Antibiotics in aggressive periodontitis, is there a clinical benefit?

Abstract

Data sourcesMedline, Embase and CENTRAL databases were searched up to December 2014. Unpublished data were sought by searching a database listing unpublished studies OpenGray [http://www.opengrey.eu/], formerly OpenSIGLE.Study selectionRandomised clinical trials assessing treatment of patients with AgP comparing scaling and root planing (SRP) alone with SRP plus a single antibiotic or a combination of drugs with a minimum of three months follow-up were considered. Studies specifically designed to evaluate smokers or subjects with diabetes mellitus and HIV/AIDS were not included.Data extraction and synthesisTwo researchers independently screened titles, abstracts and full texts of the search results. The studies, which fulfilled inclusion criteria, underwent validity assessment and data extraction using a specifically designed form. The quality of included studies was assessed using the Cochranes collaboration tool for risk of bias. Only two of the 11 included trials were considered at a low risk of bias. The data extracted from ten studies was analysed by pair-wise meta-analyses and the data extracted from five studies was included in Bayesian network meta-analyses pooled estimates. The six studies evaluated in the pairwise meta-analyses were excluded in the pooled estimates because four studies included patients with advanced disease only and one study did not present average data for pocket depth (PD) and clinical attachment level (CAL) and another one for using a different mechanical treatment.ResultsFourteen studies reporting 11 randomised clinical trials with a total of 388 patients were included in the review. Nine of 11 studies reported a statistically significant greater gain in full mouth mean clinical attachment (CA) and reduction in probing depth (PD) when a systemic antibiotic was used. From those studies the calculated mean difference for CA gained was 1.08 mm (p < 0.0001) and for PD reduction was 1.05 mm (p< 0.00001) for SRP + Metronidazole (Mtz). For SRP + Mtz+ amoxicillin (Amx) group the mean difference was 0.45 mm for CA gained and 0.53 mm for PD reduction (p<0.00001) than SRP alone/placebo. Bayesian network meta-analysis showed some additional benefits in CA gain and PD reduction when SRP was associated with systemic antibiotics.ConclusionsThe results support a statistically significant benefit of adjunctive systemic antibiotics in the treatment of AgP. The most consistent advantages - reduction in PD and CAL gain - were attained with the use of Mtz and Mtz + Amx. Future RCTs should be designed in order to directly compare these two antibiotic protocols in the treatment of AgP.

Aggressive periodontitis with a history of orthodontic treatment

“…[24] The use of adjunctive antibiotics helps in control of tissue invasive bacteria including A. actinomycetemcomitans and Porphyromonas gingivalis (causative organisms for localized and generalized aggressive periodontitis, respectively). [25] Literature supports the use of a combination of amoxicillin and metronidazole in the adjunctive treatment of aggressive periodontitis. [25]…”

Periodontitis and dental scaling associated with pyogenic liver abscess: A population‐based case‐control study

“…Thoden van Velzen et al reported that oral bacteria have 3 different mechanisms of causing non‐oral disease: (i) metastatic infection caused by bacterial translocation; (ii) metastatic damage associated with microbial toxins; and (iii) metastatic inflammation caused by immune injury. DS is one of the standard methods of preventing and treating periodontitis with or without antibiotic administration . PLA formation is thought to result from the transmission of infections through 3 major pathways, namely the biliary tract, portal vein and hepatic artery.…”

“…Although about 50% of liver abscess cases are considered cryptogenic, Yoneda et al reported liver abscess was caused by periodontal bacterial infection with Fusobacterium necrophorum . As periodontitis is typically treated using mechanical dental procedures, including DS, at regular intervals to reduce oral bacteria, which may also decrease the risk of PLA . Taken together, we proposed the hypothesis that PLA is more prevalent in individuals with periodontitis and that DS can reduce the occurrence of PLA.…”

Differential diagnosis between chronic versus aggressive periodontitis and staging of aggressive periodontitis: A cross-sectional study

“…Decision to refer cases of AgP to specialists for further management can be made if cases are diagnosed accurately in the first instance. The treatment plan for AgP includes oral hygiene instructions and motivation and mechanical therapy, which may be supplemented by systemic antimicrobial therapy,[ 12 13 ] psychological therapy,[ 14 ] assessment of periodontal status of family members,[ 12 ] and plan for long-term maintenance at shorter recall intervals. [ 15 ] Incorrect diagnosis may result in the formulation of a treatment plan without addressing these vital issues.…”