Papillary bleeding was significantly reduced after 3 months of treatment in the tetracycline group and similar trends were observed in the placebo group. The Debris Index in both experimental and placebo groups showed no significant change after treatment for 3 months. The data suggest that tetracycline therapy does not appreciably after either the Gingival Index, Debris Index, or the Papillary Bleeding Index over a 3-month period.

Topics: Clinical Trials as Topic; Double-Blind Method; Gingival Hemorrhage; Gingivitis; Humans; Periodontal Diseases; Periodontal Index; Placebos; Subgingival Curettage; Tetracycline; Time Factors; Tooth Root

For many years, tetracycline has been prescribed in the treatment of periodontal disease with little research data supporting such use. Current data suggest that most patients with periodontal disease are best treated by conventional techniques of subgingival debridement.

Topics: Adult; Child; Clinical Trials as Topic; Dental Scaling; Gram-Negative Anaerobic Bacteria; Humans; Oral Hygiene; Periodontal Diseases; Tetracycline; Tooth Root

Topics: Adolescent; Adult; Aged; Bromelains; Cellulitis; Clinical Trials as Topic; Drug Combinations; Drug Tolerance; Female; Focal Infection, Dental; Humans; Male; Middle Aged; Periodontal Diseases; Periodontitis; Tetracycline

Topics: Adolescent; Adult; Aged; Amines; Anti-Inflammatory Agents; Clinical Trials as Topic; Drug Synergism; Gingivectomy; Humans; Middle Aged; Periodontal Diseases; Tetracycline

The objective of this study was to fabricate, characterize and evaluate in vitro, an injectable calcium sulfate bone cement beads loaded with an antibiotic nanoformulation, capable of delivering antibiotic locally for the treatment of periodontal disease.. Tetracycline nanoparticles (Tet NPs) were prepared using an ionic gelation method and characterized using DLS, SEM, and FTIR to determine size, morphology, stability and chemical interaction of the drug with the polymer. Further, calcium sulfate (CaSO4) control and CaSO4-Tet NP composite beads were prepared and characterized using SEM, FTIR and XRD. The drug release pattern, material properties and antibacterial activity were evaluated. In addition, protein adsorption, cytocompatibility and alkaline phosphatase activity of the CaSO4-Tet NP composite beads in comparison to the CaSO4 control were analyzed.. Tet NPs showed a size range of 130±20nm and the entrapment efficiency calculated was 89%. The composite beads showed sustained drug release pattern. Further the drug release data was fitted into various kinetic models wherein the Higuchi model showed higher correlation value (R(2)=0.9279) as compared to other kinetic models. The composite beads showed antibacterial activity against Staphylococcus aureus and Escherichia coli. The presence of Tet NPs in the composite bead didn't alter its cytocompatibility. In addition, the composite beads enhanced the ALP activity of hPDL cells.. The antibacterial and cytocompatible CaSO4-Tet NP composite beads could be beneficial in periodontal management to reduce the bacterial load at the infection site.. Tet NPs would deliver antibiotic locally at the infection site and the calcium sulfate cement, would itself facilitate tissue regeneration.

Topics: Adsorption; Anti-Bacterial Agents; Calcium Sulfate; Nanoparticles; Periodontal Diseases; Porosity; Solubility; Tetracycline

To identify optimal formulation parameters for enhancing the incorporation of tetracycline hydrochloride into chitosan microspheres for periodontal therapy.. Tetracycline-loaded chitosan microspheres were prepared by ionotropic gelation. Various formulation parameters (salt form of drug, aqueous phase pH, anion structure, inorganic salts and electrolytes, preparation method) were investigated for their influence on drug incorporation efficiency. Microspheres were assessed in terms of drug entrapment and content, microsphere recovery, particle size and morphology.. Although drug incorporation efficiency was increased marginally, the use of a dihydrate form of the drug was not considered feasible due to the lowered microsphere recovery and higher costs. A decrease in the aqueous pH from 9 to 6 enhanced drug incorporation efficiency without an adverse effect on microsphere morphology. The use of inorganic salts/electrolytes and other approaches of microsphere preparation did not significantly enhance drug incorporation efficiency and these approaches also adversely affected microsphere morphology. The ionotropic preparation method in terms of the drug loading technique significantly affected drug incorporation efficiencies.. This study has shown that formulation variables can be exploited in order to enhance the incorporation of a water soluble drug into chitosan microspheres using the ionotropic gelation technique. Based on a comparison of all results obtained with the different approaches, the modification of the aqueous phase to pH 6 was identified as the most feasible approach.

Topics: Anions; Anti-Bacterial Agents; Chitosan; Delayed-Action Preparations; Drug Compounding; Humans; Hydrogen-Ion Concentration; Magnesium Chloride; Microscopy, Electron, Scanning; Microspheres; Particle Size; Periodontal Diseases; Sodium Chloride; Solubility; Sorbitol; Surface Properties; Tetracycline

In general, systemic and local chemotherapeutic treatments offer a variety of options as adjuncts to traditional mechanical therapy, but they should not be used routinely for every patient. In fact, initial debridement to disrupt the biofilm and remove calculus prior to drug treatment may enhance results. Dentists will need to use their clinical judgment based on disease nature and severity to make treatment decisions, with the knowledge that these therapies may be best utilized in the few localized persistent lesions present following thorough scaling and root planing.

Topics: Anti-Bacterial Agents; Biofilms; Chlorhexidine; Humans; Metronidazole; Penicillins; Periodontal Diseases; Tetracycline

Studies have shown that extracts of cementum from periodontally involved teeth stimulated cytokine secretion from cultured human monocytes and that this stimulatory effect is inhibited by conditioning of the cementum with tetracycline. Using the subcutaneous chamber model in mice, the present study was designed to test the ability of cementum extracts from periodontally diseased teeth to induce an inflammatory response in vivo and to evaluate the effect of cementum conditioning with tetracycline.. Subcutaneous chambers were implanted in 24 mice. Two weeks later, the animals received intrachamber injection of one of the following: diseased-cementum extract, healthy-cementum extract, diseased-cementum extract preconditioned with tetracycline, or medium alone. Chamber exudates were harvested and analyzed for leukocyte levels, tumor necrosis factor (TNF)-alpha, interferon (IFN)-gamma, and interleukin-10 (IL-10).. Injection of healthy- or diseased-cementum extracts increased the intrachamber levels of leukocytes. Extracts of diseased cementum were found to significantly increase the levels of TNF-alpha, IFN-gamma, and IL-10, compared with extracts of healthy cementum or media alone. Peak cytokine levels were observed 2 hours postinjection. Conditioning of diseased cementum with tetracycline before extraction resulted in augmented levels of TNF-alpha and IFN-gamma, and reduced levels of IL-10, compared with untreated diseased cementum.. The present results demonstrate that conditioning of diseased cementum with tetracycline may induce an intense inflammatory response in a mouse model, and they suggest that local application of tetracycline for root conditioning should be carefully reinvestigated.

Topics: Analysis of Variance; Animals; Anti-Bacterial Agents; Cytokines; Dental Cementum; Diffusion Chambers, Culture; Disease Models, Animal; Humans; Interferon-gamma; Interleukin-10; Leukocyte Count; Mice; Periodontal Diseases; Tetracycline; Time Factors; Tumor Necrosis Factor-alpha

This study described the drug release, rheological (dynamic and flow) and textural/mechanical properties of a series of formulations composed of 15% w/w polymethylvinylether-co-maleic anhydride (PMVE-MA), 0-9% w/w polyvinylpyrrolidone (PVP) and containing 1-5% w/w tetracycline hydrochloride, designed for the treatment of periodontal disease. All formulations exhibited pseudoplastic flow with minimal thixotropy. Increasing the concentration of PVP sequentially increased the zero-rate viscosity (derived from the Cross model) and the hardness and compressibility of the formulations (derived from texture profile analysis). These affects may be accredited to increased polymer entanglement and, in light of the observed synergy between the two polymers with respect to their textural and rheological properties, interaction between PVP and PMVE-MA. Increasing the concentration of PVP increased the storage and loss moduli yet decreased the loss tangent of all formulations, indicative of increased elastic behaviour. Synergy between the two polymers with respect to their viscoelastic properties was observed. Increased adhesiveness, associated with increased concentrations of PVP was ascribed to the increasing bioadhesion and tack of the formulations. The effect of increasing drug concentration on the rheological and textural properties was dependent on PVP concentration. At lower concentrations (0, 3% w/w) no effect was observed whereas, in the presence of 9% w/w PVP, increasing drug concentration increased formulation elasticity, zero rate viscosity, hardness and compressibility. These observations were ascribed to the greater mass of suspended drug in formulations containing the highest concentration of PVP. Drug release from formulations containing 6 and 9% PVP (and 5% w/w drug) was prolonged and swelling/diffusion controlled. Based on the drug release, rheological and textural properties, it is suggested that the formulation containing 15% w/w PMVE-MA, 6% w/w PVP and tetracycline hydrochloride (5% w/w) may be useful for the treatment of periodontal disease.

Topics: Algorithms; Anti-Bacterial Agents; Chemistry, Pharmaceutical; Drug Stability; Drug Storage; Excipients; Maleates; Periodontal Diseases; Pharmaceutic Aids; Polyethylenes; Polymers; Povidone; Rheology; Tetracycline; Tissue Adhesives; Viscosity

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

Poly(ortho esters) with a low glass transition temperature are semi-solid materials so that therapeutic agents can be incorporated at room temperature, without the use of solvents, by a simple mixing procedure. When molecular weights are limited to < 5 kDa, such materials are directly injectable using a needle size no larger than 22 gauge. Somewhat hydrophilic polymers can be produced by using the diketene acetal 3,9-diethylidene-2,4,8,10-tetraoxaspiro[5.5]undecane and triethylene glycol (TEG), while hydrophobic materials can be produced by using the diketene acetal and 1,10-decanediol. Molecular weight can be reproducibly controlled by using an excess of the diol, or by use of an alcohol that acts as a chain-stopper. Erosion rates can be controlled by varying the amount of latent acid incorporated into the polymer backbone. Toxicology studies using the TEG polymer have been completed and have shown that the polymer is non-toxic. Toxicology studies using the decanediol polymer are underway. Development studies using the TEG polymer aimed at providing a sustained delivery of an analgesic agent to control post-surgical pain are under development and human clinical trials using the decanediol polymer for the treatment of periodontitis are also underway.

Topics: Anesthetics, Local; Animals; Biocompatible Materials; Bupivacaine; Dogs; Drug Carriers; Fatty Alcohols; Gingiva; Glass; Humans; Injections; Magnetic Resonance Spectroscopy; Models, Chemical; Pain; Periodontal Diseases; Polyesters; Polyethylene Glycols; Polymers; Rats; Rats, Sprague-Dawley; Solvents; Temperature; Tetracycline; Time Factors

The management of periodontal diseases has included both non-surgical and surgical treatment options. Non-surgical treatment traditionally has referred to the role of mechanical instrumentation of the root surface with either scalers or curettes. However, the introduction of locally delivered anti-microbial medications, which can be placed directly into a periodontal pocket, has provided the practitioner with another treatment option. This article looks at the different locally delivered anti-microbial medications being used in the non-surgical management of periodontal diseases.

Topics: Absorbable Implants; Administration, Topical; Anti-Bacterial Agents; Anti-Infective Agents; Cellulose; Chlorhexidine; Contraindications; Delayed-Action Preparations; Dental Scaling; Doxycycline; Drug Delivery Systems; Drug Implants; Humans; Minocycline; Periodontal Diseases; Periodontal Pocket; Root Planing; Subgingival Curettage; Tetracycline

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

Topics: Administration, Topical; Anti-Bacterial Agents; Anti-Infective Agents, Local; Cellulose; Chlorhexidine; Delayed-Action Preparations; Doxycycline; Drug Delivery Systems; Humans; Minocycline; Periodontal Diseases; Tetracycline; Treatment Outcome

This study examined the creep behavior and oscillatory and flow properties of tetracycline-containing, bioadhesive semisolid formulations, designed for localized treatment of periodontal disease. Formulations were prepared containing hydroxyethylcellulose (HEC, 1, 3, or 5% w/w), poly(vinylpyrrolidone) (PVP, 2 or 3% w/w), polycarbophil (PC, 1 or 3% w/w), and tetracycline (5% w/w, as the hydrochloride). In creep analysis, each formulation exhibited several distinct regions that were mathematically modelled using a multi-element Voigt model with a residual spring and dashpot. Increasing the concentrations of each polymeric component decreased the elastic compliance (J(0)) yet increased the residual viscosity. In oscillatory analysis, increased polymer concentrations increased the storage modulus (G'), the loss modulus (G") and the dynamic viscosity (eta'), yet decreased the loss tangent (tan delta). The relationships between G' or G" and frequency were observed to plateau at higher frequencies, which is indicative of polymer chain entanglement and network formation. With the exception of formulations containing 1% HEC, the formulations were elastic (tan delta < 1), with large G' and small J(0) values. All formulations exhibited pseudoplastic flow with thixotropy. Increasing concentrations of each polymeric component increased the zero-shear viscosity (determined using the Cross model) and was further evidence of polymer chain entanglement. Formulations containing 1% w/w HEC possessed excellent flow properties, however, their thixotropic behavior and essentially elastoviscous nature (large J(0) and tan delta) would be disadvantageous for use in the treatment of periodontal disease because of rapid removal from the pocket and relatively uncontrolled drug release. Despite their advantageous viscoelastic properties, the flow properties of formulations containing 5% w/w HEC were inappropriate, rendering administration through a periodontal syringe potentially difficult. Based on their rheological behavior, formulations containing HEC (3% w/w), PVP (2 or 3% w/w), and PC (1 or 3% w/w) would be suitable for clinical application. However, consideration of other physicochemical properties (e.g., bioadhesion, drug release kinetics) must be performed prior to selection of the most suitable formulation for clinical examination. This study has highlighted the successful complimentary application of creep analysis and oscillatory and flow rheometry for the characterization

Topics: Adhesives; Anti-Bacterial Agents; Anti-Infective Agents; Elasticity; Periodontal Diseases; Rheology; Tetracycline; Viscosity

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

To study the healing mechanism of different etching agents for periodontitis-affected teeth in animal models.. The animal models of defect alveolar bone were prepared, and the isolated teeth with periodontitis were scaled according to periodontal surgery in vitro. After different acid acid-treatment, the dentin blocks were implanted into defect bones, then the results were examined histologically after 3, 7, 14, 28 days respectively.. There was less inflammatory reaction in tetracycline group after operation. At the later stages, the healing in tetracycline group was characterized by osseointegration without resorption. But hydrochloric acid group and citric acid group showed different reactions.. Periodontal tissue repair differs with the use of different acids.

Topics: Animals; Citrates; Hydrochloric Acid; Male; Periodontal Diseases; Rats; Rats, Wistar; Tetracycline; Tooth Root

The incidence of root caries has been found to increase as the population ages and as edentulism becomes less prevalent due to improved dental awareness and care, and as exposure of roots due to gingival recession has also increased in the elderly. The mechanism of root caries is thought to be mediated by both bacterial and mammalian proteases produced by plaque and the periodontal tissues, respectively. In the current study, a rat model of periodontal disease was used in which gnotobiotic rats were infected intra-orally with a periodontal pathogen (P. gingivalis). Infecting the rats with P. gingivalis increased the collagenase activity in the gingival tissue in association with severe alveolar bone loss. Treating P. gingivalis-infected rats with doxycycline or CMT-1 prevented the destruction of the periodontium by MMPs, thus preventing exposure of roots to subgingival bacterial plaque and host tissue collagenases and the subsequent development of root caries. In addition, a low-dose doxycycline (LDD, 20 mg bid, non-antimicrobial dose) for 3 months was used in humans predisposed to increased root caries as the result of heavy use of smokeless (chewing) tobacco, causing gingival recession, subgingival plaque accumulation with Gram-negative bacteria, increased gingival crevicular fluid flow (GCF), and elevated GCF collagenase. Daily administration of LDD in smokeless tobacco patients reduced the GCF collagenase and prevented the further development of root caries.

Topics: Adult; Analysis of Variance; Animals; Anti-Bacterial Agents; Collagenases; Doxycycline; Gingiva; Gingival Recession; Humans; Male; Matrix Metalloproteinase Inhibitors; Periodontal Diseases; Plants, Toxic; Porphyromonas gingivalis; Protease Inhibitors; Rats; Rats, Sprague-Dawley; Root Caries; Tetracycline; Tobacco, Smokeless

Topics: Anti-Bacterial Agents; Delayed-Action Preparations; Dental Implants; Doxycycline; Drug Carriers; Drug Delivery Systems; Equipment Design; Guided Tissue Regeneration, Periodontal; Humans; Lactic Acid; Membranes, Artificial; Osseointegration; Periodontal Diseases; Periodontal Pocket; Platelet-Derived Growth Factor; Polyesters; Polymers; Polytetrafluoroethylene; Somatomedins; Tetracycline

This in vitro study compares, by scanning electron microscope (SEM) examination, the surface effects of various topical applications of tetracycline on the instrumented dentin root surface of human teeth. Eighty-two (82) dentin samples were prepared from periodontally-compromised teeth planned for extraction. Solutions of tetracycline HCl, doxycycline, minocycline, sumycin, and a saline control were prepared and applied to the dentin samples for 0.5, 1, 3, 5, and 10 minutes. Each solution pH was measured: tetracycline HCI (pH 1.6), doxycycline (pH 2.2), minocycline (pH 3.8), sumycin (pH 4.4), and saline (pH 5.1). A tetracycline periodontal fiber was also evaluated at 1, 4, 7, and 10 days of exposure for dentin surface effects. Tetracycline HCI removed the dentin smear layer leaving clean and open tubules significantly better than other solutions tested in as little as 30 seconds. Doxycycline and minocycline produced similar results to each other, which were significantly better than sumycin and saline, but not as effective as tetracycline HCl. Smear layer removal was attained by doxycycline and minocycline in five to ten minutes; however, sumycin and the saline control ineffectively removed the surface smear layer and dentinal tubules remained partially to totally occluded by debris. The periodontal fiber did not significantly alter the surface smear layer. Results of this study suggest that tetracycline HCl is the best current tetracycline form for root surface conditioning as measured by its ability to affect both dentin smear layer removal and dentin tubule exposure.

Topics: Administration, Topical; Anti-Bacterial Agents; Dentin; Doxycycline; Drug Carriers; Follow-Up Studies; Humans; Microscopy, Electron, Scanning; Minocycline; Periodontal Diseases; Placebos; Root Planing; Smear Layer; Subgingival Curettage; Tetracycline; Time Factors; Tooth Root

Increased interest in the clinical use of antibiotics for periodontal therapy required the development of a sensitive assay for the quantitation of tetracycline in gingival crevicular fluid (GCF). An HPLC method was developed and validated for tetracycline which separates and identifies the degradation component epi-tetracycline. The HPLC assay employs a C18 reversed-phase Hypersil column with a mobile phase composed of methanol and sodium acetate buffer containing CaCl2 and EDTA disodium salt. The chromatographic separation was monitored by a fluorescent detector with an excitation wavelength of 375 nm and an emission wavelength of 512 nm. Tetracycline was extracted from GCF collected on Periopapers by addition of a methanol solution containing the internal standard, doxycycline, and the mobile phase buffer (25:75, v/v). The mean percent recovery for the extraction method was 107.8% with all the % R.S.D. below 7.5%. The mean inter- and intra-batch accuracy was 104.1 and 105.3%, respectively with a coefficient of variation of less than 9.5%. The lower limit of detection was 2.5 ng on the Periopapers. The typical GCF volumes collected were 0.1-1 microliter. The method was validated for the linear concentration range 2.5-1000 ng of tetracycline on the Periopaper. This assay for tetracycline was shown to be an accurate, precise and rugged method.

Topics: Buffers; Calcium Chloride; Chromatography, High Pressure Liquid; Doxycycline; Edetic Acid; Gingival Crevicular Fluid; Humans; Periodontal Diseases; Reproducibility of Results; Spectrometry, Fluorescence; Tetracycline

Topics: Anti-Bacterial Agents; Clinical Competence; Dental Hygienists; Drug Implants; Follow-Up Studies; Humans; Patient Selection; Periodontal Diseases; Periodontal Pocket; Periodontics; Pilot Projects; Surveys and Questionnaires; Teaching; Tetracycline; United States

The last 25 years have brought unprecedented advances to our understanding of periodontal disease. Consider that in 1970 periodontitis was believed to effect most individuals over the age of 35 years, to progress steadily in an individual once initiated until teeth were lost, to be the primary cause of tooth loss in adults, to be caused by the bacterial mass accumulating on the tooth surface and subgingivally, and to involve the host in some fashion or another. In the 25 years since then, impressive research advances in the epidemiology of periodontal disease, the specific bacterial etiology of periodontal disease and the immunoinflammatory mediators of periodontal tissue destruction have greatly altered our view of periodontal disease. Thus, given these research advances in the understanding of periodontitis, what may the future hold for improved diagnosis and treatment of periodontal disease? Impressive research into new ways to diagnose the periodontal diseases is well underway. Investigators are seeking new ways to diagnose an individual's degree of risk for periodontal disease initiation, susceptibility to disease progression, level of disease "activity" and the likely response to treatment and recurrence of active disease. New diagnostic tests should greatly advance our ability to more accurately and specifically diagnose periodontal disease. The future also looks promising for new treatment strategies to slow or arrest periodontal disease progression. The bacterial specificity of periodontal disease etiology revealed since 1970 has logically led to the use of antibiotics in periodontitis treatment. In the late 1980s the concept of locally delivering antibiotics to the periodontal pocket was introduced, and subsequent clinical trials have indicated that it is possible to reduce pocket depth and inflammation with tetracycline locally delivered to the periodontal pocket. Likely, we have barely scratched the surface in studying the efficacy of locally delivery antimicrobial agents to alter the progression of periodontal disease. As new agents are developed and better delivery systems to the periodontal pocket are developed, the future should see a variety of antimicrobial agents available which can slow periodontal disease progression. The future also holds promise for slowing periodontal disease progression by blocking inflammatory pathways important in periodontal tissue destruction. Clinical trials of flubiprofen, naproxen and ketoprofen indicate th

Topics: Adult; Animals; Anti-Bacterial Agents; Anti-Infective Agents, Local; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Bacterial Physiological Phenomena; Disease Models, Animal; Disease Progression; Disease Susceptibility; Drug Delivery Systems; Enzyme Inhibitors; Forecasting; Humans; Inflammation Mediators; Matrix Metalloproteinase Inhibitors; Periodontal Diseases; Periodontitis; Recurrence; Risk Factors; Technology, Dental; Tetracycline; Tooth Loss

Monocyte inflammatory cytokines, such as TNF alpha and IL-1 beta, have been implicated in the pathogenesis of periodontal destruction. The present study was designed to test the ability of extracts of cementum from periodontally diseased teeth to induce the secretion of these mediators by monocytes, to evaluate the role of adsorbed endotoxin in this process, and to test the effect of cementum conditioning with tetracycline on the monocyte response. Human monocytes were incubated with varying concentrations of cementum extracts, and TNF alpha and IL-1 beta levels in the media were measured. The results showed that while extracts of healthy cementum had no effect on monocyte secretion, concentration as low as 0.5 mg/ml of cementum from diseased sites raised the levels of TNF alpha and IL-1 beta secretion 10-fold. This response was dose-dependent. Diseased cementum were found to contain 1.5 ng/mg endotoxin, while endotoxin was not detectable in the extracts of the healthy cementum. However, neutralization of the endotoxin by polymyxin B only partially reduced the monocyte secretory response by 50 to 70%, suggesting that other factors in the extracts are also involved in monocyte stimulation. To simulate the effect of root conditioning, cementum was first agitated in a tetracycline or control solution prior to its extraction in media. Pretreatment of diseased cementum with tetracycline (50 mg/ml) was found to block the secretion of TNF alpha from cementum-stimulated monocytes. Pretreatment of the diseased cementum with 10 mg/ml tetracycline was not more effective than saline and HCI controls, with all treatments reducing cytokine secretion by approximately 80%. The direct addition of tetracycline to cementum-stimulated monocyte culture was found to block TNF alpha secretion in a dose dependent manner. The results suggest that extracts from diseased cementum are potent stimulators of monocyte secretion, and that endotoxin as well as other factor(s) appear to be involved. These factors are partially extracted by washing and a 10 mg/ml tetracycline solution is not more effective than saline in achieving this goal. In addition, tetracycline was found to be a potent inhibitor of TNF alpha secretion by cementum-stimulated monocytes, suggesting a novel mechanism for this drug in periodontal therapy.

Topics: Analysis of Variance; Cells, Cultured; Cytokines; Dental Cementum; Dose-Response Relationship, Drug; Endotoxins; Humans; Inflammation Mediators; Interleukin-1; Monocytes; Periodontal Diseases; Protein Synthesis Inhibitors; Tetracycline; Tumor Necrosis Factor-alpha

Development of new drug therapy is difficult for large companies and almost unheard of by individuals. This autobiographical account of the development of the tetracycline fiber delivery system for periodontal therapy (Actisite) relates experiences of a scientist between 1976 and 1994 which lead to FDA approval. In this account, the author acknowledges some of the key people, companies and institutions who were important in this development, makes observations concerning the process itself and offers suggestions for those who might consider commercial development of a scientific concept.

Topics: Drug Approval; Drug Delivery Systems; History, 20th Century; Humans; Periodontal Diseases; Tetracycline; United States; United States Food and Drug Administration; Vinyl Compounds

This study examined the mechanical characteristics and release of tetracycline from bioadhesive, semi-solid systems which were designed for the treatment of periodontal diseases.. Tetracycline release into phosphate buffered saline (pH 6.8, 0.03 M) was examined using a Caleva 7ST dissolution apparatus at 37 degrees C. The mechanical properties of each formulation (hardness, compressibility, adhesiveness, elasticity and cohesiveness) were determined using texture profile analysis. Syringeability was measured using the texture analyser in compression mode as the work of syringeability i.e. the force required to express the product from a periodontal syringe over a defined distance.. Tetracycline release from all formulations was zero-order for 24-54 h and ranged from 1.59 +/- 0.20 to 15.80 +/- 0.50 mg h-1. Increased concentrations of hydroxyethylcellulose (HEC) decreased the rate of release of tetracycline, due to the concomitant increase in product viscosity and the subsequent decreased rate of penetration of dissolution fluid into the formulation. Conversely, an increased polyvinylpyrrolidone (PVP) concentration increased tetracycline release rates, due to an increased formulation porosity following dissolution of this polymer. Increased concentrations of HEC and PVP increased the hardness, compressibility and work of syringeability of the semi-solid formulations, due to increased product viscosity. An increase in formulation adhesiveness, a parameter related to bioadhesion, was observed as the concentrations of HEC and PVP were increased, illustrating the adhesive nature of these polymers. Increased concentrations of HEC and PVP enhanced the semi-solid nature of the product, resulting in decreased product elasticity and cohesiveness. Several statistically significant interactions between polymeric formulation components were observed within the factorial design, with respect to rate of release and all mechanical properties. These interactions arose because of variations in the physical states (dissolved or dispersed) of polymeric formulation components.. The optimal choice of bioadhesive formulation for use in periodontal disease will involve a compromise between achieving the necessary release rate of tetracycline and the mechanical characteristics of the formulation, as these factors will affect clinical efficacy and the ease of product application into the periodontal pocket.

Topics: Acrylic Resins; Adhesives; Anti-Bacterial Agents; Cellulose; Chemical Phenomena; Chemistry, Pharmaceutical; Chemistry, Physical; Drug Administration Routes; Humans; Periodontal Diseases; Periodontal Pocket; Pharmaceutic Aids; Polymers; Povidone; Tetracycline

Topics: Administration, Topical; Drug Resistance, Microbial; Helicobacter pylori; Humans; Metronidazole; Periodontal Diseases; Tetracycline; Tetracycline Resistance

Bacterial plaque contributes to the development and progression of periodontal diseases. Therefore, therapeutics designed to stop or slow periodontal destruction must limit or eliminate the deleterious effects of plaque. Despite the recognized beneficial effects of in-office surgical and nonsurgical periodontal therapies and home mechanical plaque control, antimicrobials have been used locally, systematically, or in combination to limit plaque activity. This article discusses a new, localized antimicrobial delivery method. The technique discussed employs an ethylene/vinyl acetate copolymer, containing tetracycline hydrochloride. Description of this polymeric fiber, indications for its use, placement technique, patient education, the role of auxiliaries, and practice management aspects are reviewed. The future potential of sustained-release local pharmaceutical devices is addressed.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Delayed-Action Preparations; Drug Carriers; Humans; Patient Care Planning; Patient Selection; Periodontal Diseases; Polyvinyls; Practice Management, Dental; Tetracycline

Twenty-two tetracycline-resistant (tetr) anaerobic and facultative anaerobic bacteria isolated from periodontal pockets of 12 patients with refractory periodontitis were examined for the presence of the Tet Q determinant by DNA-DNA hybridization. Dot blots of bacterial DNA were tested with an intragenic digoxigenin-labelled tet(Q) probe consisting of a 1.45 kb EcoRI/PvuII fragment from plasmid pNFD13-2. Southern blots of chromosomal DNA digested with the restriction enzyme EcoRI were also examined. The tet(Q) probe hybridized with DNA from 8 of the 22 tetr strains, including 2 Prevotella intermedia strains and one strain each of Prevotella nigrescens, Prevotella loescheii, Prevotella veroralis and Prevotella melaninogenica. The tetr strains of Mitsuokella dentalis and Capnocytophaga ochracea also hybridized with the probe. The lack of discernible plasmid DNA in all the probe-positive isolates suggests that these tetracycline-resistance genes were chromosomally encoded. The probe hybridized with a different size fragment in all the isolates. This study extends the number of species that carry the tet(Q) gene to include several outside the genera Prevotella and Bacteroides.

Topics: Anti-Bacterial Agents; Bacteria, Anaerobic; Bacteroides; Blotting, Southern; Capnocytophaga; DNA Probes; DNA, Bacterial; Genes, Bacterial; Humans; Microbial Sensitivity Tests; Nucleic Acid Hybridization; Periodontal Diseases; Plasmids; Prevotella; Prevotella intermedia; Prevotella melaninogenica; R Factors; Restriction Mapping; Sequence Analysis, DNA; Tetracycline; Tetracycline Resistance

Studies have indicated the heterogeneity of periodontal diseases and have suggested several pathogens that may play important etiologic roles. The risk associated with individual pathogens or combinations of pathogens has been assessed, and diagnostic tests have been developed for their detection in clinical practice. Strategies are being devised to improve treatment by using appropriate agents to control different periodontal infections.

Topics: Aggregatibacter actinomycetemcomitans; Amoxicillin; Analysis of Variance; Bacteroides; Humans; Periodontal Diseases; Periodontitis; Porphyromonas gingivalis; Risk Factors; Tetracycline

Topics: Anti-Bacterial Agents; Delayed-Action Preparations; Humans; Periodontal Diseases; Periodontal Pocket; Tetracycline

Topics: Adult; Anti-Bacterial Agents; Combined Modality Therapy; Dental Scaling; Follow-Up Studies; Guided Tissue Regeneration, Periodontal; Humans; Incisor; Male; Mandible; Periodontal Diseases; Postoperative Period; Radiography; Tetracycline; Tooth Mobility

Topics: Humans; Papillon-Lefevre Disease; Periodontal Diseases; Tetracycline; Tooth Loss

This study was undertaken to provide histologic observations on the effectiveness of citric acid and tetracycline HCl root surface demineralization when used in conjunction with guided tissue regeneration (GTR) procedures. Eight beagle dogs with naturally-occurring periodontitis were initially treated with scaling and root planing. Four weeks later, 12 mandibular quadrants were treated surgically with modified Widman flap and expanded polytetrafluoroethylene (ePTFE). The teeth in 4 of the quadrants were randomly root conditioned with tetracycline HCl, while those in 4 additional quadrants were randomly treated with citric acid. ePTFE membranes were sutured in place. The beagles received prophylaxis (chlorhexidine and toothbrushing) 3 times a week. After 6 weeks, the membranes were removed; prophylaxes continued for 4 months. Histological evaluation revealed new cementum on the root surfaces. A new periodontal ligament with fibers inserting into the new cementum was noted. Statistical evaluation of the buccolingual measurements demonstrated membranes alone resulted in significantly more new connective tissue and new bone formation than membranes with root conditioning agents. Within the furcation, no significant differences were found. However, there was a trend for more bone formation with membranes alone. Within the limits of this study it may be concluded that GTR utilizing an ePTFE membrane results in new connective tissue attachment and bone regeneration in the beagle dog. Root surface demineralization with citric acid or tetracycline HCl does not enhance the results achieved with GTR when used alone.

Topics: Analysis of Variance; Animals; Citrates; Citric Acid; Dentin; Dogs; Female; Guided Tissue Regeneration, Periodontal; Periodontal Diseases; Polytetrafluoroethylene; Tetracycline; Tooth Root; Wound Healing

This study evaluated the effect of a composite graft as an adjunct to gingival flap surgery in induced chronic supraalveolar periodontal defects in the mandibular premolar region in beagle dogs. The vertical dimension of the defects, measured from the cemento-enamel junction to the alveolar bone, approximated 5 mm. Root surface treatment in quadrants receiving the graft protocol included conditioning with both critic acid and tetracycline. The composite graft (including: hydroxyapatite, freeze-dried decalcified bone, tetracycline, and fibronectin) was then fitted to the defects. Flaps were placed and sutured to cover most of the crowns of the teeth but the tips of the cusps. The root surfaces in contralateral jaw quadrants were conditioned with critic acid and the flaps similarly placed and sutured. Dogs were sacrificed 6 weeks after surgery and tissue blocks including teeth and surrounding structures processed for histometric analysis. Connective tissue repair to the root surface in teeth treated with the graft protocol approximated 60% of the defect height. Connective tissue repair in teeth treated with citric acid only was significantly greater and averaged 98% of the defect height (P less than or equal to 0.01). Cementum formation was limited following both treatments (approximately 6% of the defect height). Bone regeneration was significantly smaller in grafted sites than in sites treated with citric acid only (approximately 2% and 10% of the defect height, respectively; P less than or equal to 0.05). Root resorption was observed in almost all teeth. Ankylosis was present in two citric acid-treated specimens, both from the same dog.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acid Etching, Dental; Alveolar Bone Loss; Alveolar Process; Alveoloplasty; Animals; Bone Transplantation; Citrates; Citric Acid; Connective Tissue; Dogs; Durapatite; Fibronectins; Gingiva; Hydroxyapatites; Male; Periodontal Diseases; Periodontium; Prostheses and Implants; Root Planing; Surgical Flaps; Tetracycline; Tooth Root; Wound Healing

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: Anti-Infective Agents, Local; Citrates; Citric Acid; Dental Implants; Durapatite; Humans; Hydroxyapatites; Periodontal Diseases; Prosthesis-Related Infections; Surface Properties; Tetracycline

Tetracyclines have recently been shown to inhibit the activity of mammalian matrix metalloproteinases, i.e. type I collagenase (MMP-1) and type IV collagenase/gelatinase (MMP-2). The specificity of this effect, however, has not been examined in detail. In the present study, doxycycline (a clinically widely used commercial tetracycline) and 4-de-dimethylaminotetracycline (CMT-1, a chemically modified non-antimicrobial tetracycline) were tested, at a wide range of concentrations, for their ability to inhibit human neutrophil and fibroblast interstitial collagenases, which are distinct gene products, as well as collagenase in human gingival crevicular fluid (an inflammatory exudate in periodontal lesions) obtained from adult, juvenile and diabetic adult periodontitis patients. The concentrations of these two tetracyclines, required to inhibit 50% of the collagenase activity (IC50), were found to be 15-30 microM for purified human neutrophil collagenase as well as collagenase in gingival crevicular fluid of adult periodontitis patients and diabetic adult periodontitis patients, thus approximating in vivo therapeutic tetracycline levels. In contrast, the fibroblast collagenase and collagenase in gingival crevicular fluid of patients with juvenile periodontitis were relatively resistant to tetracycline inhibition: the IC50 for doxycycline and CMT-1 were 280 and 500 microM, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Child; Doxycycline; Fibroblasts; Gingival Crevicular Fluid; Humans; Matrix Metalloproteinase 1; Matrix Metalloproteinase 2; Matrix Metalloproteinase 8; Matrix Metalloproteinase Inhibitors; Metalloendopeptidases; Neutrophils; Periodontal Diseases; Tetracycline

The aims of this retrospective study were to assess the incidence of infection after periodontal surgery, in relation to the type of surgical procedure, and the effectiveness of prophylactic tetracycline administration. Nineteen (4.4%) of 445 surgical procedures in patients who were given no tetracycline resulted in signs of infection, while two (3.8%) in patients who were treated with tetracycline resulted in signs of infection. There was no statistically significant difference between these incidences, suggesting that there is no reason for routine tetracycline prophylaxis in periodontal surgery. There was no statistically significant difference in the incidence of infection whether or not bone (ostectomy or osteoplasty) or tooth extraction was involved in the surgical procedure.

Topics: Adolescent; Adult; Aged; Chi-Square Distribution; Chlorhexidine; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Minocycline; Periodontal Diseases; Premedication; Retrospective Studies; Surgical Wound Infection; Tetracycline

A group of cases is presented in which dramatic repair and regeneration of periodontal tissues lost as a result of periodontitis have occurred following systemic administration of tetracycline either alone or in combination with other forms of periodontal therapy. The nature and extent of regeneration demonstrated in these patients appears to be more dramatic than what has been shown previously when more conventional forms of periodontal therapy were utilized, even including bone grafting and guided tissue regeneration. The type of repair described has been shown in many instances to be long standing and is probably not totally related to the antibacterial characteristics of tetracycline. It is suggested that the ability of this drug to inhibit collagenolytic enzymes (collagenases) may have influenced the favorable clinical results achieved. The anti-collagenolytic properties of tetracycline are being considered with increasing frequency in the treatment of other systemic diseases characterized by collagen breakdown such as corneal ulcers, rheumatoid arthritis, diabetes, and dystrophic epidermolysis bullosa. Given the highly collagenous nature of the tissues of the periodontium, this report suggests that tetracycline could be of considerable value in the treatment of some types of periodontitis.

Topics: Adult; Bacteria, Anaerobic; Female; Humans; Male; Microbial Collagenase; Middle Aged; Periodontal Diseases; Tetracycline

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

Topics: Actinobacillus; Bacteroides; Humans; Metronidazole; Microbial Sensitivity Tests; Periodontal Diseases; Tetracycline

Several longitudinal studies have shown that periodontal treatment consisting of surgical and/or nonsurgical debridement of the teeth often is sufficient to prevent continued attachment loss when the patients' oral hygiene measures are good. Nevertheless, some patients will, in spite of excellent oral hygiene measures, continue to show attachment loss. The treatment of these patients has mainly been empirical, and the clinicians have used different kinds of antibiotics for different time intervals to eliminate proposed periodontal pathogens. The preferred antibiotic has been tetracycline. Most bacteria associated with destructive periodontal disease will normally be susceptible to tetracycline at the levels achieved in the gingival crevicular fluid after systemic administration of the antibiotic. Some patients have a microbial flora that will not change enough or be inhibited by these substances. The reason for this may in many cases be the development of antimicrobial resistance. Today 14 genotypes of tetracycline resistance have been found. The resistance is one of three types: active secretion, protection of the ribosomes by proteins and an active breakdown of tetracycline. The third type has recently been discovered as a cryptic gene in the microorganism Bacteroides fragilis. This gene is only expressed after transfer to Eschericia coli. Active breakdown of tetracycline does normally not occur in nature and the global level of the drug is increasing since tetracycline is the second most used antibiotic in the world today. It is therefore of interest to identify tetracycline resistance determinants in the oral cavity and to compare these with tetracycline resistance genes from other sources of human, animal and environmental origin.

Topics: Humans; Periodontal Diseases; Tetracycline; Tetracycline Resistance

The assessment of new attachment after periodontal treatment has been the focus of continuous research. An approach to longitudinally examine the deposition of cementum was devised by using fluorescence microscopy (FL), contact microradiography (CMR), and toluidine blue staining (TBS) after the injection of three labeling agents known to be incorporated within newly mineralized tissues with different tones: tetracycline, calcein, and alizarin complexion. Three adult Japanese monkeys (male, 6.0 to 8.3 Kg weight) were used for this experiment. Bone defects were surgically created in 24 mandibular sites and a copper plate was inserted for a period of 4 weeks to promote microbial colonization to form periodontal pockets. Scaling and root planing (baseline) were then performed, and the fluorescent agents were administered twice weekly leaving a 1 week interval between the different agents. The mandibular specimens were fixed in neutralized formalin and embedded in polyester resin. Undecalcified sections were prepared 3, 6, and 9 weeks after baseline. Cementum regeneration was confirmed in 18 out of 24 sites; in 6 samples only epithelial proliferation was observed. Regeneration could be seen as early as 2 weeks after debridement. Cementum was identified by observation under FL of a labeled structure, discrimination in the degree of mineralization of dentin by CMR, and by the presence of functional collagen fibers and location of the epithelial border by TBS. In this study the use of three different labeling agents using the three observation techniques was shown to be effective for the longitudinal assessment of cementum regeneration.

Topics: Alveolar Bone Loss; Animals; Anthraquinones; Dental Cementum; Dental Scaling; Fluoresceins; Fluorescent Dyes; Indicators and Reagents; Longitudinal Studies; Macaca; Male; Microradiography; Periodontal Diseases; Periodontal Pocket; Regeneration; Tetracycline; Tolonium Chloride; Tooth Root

In this study, substantivity of topically applied doxycycline hydrochloride on root surfaces obtained from patients with periodontal disease was studied in vitro. Cementum and dentin specimens were impregnated with aqueous solutions of doxycycline for 3 minutes, and incubated in serum for 10 minutes, 7 days, and 14 days. Substantivity was determined by agar diffusion inhibition assay. Comparative analyses of cementum versus dentin groups were conducted with 2-way analysis of variance. Results indicated that there was no statistically significant differences between the binding potential of doxycycline to cementum and dentin specimens. Antibacterial effect of specimens treated with the concentration of 100 mg/ml persisted for 14 days, indicating the presence of doxycycline in biologically active form. Our findings demonstrate the long lasting substantivity of doxycycline hydrochloride on periodontally diseased root surfaces and supports the concept of using root surfaces as a substrate for the deposition and slow release for local tetracycline delivery.

Topics: Actinobacillus; Actinomyces; Analysis of Variance; Bacteroides; Colony Count, Microbial; Dental Cementum; Dentin; Doxycycline; Humans; Microbial Sensitivity Tests; Periodontal Diseases; Tetracycline

A study was conducted to evaluate using SEM the earliest events of initial blood clot formation on periodontally diseased root surfaces given various treatments. Six teeth with periodontal disease were extracted from six different subjects and were studied in two individual groups. In the first group the root surfaces were divided into three individual treatment areas: (a) intact periodontal ligament, (b) planed, (c) planed and also treated with 1% citric acid. The root surfaces in the second group were likewise divided into three treatment areas: (a) intact periodontal ligament, (b) planed, (c) planed and topically conditioned with tetracycline HCl. All the roots were reinserted into the original extraction sites, and then removed at either "zero" (less than 5 s), one or 3 min and prepared for SEM evaluation. It was observed that organized clot formation occurred more rapidly in the treatment areas where both root planing and topical conditioning with tetracycline HCl had been done.

Topics: Adult; Blood Coagulation; Citrates; Citric Acid; Dental Cementum; Humans; Microscopy, Electron, Scanning; Periodontal Diseases; Periodontal Ligament; Tetracycline; Time Factors; Tooth Root

The healing potential of periodontal osseous defects treated by scaling and root planing is demonstrated by the presentation of two clinical cases.

Topics: Adolescent; Adult; Alveolar Bone Loss; Dental Calculus; Dental Scaling; Female; Humans; Periodontal Diseases; Tetracycline; Tooth Root

The purpose of this study was to determine how the treatment of human tooth roots with tetracycline-HCl and fibronectin during periodontal surgery influences the attachment of the gingiva to the root surface. Mucoperiosteal flap surgery was performed on 22 teeth with periodontal disease. Teeth were assigned to three groups. Group one received surgery with degranulation and root planing. Group two received surgery with treatment of roots with tetracycline-HCl. Group three received surgery with treatment of roots with tetracycline-HCl and fibronectin. At 90 days, block sections were taken and teeth, gingiva, alveolar bone, and periodontal ligament were evaluated histologically. Controls healed with a long junctional epithelial attachment. Tetracycline and tetracycline with fibronectin groups demonstrated some reattachment, but only within the notches placed in the root at the original level of the bone. There was a trend for greater connective tissue attachment following tetracycline-HCl treatment of roots. The additional application of fibronectin to tetracycline treated roots appeared to partially negate the enhanced connective tissue attachment observed with tetracycline treatment alone.

Topics: Acid Etching, Dental; Adult; Bone Resorption; Connective Tissue; Fibronectins; Gingiva; Humans; Middle Aged; Periodontal Diseases; Periodontal Pocket; Periodontium; Surgical Flaps; Tetracycline; Tooth Root; Wound Healing

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

Two molars having furcation grade II involvements were selected from each of six patients with periodontal diseases. One molar received a local application of tetracycline immobilized cross-liked collagen film four times at one-week intervals (TC film-treated group) and the other received no treatment (non-treated group). The clinical and microbiological effects were, as follows, 1. Throughout the experimental period, no significant differences in pocket depth, attachment level, bleeding on pocket probing, periotron unit, gingival index and plaque index were noted between the TC film-treated group and the non-treated group. 2. One week after TC-film application, the treated group showed significant decreases in the density of microorganisms and the proportion of spirochetes compared with the non-treated group. The results revealed the insufficient effectiveness of the local application of TC film by itself for the treatment of teeth having furcation grade II involvements.

Topics: Collagen; Humans; Periodontal Diseases; Tetracycline; Tooth Root

In 8 patients with periodontal diseases under good supragingival plaque control, 22 test teeth each having a pocket not more than 4 mm deep were treated respectively with 3 consecutive administrations of tetracycline immobilized cross-linked collagen film (TC film) at intervals of 1 week, with onceroot planing and with both of these. The therapeutic effects were compared both clinically and micro biologically. The results revealed improvements in clinical symptoms such as reduction in the depth of the pocket, bleeding on pocket probing and the like for each treatment group in 6-12 weeks. The second and third groups also showed remarked gingival recession. Further more, the density of intrapocket microorganisms showed a remarked decrease up to the 8th week for each treatment group and the population of spirochetes showed a decrease up to the 6th week for the first treatment group and up to the 8th-12th week for the second and third treatment group. The results show that both local application of the TC film and root planing are effective in periodontal treatment, but not the combined treatment.

Topics: Collagen; Dental Prophylaxis; Dental Scaling; Humans; Periodontal Diseases; Tetracycline; Tooth Root

Topics: Adult; Gingiva; Humans; Middle Aged; Periodontal Diseases; Spectrometry, Fluorescence; Tetracycline

The bacterium Actinobacillus actinomycetemcomitans is found in large numbers in subgingival plaque and gingival tissues of patients with LJP and PLS. This bacterium too has been found to cause infective bacterial endocarditis in patients at risk. Antibiotic prophylaxis is necessary for at risk patients with LJP and PLS because significant bacteraemia is produced during extensive periodontal instrumentation, extractions and surgery which are required in managing these cases. The current antibiotic regimens recommended by the American Heart Association/Council on Dental Therapeutics are not effective against this bacterium. A two-stage prophylactic approach is advocated, first with tetracycline for two weeks to eliminate the Actinobacillus actinomycetemcomitans, followed by the regimens recommended by the American Heart Association on the day of the dental procedure itself. Tetracycline should not be used concurrently or as a substitute for the recommended regimens by the American Heart Association/Council on Dental Therapeutics.

Topics: Actinobacillus Infections; Aggressive Periodontitis; Endocarditis, Bacterial; Humans; Keratoderma, Palmoplantar; Papillon-Lefevre Disease; Periodontal Diseases; 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

Tetracycline therapy, when used in conjunction with surgery or root planing, has been shown to be effective in controlling the progression of juvenile periodontitis. However, the ability of tetracycline alone to control the disease has not been assessed. The present study evaluated the effects of tetracycline therapy, with supragingival plaque control, on clinical attachment levels and radiographic bone height in patients with clinical and radiographic evidence of juvenile periodontitis. The four patients (mean age 15.2 +/- 0.3 yrs) each demonstrated loss of attachment of greater than or equal to 2 mm at one or more probing sites and had accompanying radiographic evidence of early localized bone loss. Following an initial clinical evaluation consisting of pocket depths, attachment levels and standardized radiographs, the patients received systemic tetracycline therapy (1 gm/day for three to six weeks) and oral hygiene instruction. At the completion of antibiotic therapy, patients received a supragingival professional prophylaxis every two weeks for three months, whereupon the initial evaluation was repeated. On comparing the initial and three-month clinical and radiographic data, there were significant decreases in clinical and radiographic measurements. For a total of 85 affected probing sites around 26 teeth, 79% decreased in pocket depth by greater than or equal to 2 mm (with no sites increasing in pocket depth) and 69% gained clinical attachment (with only one site losing attachment of 1 mm). Radiographic measurements revealed an increase in both the height and area of coronal alveolar bone. The findings indicated that six weeks of systemic tetracycline therapy combined with supragingival plaque control was effective in the initial control of early juvenile periodontitis.

Topics: Adolescent; Aggressive Periodontitis; Alveolar Process; Bone Resorption; Dental Prophylaxis; Humans; Periodontal Diseases; Periodontal Pocket; Radiography; Tetracycline

Topics: Animals; Citrates; Citric Acid; Humans; Periodontal Diseases; Tetracycline; Tooth Root

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

WITH THE MORE FREQUENT USE of antibiotics as adjuncts to periodontal therapy today, it is imperative that dental clinicians be aware of adverse reactions to these drugs, regardless of their reported incidence. It is the purpose of this case report to present and describe a rare adverse reaction to tetracycline hydrochloride called pseudotumor cerebri or benign intracranial hypertension. It is manifested by an abnormal increase in intracranial pressure and papilledema in a patient with an otherwise normal neuroradiologic condition. Although severe headache appears to be the most bothersome acute symptom, the more important long-term side effect is visual loss caused by the papilledema. Treatment should be directed towards discontinuation of the drug therapy, and immediate referral to a physician for a neuro-ophthalmic evaluation.

Topics: Actinobacillus Infections; Adult; Female; Humans; Periodontal Diseases; Pseudotumor Cerebri; Tetracycline

Topics: Collagen; Drug Implants; Humans; Periodontal Diseases; Tetracycline

Topics: Collagen; Drug Implants; Humans; Periodontal Diseases; Tetracycline

Topics: Cellulose; Drug Implants; Humans; Periodontal Diseases; Tetracycline

This study examines the effects of root surface demineralization and topical fibronectin as adjuncts to reconstructive periodontal surgery. In 14 beagle dogs, horizontal periodontal defects were surgically induced around the mandibular premolars followed by a 6-week period without plaque control. Reconstructive surgery of the defects was subsequently carried out. The root surfaces were debrided and superficially demineralized with citric acid or tetracycline hydrochloride, with or without subsequent application of fibronectin. Mucoperiosteal flaps were raised to cover most of the crowns and sutured. The animals were sacrificed 12 weeks after surgery and block sections of the teeth and surrounding tissues were processed for histology. Analysis included incidence of furcation defects presenting with an epithelial lining, quantification of connective tissue repair relative to the furcation circumference, and regeneration of alveolar bone relative to the furcation defect height. The incidence of root resorption and ankylosis was also analyzed. Within the limitations of this study it was concluded that: (1) citric acid conditioning of the root surface frequently resulted in complete connective tissue repair of the furcation defect; (2) root resorption and ankylosis were prevalent features of the healing response; (3) citric acid and tetracycline treatment had similar potential to induce connective tissue repair and resulted in corresponding incidences of root resorption and ankylosis; (4) application of fibronectin to demineralized root surfaces did not enhance the amount of connective tissue repair and did not alter the pattern of root resorption and ankylosis.

Topics: Administration, Topical; Alveolar Process; Animals; Bicuspid; Citrates; Citric Acid; Dogs; Fibronectins; Male; Periodontal Diseases; Periodontium; Surgical Flaps; Tetracycline; Tooth Root

A series of 16 substituted 2-(2-hydroxphenyl)benzimidazoles was synthesized and evaluated in vitro for antibacterial activity against bacteria associated with periodontal diseases. Several compounds demonstrated a high level of activity, in tube dilution assay, against Actinomycetes viscosus and Bacteriodes gingivalis. These results indicate that several of these compounds may serve as topical antibacterial agents for the control of acute marginal inflammatory gingivitis and periodontitis.

Topics: Actinomycetales; Anti-Bacterial Agents; Bacteroides; Benzimidazoles; Humans; Indicators and Reagents; Magnetic Resonance Spectroscopy; Microbial Sensitivity Tests; Periodontal Diseases; Phenols; Spectrophotometry, Infrared; Structure-Activity Relationship

Cost-effectiveness analysis was used to evaluate alternative methods of periodontal disease control. The alternatives considered included non-surgical and surgical procedures as well as the use of antimicrobial agents. Data on costs were obtained from American Dental Association publications of average charges for periodontal services. The concept of quality-adjusted tooth-years (QATYs) was developed to provide an outcome measure which could be compared across treatments. The conclusions of this analysis are as follows: (1) Conservative non-surgical treatments for periodontal disease control not only have costs lower than surgical alternatives, as would be expected, but also maximize expected quality-adjusted tooth-years over a wide range of estimates; (2) antimicrobial therapy used as an adjunct to non-surgical treatment is likely to be both effective and cost-effective; and (3) quality of tooth-years is a critical consideration in the determination of outcome of periodontal treatment. For example, when tooth-years are not adjusted for quality, differences between treatments are diminished, and surgical treatment becomes as good as or better than more conservative treatments for some levels of disease severity.

Topics: Alveoloplasty; Anti-Bacterial Agents; Anti-Infective Agents; Cost-Benefit Analysis; Decision Support Techniques; Dental Prophylaxis; Dental Scaling; Health Care Costs; Humans; Metronidazole; Middle Aged; Outcome Assessment, Health Care; Periodontal Diseases; Periodontal Pocket; Quality-Adjusted Life Years; Relative Value Scales; Root Planing; Sensitivity and Specificity; Subgingival Curettage; Surgical Flaps; Tetracycline

This study was designed to test the effect of tetracycline on healing subsequent to periodontal surgery. Aqueous solutions of tetracyclines are highly acidic and may therefore represent a suitable substitute for citric acid. Furthermore, tetracyclines react with dental hard tissues to from long-lasting antimicrobial compounds, and they have a retarding effect on pellicle and plaque formation and an antienzymatic effect. The alveolar bone around mandibular premolars was surgically reduced up to 6 mm from the cementoenamel junction in two beagles. The denuded root surfaces were exposed to the oral environment during 3 months without plaque control. Regenerative surgery was then carried out, using root surface conditioning with 1% tetracycline and coronally repositioned flaps. Six months later, histologic evaluation showed connective tissue attachment extending to the cementoenamel junction in most of the specimens. Superficial root resorption was prevalent in the cervical region, below which a collar of replacement resorption partly surrounded the roots in a characteristic manner. Morphometric analysis showed that attachment gain was similar to that obtained with citric acid in a preceding series of seven dogs. These preliminary results indicate that connective tissue attachment gain after topical use of tetracycline is similar to that obtained with citric acid. In addition, the antibacterial capacity and biological effects of tetracycline warrant further study of its possible clinical use in periodontal reconstructive surgery.

Topics: Administration, Topical; Animals; Citrates; Citric Acid; Connective Tissue; Dental Pellicle; Dogs; Epithelial Attachment; Periodontal Diseases; Periodontal Ligament; Regeneration; Tetracycline; Tooth Root; Wound Healing

Three treatment regimens including local tetracycline delivery, systemic doxycycline and surgery plus systemic doxycycline were investigated in a localized juvenile periodontitis (LJP) population. Of the investigated treatments only surgery plus systemic doxycycline for 14 days was effective in eliminating or suppressing Actinobacillus actinomycetemcomitans, an organism strongly associated with LJP lesions. While surgery plus antibiotics was the superior treatment, it appears that the possibility of reinfection or incomplete elimination of the organism exists. Careful long-term follow-up, including clinical and microbiological monitoring, is highly recommended in this periodontal population.

Topics: Actinobacillus; Administration, Topical; Adolescent; Aggressive Periodontitis; Doxycycline; Female; Humans; Male; Periodontal Diseases; Periodontal Pocket; Staining and Labeling; Surgical Flaps; 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

Topics: Adult; Cell Adhesion; Cell Division; Cells, Cultured; Connective Tissue; Dentin; Fibroblasts; Fibronectins; Gingiva; Humans; Male; Periodontal Diseases; Tetracycline; Time Factors

Topics: Humans; Periodontal Diseases; Tetracycline

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

In a series of experiments, Golub et al. demonstrated that tetracyclines, but not other antibiotics, can inhibit mammalian collagenases and proposed that this property could be useful in treating diseases, such as periodontal disease (but also included certain medical conditions, e.g., corneal ulcers) characterized by excessive collagen degradation (J Periodont Res 1983, 1984 and 1985; Experientia 1984; Cornea 1984). One effect was the dramatic reduction of tissue collagenase activity within the gingival crevicular fluid (GCF) of periodontal pockets after administering a standard regimen of a tetracycline (e.g., 200 mg minocycline or 1000 mg tetracycline/day). The preliminary studies described below determined the effect of (1) low-dose (LD; 40-80 mg/day) orally administered minocycline on GCF collagenase activity and on the subgingival microflora (Exp. I), and (2) tetracycline-loaded monolithic fibers (TF) on collagenase activity in vitro (Exp. II). In Exp. I, GCF collagenase activity was reduced by 45 to 80% 2 weeks after initiating LD minocycline therapy, an effect that lasted for at least several weeks after stopping drug treatment. No consistent change in the relative proportions of G(+), G(-) and motile subgingival microorganisms was detected as a result of LD treatment suggesting that the reduction in GCF collagenase activity was a direct inhibition of the enzyme by the drug. In Exp. II, 3- and 6-mm lengths of TF in vitro established tetracycline concentrations in 250 microliters of 132 micrograms/ml, from 3-mm lengths, and 265 micrograms/ml, from 6-mm lengths, after an 18-hour incubation.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Delayed-Action Preparations; Female; Gingival Crevicular Fluid; Humans; In Vitro Techniques; Male; Microbial Collagenase; Middle Aged; Minocycline; Periodontal Diseases; Periodontal Pocket; Tetracycline; Tetracyclines

Topics: Adolescent; Adult; Aggressive Periodontitis; Bacteria; Bicarbonates; Child; Female; Humans; Hydrogen Peroxide; Male; Periodontal Diseases; Sodium; Sodium Bicarbonate; Sodium Chloride; Tetracycline

A 4-quadrant, single-blind study was designed to test the efficacy of periodontal disease therapy by local drug delivery. A delivery system made of extruded ethylene vinyl acetate fibers loaded with 25% USP tetracycline hydrochloride was placed and maintained in periodontal pockets for 10 days. The clinical effects of this form of therapy were compared with treatment by periodontal scaling. In addition, the effect of treatment by combined local delivery and scaling was investigated. Untreated quadrants were included as control. Placement of tetracycline-loaded ethylene vinyl acetate fibers into periodontal pockets established a drug concentration of approximately 0.06%. By covering the delivery system with a periodontal dressing, this concentration level was maintained throughout the 10-day therapeutic period. The average tetracycline dose used was 2.4 mg/tooth treated. Following fiber therapy, treated sites improved clinically, as evidenced by a gain in periodontal attachment and a decrease in periodontal pocket depth. The rate of new lesion formation at fiber-treated sites decreased from a pretreatment rate of 26.5% of sites/year to a posttreatment rate of 4.8% of sites/year. Periodontal scaling also produced clinical improvement, as indicated by significant attachment gain, pocket depth reduction and a decreased rate of new lesion formation. However, in no case were clinical results by scaling superior to results by local drug delivery, and by several measures local drug delivery was found to provide a better clinical response. Principal measures by which the clinical response using local drug delivery exceeded that by scaling were in early (3-6 months) attachment gain and in the degree of reduction of new lesion formation.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Combined Modality Therapy; Delayed-Action Preparations; Female; Follow-Up Studies; Humans; Male; Middle Aged; Periodontal Diseases; Periodontal Pocket; Tetracycline; Time Factors

Topics: Humans; Periodontal Diseases; Tetracycline

The subgingival microbiologic composition of diseased periodontal sites was evaluated by darkfield microscopy before and after scaling or local delivery of tetracycline. A standardized sampling and counting method using a crevicular washing technique was developed to determine both numbers and proportions of morphotypes using darkfield microscopy. Tetracycline-loaded hollow fibers established an initial intrasulcular concentration of 200,000 micrograms/ml, which decreased exponentially to 15 micrograms/ml in 24 hours. Repetitive intrasulcular placement of these fibers at periodontitis sites produced an incremental reduction in bacterial counts over a 10-day period. Monolithic fibers made of ethylene vinyl acetate loaded with 25% tetracycline hydrochloride provided sustained release for 10 days under in vitro test conditions. Ten patients were treated in a study comparing the effects of these fibers with scaling. Fibers were placed subgingivally to fill pockets to their probable depth and covered with a periodontal dressing which was maintained for 10 days. The average intrasulcular tetracycline concentration measured at the end of the 10-day period was 643 micrograms/ml. At these sites, total counts, spirochetes, motile rods and nonmotile rods were significantly reduced immediately following treatment. Total counts were depressed to levels near the detection limit of darkfield microscopy. In comparison, scaling produced much smaller alterations of darkfield counts which were not statistically significant.

Topics: Adult; Bacteria; Dental Scaling; Drug Implants; Equipment Design; Humans; Microscopy; Middle Aged; Periodontal Diseases; Periodontal Pocket; Pilot Projects; Tetracycline; Time Factors

Topics: Adult; Anti-Bacterial Agents; Humans; Leucomycins; Metronidazole; Penicillins; Periodontal Diseases; Tetracycline

Eight patients (mean age 15.6 yrs) with severe molar-incisor bone loss and pocket formation characteristic of juvenile periodontitis were entered into a clinical protocol of three sequential stages: scaling and root planing (S/RP); S/RP concurrent with systemic tetracycline therapy (1 gm/day for 28 days); periodontal surgery concurrent with systemic tetracycline therapy. Clinical and microbiological examinations were scheduled at baseline, at 1 to 2 months after Stage I, at 1 to 2 months after completion of tetracycline therapy in Stages II and III, and during recall. A decision to progress to the next stage or to place the patient on a 3-month recall was based solely on clinical findings (suppuration, bleeding upon probing and pocket depth) at the deepest site in each patient. Paperpoint subgingival plaque samples from representative affected sites were analyzed for percentage of total cultivable microflora composed of black-pigmented Bacteroides species (BPB), surface translocating bacteria (STB) and Actinobacillus actinomycetemcomitans (Aa). At baseline, all sites bled to probing, seven of eight sites showed suppuration, and deepest pocket depths averaged 8.0 mm. STB were detected in one and BPB in four sites, respectively, and all sites demonstrated Aa, which constituted approximately 40% of the total cultivable flora. S/RP alone had essentially no effect on either clinical or microbiological findings, and all patients progressed to Stage II. Five went on to Stage III. S/RP with tetracycline was clinically and microbiologically more effective at sites in which Aa was predominant. Surgery was required in all sites containing high levels of both BPB and Aa. These results suggest that microbiological diagnosis may be useful in selecting and monitoring treatment for juvenile periodontitis.

Topics: Actinobacillus; Adolescent; Adult; Aggressive Periodontitis; Alveoloplasty; Bacteria; Bacteroides; Child; Combined Modality Therapy; Dental Scaling; Female; Gingival Hemorrhage; Humans; Male; Periodontal Diseases; Suppuration; 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

Topics: Anti-Infective Agents, Local; Chloramines; Dental Scaling; Humans; Periodontal Diseases; Tetracycline; Tooth Root; Tosyl Compounds

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

Four patients, ages 14-17, who demonstrated characteristics of juvenile periodontitis, underwent antibiotic and surgical therapy to control microbial etiologic factors. No occlusal equilibration or bone grafting techniques were employed. Subsequent to treatment, all four patients demonstrated decreased pocket depths and mobility on teeth associated with vertical osseous defects. Osseous repair was evident on postoperative radiographs. Reentry procedures, on one patient, confirmed that osseous repair had occurred in 2- to 3-wall, 3-wall, hemi-circumferential and furcal defects. If infection and inflammation are controlled, it appears that the potential for osseous repair in juvenile periodontitis patients is greater than has been thought.

Topics: Adolescent; Aggressive Periodontitis; Combined Modality Therapy; Humans; Male; Oral Hygiene; Patient Compliance; Periodontal Diseases; Surgical Flaps; Tetracycline

This study evaluated the effect of applying 3% Achromycin on healing following periodontal surgery. Twelve patients participated, and 15 contralateral sides with similar disease were compared. The parameters assessed included amounts of gingival crevice fluid quantitated with the Periotron, gingival bleeding tendencies, mobility scores and attachment levels. No significant differences in bleeding tendency, mobility or attachment levels were found. Significant changes were noted on amounts of gingival crevicular fluid, however. The amounts of gingival crevicular fluid collected were significantly lower on the side not treated with Achromycin throughout the observation period. Applying 3% Achromycin did not have a beneficial effect on the healing of periodontal wounds. Whether the application of an antibiotic on sutured flaps limited the bacterial contamination of the gingival tissues through a "wicking effect" of the silk suture material, or if this bacterial contamination had any consequence on gingival healing or reattachment of the periodontal tissues adjacent to the tooth, cannot be determined from this study.

Topics: Adult; Female; Gingival Crevicular Fluid; Humans; Male; Periodontal Diseases; Periodontal Index; Periodontium; Surgical Flaps; Tetracycline; Wound Healing

Topics: Bacterial Physiological Phenomena; Humans; Periodontal 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

Since recent studies have implicated Actinobacillus actinomycetemcomitans in the etiology of localized juvenile periodontitis, this investigation determined the effectiveness of subgingival debridement, topical Betadine Solution, and systemic tetracycline in suppressing subgingival A. actinomycetemcomitans and other microorganisms. A total of 20 deep periodontal pockets and 10 normal periodontal sites of 6 localized juvenile periodontitis patients was included in the study. Each patient was treated in 3 stages over a period of 22 weeks, and the result of treatment was monitored for an additional 38 weeks. The first stage of treatment included plaque control, as well as thorough scaling and root planing, composed of at least 6 h of debridement. No concomitant periodontal surgery was performed. In the second stage, Betadine saturated cotton gauze was inserted into the periodontal pockets for 10 min. Stage 3 involved systemic tetracycline therapy (1 g/day) for 14 days. The subgingival microflora was determined at frequent intervals by selective culturing of A. actinomycetemcomitans and Capnocytophaga and by direct microscopic examination. The clinical effect was assessed by measuring changes in probing periodontal attachment level, probing periodontal pocket depth, radiographic alveolar bone mass, and other relevant clinical parameters. Scaling and root planing reduced the total subgingival bacterial counts and the proportions of certain Gram-negative bacteria, but no periodontal pocket became free of A. actinomycetemcomitans. Betadine application had little or no effect on the subgingival microflora. In contrast, tetracycline administered via the systemic route suppressed A. actinomycetemcomitans, Capnocytophaga, and spirochetes to low or undetectable levels in all test periodontal pockets. A. actinomycetemcomitans reappeared in 9 of the deep periodontal pockets after the administration of tetracycline. Most of these 9 pockets became free of detectable A. actinomycetemcomitans during the second week of tetracycline administration, whereas pockets which yielded no A. actinomycetemcomitans after tetracycline therapy became free of the organisms during the first week of tetracycline treatment. This data suggests that systemic tetracycline therapy of localized juvenile periodontitis should, as a practical rule, be continued for 3 weeks. Periodontal destruction continued in 4 deep pockets which all showed high posttetracycline A. actinomycetemcomitans counts. Al

Topics: Actinobacillus; Adolescent; Aggressive Periodontitis; Bacteria; Female; Humans; Iodine; Male; Periodontal Diseases; Povidone-Iodine; Subgingival Curettage; Tetracycline

Topics: Administration, Topical; Humans; Periodontal Diseases; Tetracycline; Wound Healing

Topics: Alveolar Process; Animals; Bone Resorption; Dogs; Longitudinal Studies; Periodontal Diseases; Tetracycline; Time Factors

Topics: Alveolar Process; Animals; Bone Resorption; Diphosphonates; Dogs; Longitudinal Studies; Periodontal Diseases; Technetium; Technetium Tc 99m Medronate; Tetracycline; Time Factors

Topics: Administration, Oral; Administration, Topical; Adolescent; Adult; Alveoloplasty; Bone Transplantation; Female; Freeze Drying; Humans; Male; Periodontal Diseases; Periodontium; Tetracycline

The susceptibility of selected oral bacteria, including suspected periodontopathogens, to a commonly employed Chinese herbal medicine Huang-chin (HC, Scutellaria baicalensis) was tested in vitro. The minimum inhibitory concentration (MIC) and minimum bactericidal concentrations (MBC) were determined. HC was also compared with tetracycline, alexidine, and stannous fluoride. HC decoction, at a concentration of 2%, was bacteriostatic in eight of 11 bacteria tested, but a concentration of 3.13% or greater was required for bactericidal effect. Among the tested bacteria, Bacteroides melaninogenicus ss intermedius was the most sensitive (MIC = 1.57%, MBC = 2%); Actinomyces viscosus was the least sensitive (MIC = 6.25%, MBC = 12.5%). Tetracycline, alexidine, and SnF2 were bactericidal in vitro in all bacteria tested at concentrations lower than those used clinically.

Topics: Bacteria; Biguanides; Flavonoids; Humans; Microbial Sensitivity Tests; Periodontal Diseases; Plant Extracts; Tetracycline; Tin Fluorides

Topics: Animals; Diet; Oryza; Penicillin V; Periodontal Diseases; Periodontium; Rats; Syndrome; Tetracycline

Topics: Alveolar Process; Animals; Bacteria; Dogs; Drug Evaluation, Preclinical; Periodontal Diseases; Periodontium; Radiography; Tetracycline

Topics: Child, Preschool; Denture, Complete; Humans; Keratoderma, Palmoplantar; Papillon-Lefevre Disease; Periodontal Diseases; Tetracycline

Topics: Adolescent; Alveolar Process; Bone Resorption; Female; Humans; Middle Aged; Osteogenesis; Periodontal Abscess; Periodontal Diseases; Tetracycline

The sensitivity to tetracycline of 345 bacterial isolates from periodontal lesions was determined. Most species of bacteria, including those thought to be involved in the initiation and progress of destructive periodontal disease, were inhibited in vitro by tetracycline concentrations of 4 to 8 micrograms/ml. This concentration is equivalent to crevicular fluid levels of tetracycline at dosages of 1 gm/day. These data indicate that tetracycline is inhibitory at levels achieved in crevicular fluid for bacteria currently implicated in destructive periodontal disease.

Topics: Bacteria; Gingival Crevicular Fluid; Humans; Microbial Sensitivity Tests; Periodontal Diseases; 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

Topics: Adult; Drug Evaluation; Female; Gingiva; Humans; Periodontal Diseases; Tetracycline; Time Factors

Topics: Adolescent; Female; Humans; Molar; Periodontal Diseases; Subgingival Curettage; Tetracycline

Topics: Bacterial Infections; Humans; Microscopy, Phase-Contrast; Periodontal Diseases; Tetracycline

Topics: Adolescent; Blood Protein Disorders; Child; Child, Preschool; Dental Caries; DMF Index; Female; Gingivitis; Gingivitis, Necrotizing Ulcerative; Humans; IgA Deficiency; Male; Mouth Breathing; Oral Hygiene; Periodontal Diseases; Tetracycline; Tooth Discoloration

Topics: Acetaminophen; Adult; Brompheniramine; Dental Caries; Edema; Female; Humans; Iatrogenic Disease; Oral Hemorrhage; Periapical Tissue; Periodontal Diseases; Pulpectomy; Root Canal Obturation; Root Canal Therapy; Sodium Hypochlorite; Tetracycline; Therapeutic Irrigation

Topics: Amylases; Dentistry; Periodontal Diseases; Tetracycline

Topics: Muramidase; Periodontal Diseases; Tetracycline; Tooth Extraction

Topics: Capsules; Cellulitis; Humans; Mouth Diseases; Odontogenic Cysts; Periodontal Diseases; Powders; Tetracycline

Topics: Amphotericin B; Bacteria; Dentistry; Mouth; Penicillin G; Periodontal Diseases; Tetracycline

Topics: Abnormalities, Drug-Induced; Anesthesia, Dental; Anesthetics; Dental Caries; Dentistry; Female; Fetal Death; Fetal Diseases; Fluorides; Gingivitis; Humans; Hyperemesis Gravidarum; Hypotension; Periodontal Diseases; Pregnancy; Pregnancy Complications; Radiography, Dental; Stress, Physiological; Tetracycline

Topics: Agranulocytosis; Ecchymosis; Gingivitis; Gingivitis, Necrotizing Ulcerative; Humans; Isoniazid; Lymphadenitis; Neutropenia; Periodicity; Periodontal Diseases; Prednisone; Splenectomy; Splenomegaly; Tetracycline