Aim
To answer the following PICOS questions: in patients with periodontitis, which is the efficacy of adjunctive systemic antimicrobials, in comparison with subgingival debridement plus a placebo, in ...terms of probing pocket depth (PPD) reduction, in randomized clinical trials with at least 6 months of follow‐up?
Material and Methods
A systematic search was conducted: 34 articles (28 studies) were included. Data on clinical outcome variables changes were pooled and analysed using weighted mean differences (WMDs), 95% confidence intervals (CI) and prediction intervals (PIs), in case of significant heterogeneity.
Results
For PPD, statistically significant benefits (p < .001) were observed in short‐term studies (WMD = 0.448, 95% CI 0.324; 0.573, PI −0.10 to 0.99) and long‐term studies (WMD = 0.485, 95% CI 0.322; 0.648, PI −0.11 to 1.08). Additionally, statistically significant benefits were also found for clinical attachment level, bleeding on probing, pocket closure and frequency of residual pockets. The best outcomes were observed for the combination of amoxicillin plus metronidazole, followed by metronidazole alone and azithromycin. Adverse events were more frequently reported in groups using systemic antimicrobials.
Conclusions
The adjunctive use of systemic antimicrobials in periodontal therapy results in statistically significant benefits in clinical outcomes, with more frequent adverse events in test groups using systemic antimicrobials.
Different mechanisms have been hypothesized to explain the increase in prevalence and severity of periodontitis in older adults, including shifts in the periodontal microbiota. However, the actual ...impact of aging on the composition of subgingival biofilms remains unclear. In the present article, we provide an overview of the composition of the subgingival biofilm in older adults and the potential effects of age on the oral microbiome. In particular, this review covers the following topics: (i) the oral microbiota of an aging mouth; (ii) the effects of age and time on the human oral microbiome; (iii) the potential impact of inflammaging and immunosenescence in the host–oral microbiota interactions; and (iv) the relationship of the aging oral microbiota and Alzheimer's disease. Finally, we present analyses of data compiled from large clinical studies that evaluated the subgingival microbiota of periodontally healthy subjects and patients with periodontitis from a wide age spectrum (20–83 years of age).
A new periodontitis classification scheme has been adopted, in which forms of the disease previously recognized as “chronic” or “aggressive” are now grouped under a single category (“periodontitis”) ...and are further characterized based on a multi‐dimensional staging and grading system. Staging is largely dependent upon the severity of disease at presentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease including a history‐based analysis of the rate of periodontitis progression; assessment of the risk for further progression; analysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient.
Necrotizing periodontal diseases, whose characteristic clinical phenotype includes typical features (papilla necrosis, bleeding, and pain) and are associated with host immune response impairments, remain a distinct periodontitis category.
Endodontic‐periodontal lesions, defined by a pathological communication between the pulpal and periodontal tissues at a given tooth, occur in either an acute or a chronic form, and are classified according to signs and symptoms that have direct impact on their prognosis and treatment.
Periodontal abscesses are defined as acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus, rapid tissue destruction and are associated with risk for systemic dissemination.
A new periodontitis classification scheme has been adopted, in which forms of the disease previously recognized as “chronic” or “aggressive” are now grouped under a single category (“periodontitis”) ...and are further characterized based on a multi‐dimensional staging and grading system. Staging is largely dependent upon the severity of disease at presentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease including a history‐based analysis of the rate of periodontitis progression; assessment of the risk for further progression; analysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient.
Necrotizing periodontal diseases, whose characteristic clinical phenotype includes typical features (papilla necrosis, bleeding, and pain) and are associated with host immune response impairments, remain a distinct periodontitis category.
Endodontic‐periodontal lesions, defined by a pathological communication between the pulpal and periodontal tissues at a given tooth, occur in either an acute or a chronic form, and are classified according to signs and symptoms that have direct impact on their prognosis and treatment.
Periodontal abscesses are defined as acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus, rapid tissue destruction and are associated with risk for systemic dissemination.
Objective
To critically evaluate the existing literature on acute lesions occurring in the periodontium (periodontal abscesses PA, necrotizing periodontal diseases NPD, and endo‐periodontal lesions ...EPL) to determine the weight of evidence for the existence of specific clinical conditions that may be grouped together according to common features. The ultimate goal is to support an objective classification system.
Importance
Although PA, NPD, and EPL occur with relatively low frequency, these lesions are of clinical relevance, because they require immediate management and might severely compromise the prognosis of the tooth.
Findings
In general, the evidence available to define these three conditions was considered limited. PA and EPL are normally associated with deep periodontal pockets, bleeding on probing, suppuration, and almost invariably, with pain. EPL are also associated with endodontic pathology. NPDs have three typical features: pain, bleeding, and ulceration of the gingival interdental papilla. The available data suggested that the prognosis of PA and EPL are worse in periodontitis than in nonperiodontitis patients. Lesions associated with root damage, such as fractures and perforations, had the worst prognosis. NPD progression, extent and severity mainly depended on host‐related factors predisposing to these diseases.
Conclusions
PA should be classified according to the etiological factors involved, with the most frequent being those occurring in pre‐existing periodontal pockets. NPD are clearly associated with the host immune response, which should be considered in the classification system for these lesions. EPLs should be classified according to signs and symptoms that have direct impact on their prognosis and treatment, such as presence or absence of fractures and perforations, and presence or absence of periodontitis.
Objective
To critically evaluate the existing literature on acute lesions occurring in the periodontium (periodontal abscesses PA, necrotizing periodontal diseases NPD, and endo‐periodontal lesions ...EPL) to determine the weight of evidence for the existence of specific clinical conditions that may be grouped together according to common features. The ultimate goal is to support an objective classification system.
Importance
Although PA, NPD, and EPL occur with relatively low frequency, these lesions are of clinical relevance, because they require immediate management and might severely compromise the prognosis of the tooth.
Findings
In general, the evidence available to define these three conditions was considered limited. PA and EPL are normally associated with deep periodontal pockets, bleeding on probing, suppuration, and almost invariably, with pain. EPL are also associated with endodontic pathology. NPDs have three typical features: pain, bleeding, and ulceration of the gingival interdental papilla. The available data suggested that the prognosis of PA and EPL are worse in periodontitis than in nonperiodontitis patients. Lesions associated with root damage, such as fractures and perforations, had the worst prognosis. NPD progression, extent and severity mainly depended on host‐related factors predisposing to these diseases.
Conclusions
PA should be classified according to the etiological factors involved, with the most frequent being those occurring in pre‐existing periodontal pockets. NPD are clearly associated with the host immune response, which should be considered in the classification system for these lesions. EPLs should be classified according to signs and symptoms that have direct impact on their prognosis and treatment, such as presence or absence of fractures and perforations, and presence or absence of periodontitis.
Despite the fact that several clinical studies have shown additional benefits when certain systemic antibiotics are used as adjuncts to periodontal treatment, clear guidelines for the use of these ...agents in the clinical practice are not yet available. Basic questions concerning the use of systemic antibiotics to treat periodontitis remain unanswered, such as: which drug(s) should be used; which patients would most benefit from treatment; which are the most effective protocols (i.e. doses and durations); and in which phase of the mechanical therapy should the drug(s) be administered? Although not all of those questions have been directly addressed by controlled randomized clinical trials, recent concepts related to the ecology of periodontal diseases, as well as the major advances in laboratory and clinical research methods that have occurred in the past decade, have significantly broadened our knowledge in this field. This article endeavored to provide a ‘state of the art’ overview on the use of systemic antibiotics in the treatment of periodontitis, based on the most recent literature on the topic as well as on a compilation of data from studies conducted at the Center of Clinical Trials at Guarulhos University (São Paulo, Brazil) from 2002 to 2012.
The starting point for defining effective treatment protocols is a clear understanding of the etiology and pathogenesis of a condition. In periodontal diseases, this understanding has been hindered ...by a number of factors, such as the difficulty in differentiating primary pathogens from nonpathogens in complex biofilm structures. The introduction of DNA sequencing technologies, including taxonomic and functional analyses, has allowed the oral microbiome to be investigated in much greater breadth and depth. This article aims to compile the results of studies, using next‐generation sequencing techniques to evaluate the periodontal microbiome, in an attempt to determine how far the knowledge provided by these studies has brought us in terms of influencing the way we treat periodontitis. The taxonomic data provided, to date, by published association and elimination studies using next‐generation sequencing confirm previous knowledge on the role of classic periodontal pathogens in the pathobiology of disease and include new species/genera. Conversely, species and genera already considered as host‐compatible and others less explored were associated with periodontal health as their levels were elevated in healthy individuals and increased after therapy. Functional and transcriptomic analyses also demonstrated that periodontal biofilms are taxonomically diverse, functionally congruent, and highly cooperative. Very few interventional studies to date have examined the effects of treatment on the periodontal microbiome, and such studies are heterogeneous in terms of design, sample size, sampling method, treatment provided, and duration of follow‐up. Hence, it is still difficult to draw meaningful conclusions from them. Thus, although OMICS knowledge has not yet changed the way we treat patients in daily practice, the information provided by these studies opens new avenues for future research in this field. As new pathogens and beneficial species become identified, future randomized clinical trials could monitor these species/genera more comprehensively. In addition, the metatranscriptomic data, although still embryonic, suggest that the interplay between the host and the oral microbiome may be our best opportunity to implement personalized periodontal treatments. Therapeutic schemes targeting particular bacterial protein products in subjects with specific genetic profiles, for example, may be the futuristic view of enhanced periodontal therapy.
Aim
To evaluate whether obesity affects the subgingival microbial composition of patients with periodontal health or chronic periodontitis (CP).
Materials and Methods
Based on periodontal parameters, ...body mass index and waist‐hip ratio, 166 patients were allocated into one of the following groups: Normal weight (NW) patients with periodontal health (n = 44), NW patients with CP (n = 40), obese patients with periodontal health (n = 40) and obese patients with CP (n = 42). Six subgingival biofilm samples per patient were analysed for their content of 40 bacterial species using checkerboard DNA‐DNA hybridization.
Results
Obese patients with CP harboured higher levels and/or higher proportions of several periodontal pathogens than those with NW and CP, including Aggregatibacter actinomycetemcomitans, Eubacterium nodatum, Fusobacterium nucleatum ss vincentii, Parvimonas micra, Prevotella intermedia, Tannerella forsythia, Prevotella melaninogenica and Treponema socranskii. The proportions of most of these pathogens, as well Campylobacter rectus and Eikenella corrodens, were more increased in the diseased sites of the obese patients than in those with NW. Furthermore, the healthy sites of the obese patients, presenting or not CP, also exhibited higher proportions of some of the pathogens than patients with NW.
Conclusions
Obesity is associated with increased levels and proportions of periodontal pathogens, especially in patients with CP.
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