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Kardaras G, Christodorescu R, Boariu M, Rusu D, Belova A, Chinnici S, Vela O, Radulescu V, Boia S, Stratul SI. A Low-Cost Protocol Using the Adjunctive Action of Povidone-Iodine Irrigations and Sodium Hypochlorite Rinsing Solution in Step 2 of Periodontal Therapy for Patients with Stage III-IV Periodontitis: A Single-Blind, Randomized Controlled Trial. Dent J (Basel) 2024; 12:144. [PMID: 38786542 PMCID: PMC11119210 DOI: 10.3390/dj12050144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/18/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
In severe stages of periodontitis, conventional periodontal therapy and maintenance care are usually insufficient due to the viral and bacterial etiology; thus, a mechanical approach alone may not be sufficient to eliminate a substantial portion of subgingival pathogens, especially in deep periodontal sites. Background and Objectives: This single-blind, randomized clinical trial aimed to compare the clinical and microbiological efficacy of a low-cost protocol using povidone-iodine and sodium hypochlorite formulations as adjuncts to non-surgical therapy for patients with stage IV periodontitis when compared with chlorhexidine, the most commonly employed substance to date for antimicrobial regimens in periodontal therapy. Materials and Methods: Forty-five patients were randomly divided into two groups: control (subgingival instrumentation, chlorhexidine-assisted) and test (antiviral medication, subgingival instrumentation with povidone-iodine, sodium hypochlorite rinsing solution, and antibiotics). Clinical measurements and microbiological analyses were performed at baseline and after three months. Results: After three months, notable differences were found in the bacterial detection scores for Porphyromonas gingivalis (a significant reduction in detection frequency was observed in the test compared to the control (p = 0.021)), and there were significant reductions in detection in the test group for Tannerella forsythia and Treponema denticola, showing undetectable levels (p < 0.0001 for both). In the test group, the pocket probing depth median value was reduced significantly (p = 0.0005); similarly, bleeding on probing showed a marked decrease (p < 0.0001). However, changes in clinical attachment loss and full-mouth plaque score were not statistically significant. Conclusions: Using the proposed protocol, substantial improvements in clinical and microbiological parameters were obtained when compared with the current antimicrobial recommendations.
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Affiliation(s)
- Georgios Kardaras
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Ruxandra Christodorescu
- Department V Internal Medicine, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Marius Boariu
- Department of Endodontics, Faculty of Dental Medicine, TADERP Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Darian Rusu
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Alla Belova
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Salvatore Chinnici
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Octavia Vela
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Viorelia Radulescu
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Simina Boia
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
| | - Stefan-Ioan Stratul
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (G.K.); (D.R.); (A.B.); (S.C.); (O.V.); (V.R.); (S.B.); (S.-I.S.)
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Svellenti L, Karacic J, Herzog J, Tanner M, Sahrmann P. Effects of Rinsing with Povidone-Iodine during Step II Periodontal Therapy: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:2111. [PMID: 38610876 PMCID: PMC11012979 DOI: 10.3390/jcm13072111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Background and Objectives: Antiseptics have been suggested to enhance the outcomes of non-surgical periodontal treatment (NSPT). Among these, povidone-iodine (PVP-iodine) was reported to significantly reduce periodontal pocket depths (PPDs). The aim of this study was to systematically re-assess the existing literature regarding the potential benefit of using PVP-iodine in step II periodontal therapy. Material and Methods: The scientific literature was systematically searched across electronic libraries for randomized controlled trials employing PVP-iodine during NSPT through to September 2023, using search items related to PVP-iodine and periodontitis. The selection process was performed by two independent reviewers. The primary outcomes were reductions in periodontal probing depth (PPD) and clinical attachment level (CAL). When reasonable, a meta-analysis of the included studies was performed. Results: Initially, 799 records were identified. After abstract and title screening and fulltext revision, 15 RCTs were included. The data from eight studies were merged in meta-analyses. The use of PVP-iodine had no significant effect on PPD reduction at 6 months (means [standard deviation]: -0.12 mm [-0.33; 0.09]) but it did at 12 months (-0.29 mm [-0.56; -0.02]). CAL was significantly better at 6 (-0.42 mm [-0.64; -0.20]) and 12 months (-0.39 mm [-0.66; -0.11]). Conclusions: PVP-iodine rinsing during NSPT may slightly improve patients' PPD and CAL.
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Affiliation(s)
- Leonardo Svellenti
- Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland
| | - Jelena Karacic
- Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland
| | - Johannes Herzog
- Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland
| | - Moritz Tanner
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Philipp Sahrmann
- Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland
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Ferreira JA, Kantorski KZ, Dubey N, Daghrery A, Fenno JC, Mishina Y, Chan HL, Mendonça G, Bottino MC. Personalized and Defect-Specific Antibiotic-Laden Scaffolds for Periodontal Infection Ablation. ACS APPLIED MATERIALS & INTERFACES 2021; 13:49642-49657. [PMID: 34637255 DOI: 10.1021/acsami.1c11787] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Periodontitis compromises the integrity and function of tooth-supporting structures. Although therapeutic approaches have been offered, predictable regeneration of periodontal tissues remains intangible, particularly in anatomically complex defects. In this work, personalized and defect-specific antibiotic-laden polymeric scaffolds containing metronidazole (MET), tetracycline (TCH), or their combination (MET/TCH) were created via electrospinning. An initial screening of the synthesized fibers comprising chemo-morphological analyses, cytocompatibility assessment, and antimicrobial validation against periodontopathogens was accomplished to determine the cell-friendly and anti-infective nature of the scaffolds. According to the cytocompatibility and antimicrobial data, the 1:3 MET/TCH formulation was used to obtain three-dimensional defect-specific scaffolds to treat periodontally compromised three-wall osseous defects in rats. Inflammatory cell response and new bone formation were assessed by histology. Micro-computerized tomography was performed to assess bone loss in the furcation area at 2 and 6 weeks post implantation. Chemo-morphological and cell compatibility analyses confirmed the synthesis of cytocompatible antibiotic-laden fibers with antimicrobial action. Importantly, the 1:3 MET/TCH defect-specific scaffolds led to increased new bone formation, lower bone loss, and reduced inflammatory response when compared to antibiotic-free scaffolds. Altogether, our results suggest that the fabrication of defect-specific antibiotic-laden scaffolds holds great potential toward the development of personalized (i.e., patient-specific medication) scaffolds to ablate infection while affording regenerative properties.
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Affiliation(s)
- Jessica A Ferreira
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
| | - Karla Z Kantorski
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
- Post-Graduate Program in Oral Sciences (Periodontology Unit), School of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, 97105-900, Brazil
| | - Nileshkumar Dubey
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
| | - Arwa Daghrery
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
| | - J Christopher Fenno
- Department of Biologic and Materials Sciences & Prosthodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
| | - Yuji Mishina
- Department of Biologic and Materials Sciences & Prosthodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
| | - Gustavo Mendonça
- Department of Biologic and Materials Sciences & Prosthodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
| | - Marco C Bottino
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
- Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan 48109-1078, United States
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Abstract
Four billion individuals worldwide have a history of periodontitis, with the poorest people in society most affected. Periodontitis can lead to unsightly drifting of teeth and tooth loss that may interfere with the wellbeing of daily living and has also been linked to at least 57 medical diseases and disabilities. The etiology of severe periodontitis includes active herpesviruses, specific bacterial pathogens, and destructive immune responses, but herpesviruses seem to be the major pathogenic determinant. Periodontal herpesviruses that disseminate via the systemic circulation to nonoral sites may represent a major link between periodontitis and systemic diseases. Current treatment of periodontitis focuses almost exclusively on bacterial biofilm and will require revision. Periodontal therapy that targets both herpesviruses and bacterial pathogens can provide long-term clinical improvement and potentially reduces the risk of systemic diseases. Molecular diagnostic tests for periodontal pathogens may enable early microbial identification and preemptive therapy. This review details an efficient and reliable anti-infective treatment of severe periodontitis that can be carried out in minimal time with minimal cost.
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Affiliation(s)
- Jørgen Slots
- School of Dentistry, University of Southern California, Los Angeles, California
| | - Henrik Slots
- University of Nevada at Reno School of Medicine, Reno, Nevada.,St. George's School of Medicine, St. George, Grenada.,Renown Medical Center, Reno, Nevada
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Ismail HA, Asfour H, Shikho SA. A self-disinfecting irreversible hydrocolloid impression material mixed with povidone iodine powder. Eur J Dent 2017; 10:507-511. [PMID: 28042266 PMCID: PMC5166307 DOI: 10.4103/1305-7456.195172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives: The aim was to evaluate the effect of adding povidone (PVP) iodine powder with different concentrations to irreversible hydrocolloid on both microbiological and dimensional stability. Materials and Methods: Regular set of (alginate) irreversible hydrocolloid was selected as control group. PVP-iodine powder was mixed with the alginate powder at concentrations of 1, 5, 10, 15, and 20% by weight (test groups). All specimens were tested for their antimicrobial effect against Streptococcus mutans and Staphylococcus aureus as well as dimensional stability. Results: The results of test groups showed that concentrations 1, 5, and 10, weight % had little effect against S. mutans and S. aureus microorganisms. While concentrations 15 and 20 weight % had demonstrated greater effect on microbial growth. The mean of dimensional stability in mm of modified alginate with PVP-iodine at 15 and 20 weight % was –0.119 ± 0.255 and –0.035 ± 0.074, respectively. While the mean dimensional stability in mm of unmodified alginate was –0.112 ± 0.176. The results of dimensional stability showed that 15 and 20 concentrations of test groups adversely affect the dimensional stability. The adverse effect was noticed to be significant in concentration 20%, where as it was nonsignificant in 15% concentration. Conclusion: Modified alginate impression material with 15 weight % PVP-iodine powered give the material, a self-disinfected properties with less deteriorating effect on dimensional stability.
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Affiliation(s)
| | - Hani Asfour
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdul Aziz University, Jeddah, KSA
| | - Souaad Abdulelah Shikho
- Removable Prosthodontics Department, Al-Farabi Colleges of Dentistery and Nursing, Jeddah, KSA
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Belibasakis GN, Schmidlin PR, Sahrmann P. Molecular microbiological evaluation of subgingival biofilm sampling by paper point and curette. APMIS 2013; 122:347-52. [DOI: 10.1111/apm.12151] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 06/10/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Georgios N. Belibasakis
- Oral Microbiology and Immunology; Faculty of Medicine; Institute of Oral Biology; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Patrick R. Schmidlin
- Periodontology; Clinic for Preventive Dentistry; Periodontology and Cariology; Center of Dental Medicine; Faculty of Medicine; University of Zurich; Zurich Switzerland
| | - Philipp Sahrmann
- Periodontology; Clinic for Preventive Dentistry; Periodontology and Cariology; Center of Dental Medicine; Faculty of Medicine; University of Zurich; Zurich Switzerland
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Kaur K, Sikri P. Evaluation of the effect of allograft with doxycycline versus the allograft alone in the treatment of infrabony defects: A controlled clinical and radiographical study. Dent Res J (Isfahan) 2013; 10:238-46. [PMID: 23946743 PMCID: PMC3731967 DOI: 10.4103/1735-3327.113359] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Successful prevention and treatment of periodontal disease are contingent on effective control of periodontopathic microbiota based on the premise of periodontal disease being infectious disorders. An anti-microbial agent, i.e., doxycycline has been incorporated into the allograft to control infection and facilitate healing during and after periodontal therapy. MATERIALS AND METHODS Using a split-mouth design, 15 patients showing clinical evidence of almost identical bilateral infrabony defects requiring bone grafting procedures were randomly selected. In each patient, infrabony defects on one side were designated as Group A (control group) and infrabony defects of the contralateral side of the same arch were designated as Group B (test group). Clinical assessment of probing pocket depth and attachment level and radiographic evaluation of the defect depth was done pre-operatively and at 12-week and 24-week post-operatively. The relative efficacy of the two treatment modalities was evaluated using paired Student's t-test and the comparative evaluation between the two groups over the 3 time intervals was done using independent Student's t-test. RESULTS Both the groups exhibited a highly significant reduction in probing depth and gain in clinical attachment level (CAL) and a linear bone fill at the end of 12 and 24 weeks. Comparative evaluation showed a statistically significant gain in bone fill in Group B as compared to Group A, whereas a non-significant reduction in probing depth and gain in CALs between the two groups at the end of 24 weeks (whereas mean reduction in probing depth and gain in CAL were also greater in Group B but the difference was statistically non-significant). CONCLUSION The increase in linear bone fill in Group B signifies the role of doxycycline in augmenting regenerative potential of allograft by combating residual infection and through host modulation.
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Affiliation(s)
- Kulmeet Kaur
- Department of Periodontology and Oral Implantology, B.J.S. Dental College, Ludhiana, India
| | - Poonam Sikri
- Department of Periodontology and Oral Implantology, Desh Bhagat Dental College and Research Institute, Mukatsar, Punjab, India
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Aguiar JCA, Gomes EPP, Fonseca-Silva T, Velloso NA, Vieira LT, Fernandes MF, Santos SHS, Neto JFR, De-Paula AMB, Guimarães ALS. Fluoxetine reduces periodontal disease progression in a conditioned fear stress model in rats. J Periodontal Res 2013; 48:632-7. [DOI: 10.1111/jre.12049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2012] [Indexed: 11/29/2022]
Affiliation(s)
- J. C. A. Aguiar
- Department of Dentistry; Universidade Estadual de Montes Claros; Montes Claros Brazil
- School of Psychology; Faculdades Integradas Pitágoras; Montes Claros Brazil
| | - E. P. P. Gomes
- Department of Dentistry; Universidade Estadual de Montes Claros; Montes Claros Brazil
| | - T. Fonseca-Silva
- Department of Dentistry; Universidade Estadual de Montes Claros; Montes Claros Brazil
| | - N. A. Velloso
- School of Pharmacy; Faculdades Santo Agostinho; Montes Claros Brazil
| | - L. T. Vieira
- Department of Dentistry; Universidade Estadual de Montes Claros; Montes Claros Brazil
| | - M. F. Fernandes
- Department of Mathematics; Universidade Estadual de Montes Claros; Montes Claros Brazil
| | - S. H. S. Santos
- Department of Medicine; Universidade Estadual de Montes Claros; Montes Claros Brazil
- Department of Pharmacology; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | - J. F. R. Neto
- Department of Medicine; Universidade Estadual de Montes Claros; Montes Claros Brazil
| | - A. M. B. De-Paula
- Department of Dentistry; Universidade Estadual de Montes Claros; Montes Claros Brazil
| | - A. L. S. Guimarães
- Department of Dentistry; Universidade Estadual de Montes Claros; Montes Claros Brazil
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Sahrmann P, Sener B, Ronay V, Attin T, Schmidlin PR. Clearance of topically-applied PVP-iodine as a solution or gel in periodontal pockets in men. Acta Odontol Scand 2012; 70:497-503. [PMID: 22181668 DOI: 10.3109/00016357.2011.640276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the clearance of PVP-iodine applied as a gel or solution in periodontal pockets. METHODS Teeth of 12 subjects with at least eight periodontal pockets of ≥5 mm probing depth were isolated with a rubber dam to allow contamination-free access to the pockets. In each subject, three pockets were filled with PVP-iodine gel (10%) and three with PVP-iodine solution (10%). One pocket of each subject without iodine application served as a negative control. The treatment allocation was assigned randomly. Any excess material was removed subsequently. After 1, 5 and 15 min, a paper point was used to collect the sulcus liquid and the concentration of PVP-iodine was chemically determined. In addition, PVP-iodine gel was administered into 12 periodontal pockets immediately after sub-gingival ultrasound debridement and the concentration of PVP-iodine was determined after 1 min. RESULTS Descending concentrations of PVP-iodine were determined at 1, 5 and 15 min after the application. No PVP-iodine was found in the pockets serving as negative controls. The mean concentrations of the gel and solution were 6.14 μg/ml and 4.44 μg/ml (1 min; p ≥ 0.028), 3.20 μg/ml and 1.44 μg/ml (5 min; p ≥ 0.126), 0.69 μg/ml and 0.23 μg/ml (15 min; p ≤ 0.019), respectively. In the pockets with previous debridement the mean concentration was 1.68 ± 1.97 μg/ml. CONCLUSION The application of PVP-iodine gel in periodontal pockets allows a prolonged remnant effect as compared to that of the solution formula.
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Affiliation(s)
- Philipp Sahrmann
- Clinic for Preventive Dentistry, Periodontology and Cariology, Center for Dental and Oral Medicine and Maxillofacial Surgery, University of Zurich, Switzerland.
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Koide M, Kinugawa S, Takahashi N, Udagawa N. Osteoclastic bone resorption induced by innate immune responses. Periodontol 2000 2010; 54:235-46. [PMID: 20712643 DOI: 10.1111/j.1600-0757.2010.00355.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Al-Saeed MY, Babay N. The use of povidone-iodine and hydrogen peroxide mixture as an adjunct to non-surgical treatment of slight to moderate chronic periodontitis. Saudi Dent J 2009; 21:127-33. [PMID: 23960471 PMCID: PMC3723277 DOI: 10.1016/j.sdentj.2009.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Revised: 11/17/2008] [Accepted: 03/22/2009] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical effects of the adjunctive use of povidone-iodine with or without hydrogen peroxide as coolant and disinfectant during ultrasonic scaling and root planing in the treatment of chronic periodontitis. MATERIALS AND METHODS Sixteen patients initially participated in the study. Thirteen patients (8 males and 5 females) completed the 3-month follow-up period. Their mean (±SD) age was 42.92 ± 7.55 years. In each experimental subject, the mouth was split into four quadrants. A randomly selected quadrant was chosen to receive one of the three treatment group modalities which were: Group 1 - ultrasonic scaling and root planing plus irrigation with 1% povidone-iodine and 3.0% hydrogen peroxide mixture; Group 2 - ultrasonic scaling and root planing plus irrigation with 1% povidone-iodine; Group 3 - ultrasonic scaling and root planing plus irrigation with normal saline. The fourth quadrant served as a control group. RESULTS At the 3-month evaluation, there was no significant difference between the three treatment groups in terms of probing depth reduction, clinical attachment gain, gingival recession increase, reduction in the bleeding upon probing or plaque score reduction (P > 0.05). However, the three treatment groups had statistically significant higher mean reduction in the probing depth, gain in the clinical attachment level and reduction in the bleeding upon probing than the control group (P < 0.05). CONCLUSION There were no added benefits of using a mixture of povidone-iodine and hydrogen peroxide or povidone-iodine as disinfectants during ultrasonic scaling and root planing in the treatment of chronic periodontitis.
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Affiliation(s)
- Mohammed Y. Al-Saeed
- Dental Department, Qatif Central Hospital, P.O. Box 20052, Qatif 31911, Saudi Arabia
| | - Nadir Babay
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Polat HB, Özdemir H, Ay S. Effect of different mouth rinses on third molar surgery–related oral malodor. ACTA ACUST UNITED AC 2008; 105:e1-8. [DOI: 10.1016/j.tripleo.2007.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Revised: 08/22/2007] [Accepted: 09/24/2007] [Indexed: 10/22/2022]
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13
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Bercy P, Lasserre J. Susceptibility to various oral antiseptics of Porphyromonas gingivalis W83 within a biofilm. Adv Ther 2007; 24:1181-91. [PMID: 18165200 DOI: 10.1007/bf02877764] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The origin of chronic periodontal disease is strongly related to the nature and physiology of the subgingival bacterial biofilm, of which Porphyromonas gingivalis is a main protagonist. This study was conducted in vitro, to test the susceptibility of the W83 strain of P gingivalis to several oral antiseptics, bearing in mind its mode of growth as biofilm. To this end, the investigators inoculated a brain-heart infusion broth with Streptococcus gordonii, to which P gingivalis was added before perfusion for 7 d via a closed circuit containing a modified Robbins device. Then, various antiseptics were perfused through the circuit over 30 min, and their bactericidal effects were evaluated after culture by comparison of the mean proportion of bacteria killed. The average proportion of P gingivalis W83 killed after 15 min of contact with antiseptics was 90.51% (+/-4.78) for chlorhexidine 0.2%, 89.87% (+/-6.58) for povidone-iodine 1%, and 98.6% (+/-0.86) for Listerine (McNeil-PPC, Inc., Morris Plains, NJ). After 30 min of contact, survival of P gingivalis was nil, irrespective of the antimicrobial agent used. Preliminary results show that antiseptic mouth rinses, when used in pure concentrations in the traditional way, are effective in killing P gingivalis W83 within a biofilm. Furthermore, in light of these experiments, it appears that the best results are obtained when Listerine is used; however, new trials should be conducted to confirm this observation.
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Affiliation(s)
- Pierre Bercy
- Department of Periodontology, Catholic University of Louvain, School of Dental Medicine and Stomatology, Brussels, Belgium.
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Lakhssassi N, Elhajoui N, Lodter JP, Pineill JL, Sixou M. Antimicrobial susceptibility variation of 50 anaerobic periopathogens in aggressive periodontitis: an interindividual variability study. ACTA ACUST UNITED AC 2005; 20:244-52. [PMID: 15943770 DOI: 10.1111/j.1399-302x.2005.00225.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/AIMS The frequent use of antibiotics in developed countries has led to the emergence of widespread bacterial resistance. In this study, the interindividual variability of the antibiotic susceptibility of 50 putative microorganisms in aggressive periodontitis patients has been evaluated by means of VC (variation coefficient). MATERIAL AND METHODS A total of 60 microbial samples were collected from 20 adult patients diagnosed with aggressive periodontitis (2-4 samples by patient). Bacterial strains of Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, Fusobacterium nucleatum, and Peptostreptococcus micros were isolated according to Slots' rapid identification method. The susceptibilities to 10 antibiotics were studied: penicillin G (PEN), ampicillin (AMP), amoxicillin (AMX), amoxicillin/clavulanate (AMC), tetracycline (TET), doxycycline (DOX), ciprofloxacin (CIP), erythromycin (ERY), spiramycin (SPI) and clindamycin (CLIN), using the Disk Diffusion Susceptibility test (DDS test: Kirby-Bauer's modified method for anaerobic bacteria). The broth microdilution Minimum Inhibitory Concentration test was carried out as a control test. RESULTS Among the 50 identified bacteria, 15 were P. gingivalis, 12 P. intermedia, 8 T. forsythia, 9 F. nucleatum, and 6 P. micros. The results of the DDS test show that penicillins (especially AMC, AMP, and AMX), cyclines (especially DOX) and CLIN are highly effective against the 50 anaerobic studied bacteria. CIP and ERY have the lowest efficacy against those bacteria. CIP shows a very variable activity according to anaerobic bacteria species, being particularly inactive against P. gingivalis and very efficient against T. forsythia and P. micros. SPI is also highly efficient but not against P. micros. CONCLUSIONS The interindividual susceptibility of principal periodontal pathogens to antibiotics is not homogeneous and seems to vary according to bacterial species and antimicrobial molecules. This variability seems to be greater with older molecules (PEN, TET, ERY) than with more recent ones, which indicates more stable results (AMC, AMX, AMP, and DOX). P. intermedia appeared to be the bacteria most resistant to penicillins and showed the highest coefficient variation. Together with scaling and root planing, the combination of two antibiotics would therefore seem to be recommended in the treatment of aggressive periodontitis, particularly in the presence of P. intermedia.
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Affiliation(s)
- N Lakhssassi
- Laboratory of Epidemiology and Infectious Diseases, Clinical Research Study Group, Faculty of Dentistry, Paul-Sabatier University, Toulouse, France
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Umeda M, Takeuchi Y, Noguchi K, Huang Y, Koshy G, Ishikawa I. Effects of nonsurgical periodontal therapy on the microbiota. Periodontol 2000 2004; 36:98-120. [PMID: 15330945 DOI: 10.1111/j.1600-0757.2004.03675.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Makoto Umeda
- Department of Hard Tissue Engineering, Tokyo Medical and Dental University Graduate School, JapanDepartment of Hard Tissue Engineering, Tokyo Medical and Dental University Graduate School, Japan
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16
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Abstract
With a greater understanding of the components that initiate the host into the downward spiral of periodontal disease, the clinician must look for better treatment and therapy options. Clinical observations and studies show good results, making incorporation of the laser into the first phase of nonsurgical periodontal therapy an excellent choice.
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17
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Hoang T, Jorgensen MG, Keim RG, Pattison AM, Slots J. Povidone-iodine as a periodontal pocket disinfectant. J Periodontal Res 2003; 38:311-7. [PMID: 12753370 DOI: 10.1034/j.1600-0765.2003.02016.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES AND BACKGROUND Povidone-iodine [polyvinylpyrrolidone-iodine complex (PVP-iodine)] might constitute a valuable adjunct to current periodontal therapy because of its broad-spectrum antimicrobial activity, low potential for developing resistance and adverse reactions, wide availability, ease of use, and low financial cost. This investigation employed a randomized, split-mouth study design to determine the microbiological and clinical effects of 10% PVP-iodine subgingival irrigation in periodontitis lesions showing radiographic evidence of subgingival calculus. METHODS Sixteen adults having at least one periodontal pocket of 6 mm or more in each quadrant of the dentition and harboring one or more periodontopathic bacteria participated in the study. In each subject, a study site in each quadrant was randomly chosen to receive either subgingival irrigation with 10% PVP-iodine together with scaling and root planing, scaling and root planing alone, subgingival irrigation with 10% PVP-iodine, or subgingival irrigation with sterile saline. Prior to therapy and at 5 weeks post-treatment, microbiological culture was carried out without knowledge of the clinical status or the type of treatment rendered. A blinded clinical examiner determined presence of dental plaque, probing pocket depth, and gingival bleeding on probing. Microbiological and clinical data were analyzed using a repeated measures analysis of variance and Kruskal-Wallis rank test with the Tukey and Mann-Whitney post hoc tests. RESULTS At 5 weeks post-treatment, subgingival irrigation with PVP-iodine together with scaling and root planing caused a 95% or greater reduction in total pathogen counts in 44% of pockets having >/= 6 mm depth whereas scaling and root planing alone, povidone-iodine irrigation alone and water irrigation alone caused 95% reduction of total pathogens only in 6-13% of similar study sites (P = 0.02). Reduction in mean pocket depth was 1.8 mm for the PVP-iodine/scaling and root planing group, 1.6 mm for the scaling and root planing group, and 0.9 mm for the PVP-iodine and the saline monotherapy groups, with statistical significance reached for the scaling and root planing group vs. the PVP-iodine group (P = 0.04) and for the scaling and root planing group vs. the saline group (P = 0.02). Reduction in visible dental plaque, which ranged from 38% to 62%, showed no significant differences among treatment groups. CONCLUSIONS The addition of subgingival PVP-iodine irrigation to conventional mechanical therapy may be a cost-effective means of reducing total counts of periodontal pathogens and helping control periodontal disease. However, subgingival irrigation with PVP-iodine without concomitant mechanical debridement might not improve microbiological and clinical variables in comparison with saline irrigation, at least not in sites with radiographic evidence of subgingival calculus.
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Affiliation(s)
- T Hoang
- University of Southern California, School of Dentistry, Los Angeles, CA 90089-0641, USA
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18
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Zijnge V, Harmsen HJM, Kleinfelder JW, van der Rest ME, Degener JE, Welling GW. Denaturing gradient gel electrophoresis analysis to study bacterial community structure in pockets of periodontitis patients. ORAL MICROBIOLOGY AND IMMUNOLOGY 2003; 18:59-65. [PMID: 12588461 DOI: 10.1034/j.1399-302x.2003.180110.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Bacteria are involved in the onset and progression of periodontitis. A promising molecular technique, denaturing gradient gel electrophoresis (DGGE), to study microbial population dynamics in the subgingival pocket is presented. Twenty-three samples were taken from the subgingival pockets of nine patients and six healthy family members. From four periodontitis patients, 12 samples were evaluated before, 1 day after and 3 months after treatment. Part of the 16S rRNA gene of all bacteria was amplified by PCR and separated by DGGE, creating banding patterns representative of the community structure. Shifts in composition and diversity of the microbial population could be determined semiquantitatively, and this showed that treatment resulted in a decrease in the diversity of the population. After 3 months a microbial population 33-47% different from the population before treatment had re-established. Intense bands representing Exiguobacterium aurantiacum were present in 13 out of 25 samples, indicating that this species may play a role in periodontal disease.
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Affiliation(s)
- V Zijnge
- Department of Medical Microbiology, University of Groningen, Groningen, the Netherlands
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Ikeda T, Yoshimura F. A resistance-nodulation-cell division family xenobiotic efflux pump in an obligate anaerobe, Porphyromonas gingivalis. Antimicrob Agents Chemother 2002; 46:3257-60. [PMID: 12234854 PMCID: PMC128772 DOI: 10.1128/aac.46.10.3257-3260.2002] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Porphyromonas gingivalis, a gram-negative obligate anaerobe, contains two homologs of an Escherichia coli resistance-nodulation-cell division-type multidrug exporter gene, acrB, in putative operons, together with homologs of membrane fusion protein gene acrA and outer membrane channel gene tolC. MIC determination and accumulation assays with mutants with disruptions of one or more genes showed that one cluster, named xepCAB, pumped out multiple agents including rifampin, puromycin, and ethidium bromide.
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Affiliation(s)
- Takeshi Ikeda
- Department of Microbiology, School of Dentistry, Aichi-Gakuin University, Nagoya 464-8650, Japan.
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20
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Abstract
BACKGROUND The recognition over the past 3 decades of microbial specificity in periodontitis has afforded dental practitioners the ability to prevent and treat the disease with a variety of antimicrobial drugs. These include systemic antibiotics, topical antibiotics and topical antiseptics. RESULTS Systemic antibiotic therapy can be essential in eliminating pathogenic bacteria that invade gingival tissue and in helping control periodontal pathogens residing in various domains of the mouth from where they may translocate to periodontal sites. Frequently used periodontal combination antibiotic therapies are metronidazole-amoxicillin (250-375 mg of each 3 x daily for 8 days) and metronidazole-ciprofloxacin (500 mg of each 2 x daily for 8 days). Microbiological analysis helps determine the optimal antibiotic therapy and effectiveness of treatment. Topical antibiotics that are commercially available as controlled release devices suffer from several potential problems, including insufficient spectrum of antimicrobial activity in some periodontal polymicrobial infections, risks of producing an antibiotic resistant microbiota, and high acquisition costs. Topical antiseptics of relevance in periodontal treatment include 10% povidone-iodine placed subgingivally by a syringe for 5 min, and 0.1% sodium hypochlorite solution applied subgingivally by patients using an irrigation device. CLINICAL IMPLICATIONS The present paper recommends periodontal treatment that includes a battery of professionally and patient-administered antimicrobial agents (properly prescribed systemic antibiotics, povidone-iodine and sodium hypochlorite subgingival irrigants, and chlorhexidine mouthrinse). Available chemotherapeutics can provide effective, safe, practical and affordable means of controlling subgingival colonization of periodontal pathogens and various types of periodontal disease.
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Affiliation(s)
- Jørgen Slots
- University of Southern California School of Dentistry, Department of Periodontology, Los Angeles, CA 90089-0641, USA.
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21
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Iwami Y, Kawarada K, Kojima I, Miyasawa H, Kakuta H, Mayanagi H, Takahashi N. Intracellular and extracellular pHs of Streptococcus mutans after addition of acids: loading and efflux of a fluorescent pH indicator in streptococcal cells. ORAL MICROBIOLOGY AND IMMUNOLOGY 2002; 17:239-44. [PMID: 12121474 DOI: 10.1034/j.1399-302x.2002.170406.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A pH-sensitive fluorescent dye, 2', 7'-bis-(2-carboxyethyl)-5 and 6-carboxyfluorescein (BCECF), was used to determine intracellular pH (pH(in)). The efflux of BCECF loaded into oral streptococcal cells was determined after incubation of the cells at 35 degrees C for 20 min in the presence and absence of glucose. In the absence of glucose, the fluorescence of intracellular BCECF in Streptococcus mutans, Streptococcus sanguis, Streptococcus salivarius and Streptococcus sobrinus decreased only very slightly, indicating that the dye could be useful for pH(in) determination. In the presence of glucose, however, the fluorescence decreased by 57%. Thus, the pH(in) of S. mutans cells was measured by the BCECF method in the absence of glucose at various acidic pH levels by adding lactic, acetic and hydrochloric acids to the cell suspensions. The pH(in) was almost equal to the extracellular pH (pH(out)) for pH(out) values of between 8 and 5, indicating that protons permeated easily across the S. mutans cell membrane. For pH(out) between 5 and 4, pH(in) was constant at around 5, suggesting that the cell membrane was impermeable to protons, or that a cytoplasmic buffering system functioned. pH(in) decreased at pH(out) values of < 4. The constant pH(in) at acidic pH(out) levels could protect intracellular components, such as proteins, against acidification by sugar fermentation.
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Affiliation(s)
- Y Iwami
- Division of Oral Biochemistry, Tohoku University, Graduate School of Dentistry, Aobaku, Sendai, Japan
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Affiliation(s)
- Jørgen Slots
- Department of Periodontology, School of Dentistry, University of Southern California, Los Angeles, USA
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Quirynen M, Teughels W, De Soete M, van Steenberghe D. Topical antiseptics and antibiotics in the initial therapy of chronic adult periodontitis: microbiological aspects. Periodontol 2000 2002; 28:72-90. [PMID: 12013349 DOI: 10.1034/j.1600-0757.2002.280104.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Marc Quirynen
- Department of Periodontology, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Catholic University Leuven, Belgium
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24
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Affiliation(s)
- Jørgen Slots
- Department of Periodontology, School of Dentistry, University of Southern California, Los Angeles, USA
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25
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Slots J, Jorgensen MG. Effective, safe, practical and affordable periodontal antimicrobial therapy: where are we going, and are we there yet? Periodontol 2000 2002; 28:298-312. [PMID: 12013347 DOI: 10.1034/j.1600-0757.2002.2801123.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Several important trends are noticeable in the management of periodontal disease. Searching for specific risk factors for periodontal disease permits therapy planning with the intention of doing less for low-risk patients and increasing the preventive and therapeutic modalities for high-risk patients. Also, significant progress in the area of chemotherapeutic development enables dentists to increase the number of periodontitis patients receiving nondisruptive antimicrobial therapy and decreases the need for surgical treatment. Use of anti-infective chemotherapeutic and antibiotic agents has become a specialized and increasingly effective means of preventing and treating destructive periodontal disease. Local care, including subgingival application of some type of antiseptics, is widely accepted. The use of systemic antibiotics is not routine and should be reserved for aggressive and refractory periodontal infections. In general, it is better to be thoroughly familiar with a limited number of drugs and treatment methods and use them properly than to try to master a plethora of antimicrobial therapies. Combating periodontal infections is best accomplished by combined mechanical and chemotherapeutic efforts of the dental professional and the patient. The trend during recent years has been to treat periodontal infections aggressively, employing short-course antimicrobial therapy using a battery of safe and affordable antimicrobial agents, each exhibiting high activity against various periodontal pathogens and administered in ways to concurrently affect pathogens residing in different oral ecological niches, followed by regular maintenance visits having a strong anti-infective emphasis. At the beginning of therapy, patients should be assigned self-help tasks having maximal antimicrobial effectiveness, with a focus on control of the subgingival periodontopathic microbiota. When patients see positive clinical results from their daily oral hygiene efforts, they are motivated to remain active participants in managing their periodontal condition. This article emphasizes anti-infective periodontal therapies that are effective and, when properly administered, are essentially nontoxic; are widely available around the world to dentists as well as to patients; and are acceptable to most patients in terms of methods of application, supporting oral hygiene efforts and financial costs. We believe that, with improved knowledge of the periodontopathic microbiota, with the availability of microbiological tests to identify periodontal pathogens and optimal therapy, with various safe and affordable yet effective antimicrobial agents and therapies and, eventually, with the development of one or more effective vaccines, the future looks very bright for patients at risk for or suffering from destructive periodontal disease.
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Affiliation(s)
- Jørgen Slots
- Department of Periodontology, School of Dentistry, University of Southern California, Los Angeles, USA
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Abstract
BACKGROUND The goal of follow-up care after periodontal therapy is to preserve the function of individual teeth and the dentition, ameliorate symptoms and simplify future surgery or make it unnecessary. Effective follow-up periodontal care depends on early diagnosis and treatment, as well as patient education. RESULTS The main determinants of successful periodontal maintenance therapy are dental professionals' ability to combat periodontal infections and patients' compliance with prescribed follow-up care. Mechanical and chemical antimicrobial intervention is the mainstay of preventive periodontal therapy. Chemotherapeutics alone are unlikely to be effective in the presence of subgingival calculus, underscoring the importance of subgingival mechanical débridement. Also, because toothbrushing and rinsing alone do not reach pathogens residing in periodontal pockets of increased depths, oral hygiene procedures should include subgingival treatment with home irrigators or other appropriate self-care remedies. CLINICAL IMPLICATIONS When considering possible preventive therapies, dental professionals must weigh the risk of patients' acquiring destructive periodontal disease against potentially adverse effects, financial costs and inconvenience of the preventive treatment. The authors discuss theoretical and practical aspects of follow-up care for patients with periodontal disease. In addition, because it can be both difficult and expensive to control periodontal disease via conventional preventive measures alone, they present a new, simple and more cost-effective antimicrobial protocol for supportive periodontal therapy.
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Affiliation(s)
- J Slots
- Oral Microbiology Testing Laboratory, University of Southern California, School of Dentistry, Los Angeles 90089-0641, USA
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