ACTA
FAC. MED. NAISS. 2003; 20 (2): 127-130|
ACTA
FAC. MED. NAISS. 2003; 20 (2): 127-130 |
Original article
ANTIBIOTICS IN THERAPY OF PERIODONTOLOGY- OUR EXPIRIENCE
Vesna Branković, Ana Pejčić, Branislava Mirković,Draginja Kojović, Ivana Grigorov
Faculty of Medicine Nis Clinic for Stomatology, Department for the mouth disease and parodonty
INTRODUCTION
Periodontal disease (Parodontopathia) is inflammatic disease which matifests by destruction of some soft tissues and supporting bone structure of periodontium. This is a very important cause of teeth losing, and it is increased in prevalence and strength in the course of life (1).
Parodontopathia appears by acting of microorganisms of dental plaque, i. e. by subgingival dental plaque, which make Gram negative, anaerobic microbes. At the beginning of experiment the importance of quantitative plaque structure was emphasized.
At that time the ˝nonspicific˝ theory of dental plaque dominted. Contrary to this theory, today, a ˝spicific˝ theory prevales, according to which the parodontopathia is classified in specific infections associated with the group of specific microorganisms(2,3). It is known, nowadays, that for Juvenile parodontopathia appearance, Actinobacillus actinomycetemcomitans (A.a) has the main role. This microorganism is very important for other aggresive forms of parodontopathia (such as Pripuberty, Rapid and Refractoral one). For the appearance of chronical form of parodontopathia in adults the importance of Bacteroides gingivalis is emphasized, as well as Bacteroides intermedius. According to up-to-date data these microorganisms are most often in connection with parodont disease, while other microorganisms which are discovered (Fusobacteriae, Actinomyces, Capnocytophagae, Spirochetae), can partake in disease appearence, but they appear in much less number (4).
According to this knowledge which came in sight that parodontopathia is infective by nature, very soon the conclusion was made that antibiotic can applied in treatment of parodontopathy patients. Experiments have shown that antibiotics lead to reduction of dental plaque, they slowed down the process of gingivit progress to parodontopathia, the reduction inflammation of gingiva, as well as they fasten the reovery and they also make better and fasten the effect of treatment which appeares after the mechanic treatment of parodontal pocket (5).
Indications for antibiotic application in parodontopathia:
1. Pri-puberty parodontopathia
2. Juvenile parodontopathia
3. Refractoral parodontopathia
4. Rapid form of parodontopathia
5. Adult parodontopathia with extreme supuration
6. Abscessus parodontalis
7. Parodontopathia ulcerosa
8. at surgical intervention
9. at medical risk patients.
ANTIBIOTIC WHICH ARE USED IN PARODONTOPATHIA
TETRACYCLINE – are antibiotic of large spectrum. They are mainly used in Juvenil parodontopathia, because it is very effective in (A.a) elimination. Therapy doze is 250mg 4 times a day in duration from 3 to 8 weeks, or 500mg every six hour in 3 week. It also gives good results in Refractoral parodontopathia treatment (6).
DOXICYCLINE – is tetracycline remedy which is given in the doze of 200mg or 100mg a day in 3 week time. All mentioned microorganisms are sensitive to doxicycline.
MINOCYCLINE – is given in small dozes 100-200mg, it is expressive anaerobic, but it acts slighter on A.a.
METRONIDAZOLE – is bacteriological chemiotherapeutic. It acts on Gram positive and negative bacteria. It is given in doze of 250mg 10-12 days at Refractoral parodontopathia (7).
CYPROFLOXACIN – acts on Gram negative bacteria.
PENICILLIN – is one of the first antibiotics which was used in parodontal therapy. It is specially effective at infections by Bacillus fusiformis and Vensan spirocheta. It is given from 250-500mg at every 6 hour in 10 days. It is less effective than previous antibiotics (8).
AMOXICILIN – is very close to penicillin. It is more effective than penicillin because it is given in combination with Clavulanate-acid which inhibits ß-lactam bacteria products.
ERYTHROMYCIN – is microlid, but has less effects.
Combination of METRONIDAZOLE + AMOXICLIN is very good and effective one, which is used at all cases of parodontopathia. It is given in combination of 250-500mg metronidazole and 375mg of amoxicyline in 7-8 days time (9,10).
CLINDAMYCIN
OUR EXPERIENCE
In the course of our work and routine patients periodontal therapy, at Oral Medicine and Periodontology at Dental Clinic, Nis, we have, also used systemic antibiotic application.
The number of treated patients is shown in Table 1.
Table 1. Antibiotic application in parodontal therapy
|
antibiotic |
Adult parodontopathia |
Juvenile parodontopathia |
Abscessus parodontalis |
Parodontopathia supurativa |
|
metronidazole |
60 |
3 |
17 |
9 |
|
tetracycline |
41 |
5 |
11 |
8 |
|
erythromycin |
21 |
- |
8 |
3 |
|
summary |
122 |
8 |
36 |
20 |
REGIME OF ANTIBIOTIC APPLICATION
METRNIDAZOLE: 200mg 3 times a day 10 days
TETRACYCLINE: 250mg 4 times a day 12 days
ERYTHROMYCIN: 250mg 3 times a day 14 days
We have done bacteria sensibility on antibiotic application by using method of Gas-Pach system, at Microbiology Institute, Nis.
We used some of the clinical parameters, which helped us to estimate our results. We used gingival index, blooding index and we looked after supuration from parodontal pockets. Parameters were determinated at the beginning and at the end of antibiotic application.
RESULTS AND DISCUSSION
In the last five years, there were 186 patients, of both sexes, from 17-69 years old, determined according to inducations, for antibiotic application. Antibiotic was given to Adult parodontopathia patients, when the disease went with Refractor form, a small number with Juvenile form, at Abscessus as well as in cases of manure exudation. We applied metronidazole, tetracycline, and erythromycin.
As a therapy patients used antibiotics by our conventional mechanical parodontal pocket treatment and physical measures.
Clinical parameters used for condition evaluation have shown that all the patients grew better, in two days time, in comparison with usual treatment which last for seven days. The control was done after three months and the changings of clinic parameter were more stable.
Metronidazole was more effective at Adult chronic parodontopathia, at Juvenile parodontopathia, although it was a small number, we had good tetracycline results. The results at Parodontal abscessus and Parodontopathia supurativa were similar with application both metronidazole and tetracycline.
Our experiments have discovered very small nonsignificant distinctions between various treatment regimes, in comparison with other authors.
As the matter of microbe sensibility of dental plaque, our results show that the most isolated microbes are the most sensitive on metronidazole and more less on tetracycline, erythromycin and on other antibiotic as well. (All of these have been published).
When we apply metronidazole and tetracycline, the improvement is very important in fast blood repression, suppuration, and pain which can show that antibiotic application itself has some additional effects on soft tissue inflammation, probably by antibiotic effect on bacteria.
Our experiences are in complete consolidation with other authors experiments.
Instead of conclusion we would like to express some more notices which come over from antibiotic therapy at parodontopathia.
First of all, we would like to point out that the system antibiotic application can have some undesired effects.
That uncontrolled application can be a risk for convensal flora development and resistental bacteria effects on applied medicaments.
Besides that, metronidazole application can be cancer effect by some authors. It mustn`t be used with alchocol or with some other drugs, because it can cause sickness.
At tetracycline application, the known discoloration of teeth growing, in children under 10 can be found, because of tetracycline which links to calcium ion. Minocycline therapy can also cause both skin and mucous pigmentation.
Because of undesired effects, a lot is done in the field of science today, to make possibilites of local antibiotic application in parodontal therapy.
The improvements which were gained by antibiotic therapy can`t be everlasting especially if they were not followed by good oral hygienic. It is not correct to apply antibiotic therapy, which can`t decline the cause of disease for a longer period of time, so the system medical application is strictly if they were not followed strictlly indicated only in determitated forms of parodontopathia.
Antibiotic therapy also in these indicated fields, can be used like an additional therapy, in usual mechanical treatment of parodontal pockets.
REFERENCES