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Belibasakis GN, Belstrøm D, Eick S, Gursoy UK, Johansson A, Könönen E. Periodontal microbiology and microbial etiology of periodontal diseases: Historical concepts and contemporary perspectives. Periodontol 2000 2023. [PMID: 36661184 DOI: 10.1111/prd.12473] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/21/2022] [Accepted: 09/06/2022] [Indexed: 01/21/2023]
Abstract
This narrative review summarizes the collective knowledge on periodontal microbiology, through a historical timeline that highlights the European contribution in the global field. The etiological concepts on periodontal disease culminate to the ecological plaque hypothesis and its dysbiosis-centered interpretation. Reference is made to anerobic microbiology and to the discovery of select periodontal pathogens and their virulence factors, as well as to biofilms. The evolution of contemporary molecular methods and high-throughput platforms is highlighted in appreciating the breadth and depth of the periodontal microbiome. Finally clinical microbiology is brought into perspective with the contribution of different microbial species in periodontal diagnosis, the combination of microbial and host biomarkers for this purpose, and the use of antimicrobials in the treatment of the disease.
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Affiliation(s)
- Georgios N Belibasakis
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Belstrøm
- Section for Clinical Oral Microbiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sigrun Eick
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Ulvi K Gursoy
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | | | - Eija Könönen
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
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Recent Updates on Microbial Biofilms in Periodontitis: An Analysis of In Vitro Biofilm Models. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1373:159-174. [DOI: 10.1007/978-3-030-96881-6_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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3
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Tent PA, Juncar RI, Onisor F, Bran S, Harangus A, Juncar M. The pathogenic microbial flora and its antibiotic susceptibility pattern in odontogenic infections. Drug Metab Rev 2019; 51:340-355. [PMID: 30999773 DOI: 10.1080/03602532.2019.1602630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Suppurative head and neck infections of odontogenic origin are the most frequent type of head and neck infections. According to the literature, 7-10% of all antibiotics are currently prescribed for their treatment. Since penicillin was invented, the overall antibiotic sensitivity and resistance pattern of the isolated pathogenic microflora has continuously changed. The response of microorganisms to antibiotics and the development of resistance to their action is a purely evolutive process characterized by genetic mutations, acquisition of genetic material or alteration of gene expression and metabolic adaptations. All this makes challenging and difficult the correct choice of empirical antibiotic treatment for head and neck space infections even today. The aim of this paper was to evaluate the literature and to evidence the most frequent locations of odontogenic head and neck infections, the dominant pathogenic microbial flora, the genetic mutations and metabolic changes necessary for bacteria in order to aquire antibiotic resistance and as well its susceptibility and resistance to common antibiotics. We also aimed to highlight the possible changes in bacterial resistance to antibiotics over time, and to assess whether or not there is a need for fundamental changes in the empirical antibiotic treatment of these infections and show which these would be.
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Affiliation(s)
- Paul Andrei Tent
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
| | - Raluca Iulia Juncar
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
| | - Florin Onisor
- Department of Oral and Maxilo-Facial surgery and Radiology, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Simion Bran
- Department of Oral and Maxilo-Facial surgery and Radiology, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Antonia Harangus
- Spitalul Clinic de Pneumoftiziologie Leon Daniello Cluj-Napoca , Cluj-Napoca , Romania
| | - Mihai Juncar
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
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Kaufmann M, Lenherr P, Walter C, Thurnheer T, Attin T, Wiedemeier DB, Schmidlin PR. Comparing the Antimicrobial In Vitro Efficacy of Amoxicillin/Metronidazole against Azithromycin-A Systematic Review. Dent J (Basel) 2018; 6:E59. [PMID: 30347835 PMCID: PMC6313342 DOI: 10.3390/dj6040059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 11/16/2022] Open
Abstract
On account of its proven clinical efficacy, the combination of systemically administered amoxicillin and metronidazole is frequently adjuncted to non-operative periodontal therapy and well documented. Potential drawbacks of this regimen, e.g., side effects and problems with the compliance, led to an ongoing search for alternatives. Azithromycin, an antibiotic extensively used in general medicine, has recently found its niche in periodontal therapy as well. This systematic review aimed to analyze the in vitro antimicrobial efficacy of amoxicillin plus metronidazole versus azithromycin. For this purpose, a systematic literature search was performed, and studies published up to 29 March 2018 referenced in Medline, Embase, Cochrane, and Biosis were independently screened by two authors. An additional hand search was performed and studies focusing on the evaluation of in vitro antimicrobial efficacy of amoxicillin + metronidazole or azithromycin on bacteria from the subgingival biofilm were included. English and German language research reports were considered. From 71 identified articles, only three articles were eligible for inclusion. These studies showed heterogeneity in terms of analytical methods and strains explored. However, all studies used multispecies biofilm models for analysis of the antimicrobial activity. Unanimously, studies reported on more pronounced antimicrobial effects when applying the combination of amoxicillin + metronidazole, compared to azithromycin. Based on the few studies available, the combination of amoxicillin + metronidazole seemed to display higher antimicrobial efficacy in vitro than azithromycin.
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Affiliation(s)
- Manuela Kaufmann
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, CH-8032 Zurich, Switzerland.
| | - Patrik Lenherr
- Private Practice, Zahnmedizin Wiesental, CH-9100 Herisau, Switzerland.
| | - Clemens Walter
- Department of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, CH-4056 Basel, Switzerland.
| | - Thomas Thurnheer
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, CH-8032 Zurich, Switzerland.
| | - Thomas Attin
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, CH-8032 Zurich, Switzerland.
| | - Daniel B Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, CH-8032 Zurich, Switzerland.
| | - Patrick R Schmidlin
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, CH-8032 Zurich, Switzerland.
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Loyola-Rodriguez JP, Ponce-Diaz ME, Loyola-Leyva A, Garcia-Cortes JO, Medina-Solis CE, Contreras-Ramire AA, Serena-Gomez E. Determination and identification of antibiotic-resistant oral streptococci isolated from active dental infections in adults. Acta Odontol Scand 2018; 76:229-235. [PMID: 29160117 DOI: 10.1080/00016357.2017.1405463] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine and identify antibiotic-resistant bacteria (ARB) of oral streptococci from active dental infections in adults and its association with age and gender. MATERIAL AND METHODS This cross-sectional study included 59 subjects from 18 to 62 years old. Ninety-eighth samples obtained from the subjects were cultivated in agar plates containing antibiotics amoxicillin/clavulanic acid (A-CA), clindamycin, and moxifloxacin (concentrations of 16, 32 or 64 µg/ml). PCR assay was performed to identify bacterial species. RESULTS The bacterial species that showed more antibiotic-resistance (AR) was S. mutans (45.9%), followed by S. gordonii (21.6%), S. oralis (17.6%), S. sanguinis (9.5%), S. salivarius (5.4%) and S. sobrinus (0%). Moreover, clindamycin (59.4%) showed the highest frequency of AR. Moxifloxacin and A-CA showed an susceptibility >99.1%, while clindamycin showed the lowest efficacy (93.3%); there was a significant statistically difference (p < .01). The age group between 26 and 50 years old (32.2%) and females (28.8%) showed more multiresistance. Clindamycin showed a statistical difference (p < .05) when comparing groups by gender. CONCLUSIONS Clindamycin was the antibiotic with the highest frequency of ARB and lower bactericidal effect. Moxifloxacin and A-CA showed the highest efficacy and the lowest ARB frequency. Streptococcus mutans was the bacterial specie that showed an increased frequency of AR.
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Affiliation(s)
| | - Maria Elena Ponce-Diaz
- Area of Dentistry of the Institute of Health´s Sciences, Autonomous University of the State of Hidalgo, Pachuca, Mexico
| | - Alejandra Loyola-Leyva
- Doctorado en Ciencias Biomédicas Básicas, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Jose O. Garcia-Cortes
- Facultad de Estomatología, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Carlo E. Medina-Solis
- Area of Dentistry of the Institute of Health´s Sciences, Autonomous University of the State of Hidalgo, Pachuca, Mexico
| | - Azael A. Contreras-Ramire
- Area of Dentistry of the Institute of Health´s Sciences, Autonomous University of the State of Hidalgo, Pachuca, Mexico
| | - Eduardo Serena-Gomez
- CISALUD Valle de las Palmas, Universidad Autónoma de Baja California, Tijuana, México
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Guzeldemir-Akcakanat E, Gurgan CA. Systemic moxifloxacin vs amoxicillin/metronidazole adjunct to non-surgical treatment in generalized aggressive periodontitis. Med Oral Patol Oral Cir Bucal 2015; 20:e441-9. [PMID: 26034931 PMCID: PMC4523257 DOI: 10.4317/medoral.20552] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/16/2015] [Indexed: 11/20/2022] Open
Abstract
Background The objective of this randomized clinical study was to evaluate the effect of systemic administration of moxifloxacin compared to amoxicillin and metronidazole, combined with non-surgical treatment in patients with generalized aggressive periodontitis (GAgP) in a 6-month follow-up. Material and Methods A total of 39 systemically healthy patients with GAgP were evaluated in this randomized clinical trial. Periodontal parameters were recorded at the baseline during the 1st, 3rd and 6th month. Patients received either 400 mg of moxifloxacin per os once daily or 500 mg of metronidazole and 500 mg amoxicillin per os three times daily for 7 days consecutively. Results No significant differences between groups were found in any parameters at the baseline. Both groups led to a statistically significant decrease in all clinical periodontal parameters compared to the baseline (PI, p<0.001 and GI, PD, BOP, CAL, p<0.01). There were no differences between the 1st and 3rd months or the 3rd and 6th months for clinical parameters in the groups. Also, no intergroup difference was observed in any parameters at any time, except the gingival index at 6th months. Conclusions Systemic administration of moxifloxacin as an adjunct to non-surgical treatment significantly improves clinical outcomes and provides comparable clinical improvement with less adverse events to that of combination of amoxicillin and metronidazole in the treatment of GAgP. Key words:
Aggressive periodontitis, amoxicillin, metronidazole, moxifloxacin, nonsurgical periodontal debridement.
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Affiliation(s)
- Esra Guzeldemir-Akcakanat
- Kocaeli University, Dis Hekimligi Fakultesi, Periodontoloji AD. Yuvacik Yerleskesi, 41190 Yuvacik-Başiskele-Kocaeli, Turkey,
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Cruz Olivo EA, Ramirez Escobar JH, Contreras Rengifo A. La moxifloxacina como coadyuvante en el tratamiento de las periodontitis. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.piro.2014.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bolt R, Yates JM, Mahon J, Bakri I. Evidence of frequent dosing errors in paediatrics and intervention to reduce such prescribing errors. J Clin Pharm Ther 2014; 39:78-83. [DOI: 10.1111/jcpt.12114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 10/31/2013] [Indexed: 11/29/2022]
Affiliation(s)
- R. Bolt
- Department of Oral Surgery; School of Clinical Dentistry; University of Sheffield; Sheffield UK
| | - J. M. Yates
- Oral and Maxillofacial Surgery; School of Dentistry; University of Manchester; Manchester UK
| | - J. Mahon
- Oral and Maxillofacial Surgery; Sheffield Teaching Hospitals NHS Trust; Sheffield UK
| | - I. Bakri
- Department of Oral Surgery; Sheffield Teaching Hospitals NHS Trust; Sheffield UK
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Figueiredo R, Valmaseda-Castellón E, Formoso-Senande MF, Berini-Aytés L, Gay-Escoda C. Delayed-onset infections after impacted lower third molar extraction: involved bacteria and sensitivity profiles to commonly used antibiotics. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:43-8. [DOI: 10.1016/j.tripleo.2011.06.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 05/07/2011] [Accepted: 06/25/2011] [Indexed: 10/14/2022]
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Poeschl PW, Crepaz V, Russmueller G, Seemann R, Hirschl AM, Ewers R. Endodontic Pathogens Causing Deep Neck Space Infections: Clinical Impact of Different Sampling Techniques and Antibiotic Susceptibility. J Endod 2011; 37:1201-5. [DOI: 10.1016/j.joen.2011.05.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/20/2011] [Accepted: 05/21/2011] [Indexed: 10/18/2022]
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Flemmig TF, Petersilka G, Völp A, Gravemeier M, Zilly M, Mross D, Prior K, Yamamoto J, Beikler T. Efficacy and safety of adjunctive local moxifloxacin delivery in the treatment of periodontitis. J Periodontol 2010; 82:96-105. [PMID: 20843236 DOI: 10.1902/jop.2010.100124] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Moxifloxacin exerts excellent antibacterial activity against most putative periodontal pathogens and has been shown to kill bacteria in biofilm and host cells. METHODS Patients with chronic periodontitis were randomly assigned to receive a single subgingival application of a 0.125%, 0.4%, or 1.25% moxifloxacin gel or placebo gel immediately after full-mouth scaling and root planing (SRP). Clinical efficacy measurements were assessed in sites with baseline probing depth (PD) of ≥5.4 mm at 6 weeks and 3 months and any adverse events were determined. In addition, putative periodontal pathogens and resistance of subgingival bacteria against moxifloxacin were assessed. RESULTS Data of 57 patients were included in the statistical analysis. In all treatment groups, the PD decreased from baseline to 3 months, with the greatest reduction seen in patients treated with moxifloxacin 0.4% (1.5 ± 0.6 mm; P = 0.023 compared to placebo), followed by patients receiving moxifloxacin 1.25% (1.2 ± 0.4), moxifloxacin 0.125% (1.1 ± 1.1), and placebo (1.0 ± 0.6). No linear trend for PD reduction with increasing moxifloxacin concentrations was found. Porphyromonas gingivalis showed the greatest reduction in prevalence among the assessed pathogens, without any significant intergroup differences. No correlation or systematic relationship between adverse events, including bacterial resistance against moxifloxacin, and the investigational gels was found. CONCLUSIONS In periodontal pockets with PD of ≥5.4 mm, a single subgingival administration of a 0.4% moxifloxacin gel as an adjunct to SRP may result in additional PD reduction compared to SRP alone. In addition, the investigated moxifloxacin gels seem to be safe.
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Affiliation(s)
- Thomas F Flemmig
- Department of Periodontics, School of Dentistry, University of Washington, Seattle, WA 98195–7444, USA.
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Antibiotic susceptibility and resistance of the odontogenic microbiological spectrum and its clinical impact on severe deep space head and neck infections. ACTA ACUST UNITED AC 2010; 110:151-6. [PMID: 20346713 DOI: 10.1016/j.tripleo.2009.12.039] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 11/18/2009] [Accepted: 12/23/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this retrospective study was to identify the major pathogens responsible for deep space head and neck infections and their current resistance to routinely used antibiotics in a university hospital setting. STUDY DESIGN A total of 206 patients suffering from odontogenic deep space infections were treated at our department by means of surgical intervention and intravenous administration of antibiotics. RESULTS The predominant bacteria were viridans group streptococci (VGS), staphylococci, Prevotella, Peptostreptococcus, and Bacteroides. In the aerobic spectrum, resistance against clindamycin was found in 18%, against macrolides in 14%, and against penicillin G in 7%. The anaerobes were resistant to clindamycin in 11%, to metronidazole in 6%, and to penicillin G in 8%. CONCLUSION The high resistance rate for clindamycin and macrolides was especially striking and may necessitate an adaptation of our antibiotic regime in the future.
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Yu L, Liu H, E L, Wu X, Wang D. Uptake of Metronidazole by Human Gingival Fibroblasts. J Periodontol 2009; 80:993-8. [DOI: 10.1902/jop.2009.080617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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