Classic vs. Novel Antibacterial Approaches for Eradicating Dental Biofilm as Adjunct to Periodontal Debridement: An Evidence-Based Overview

Periodontitis is a multifactorial chronic inflammatory disease that affects tooth-supporting soft/hard tissues of the dentition. The dental plaque biofilm is considered as a primary etiological factor in susceptible patients; however, other factors contribute to progression, such as diabetes and smoking. Current management utilizes mechanical biofilm removal as the gold standard of treatment. Antibacterial agents might be indicated in certain conditions as an adjunct to this mechanical approach. However, in view of the growing concern about bacterial resistance, alternative approaches have been investigated. Currently, a range of antimicrobial agents and protocols have been used in clinical management, but these remain largely non-validated. This review aimed to evaluate the efficacy of adjunctive antibiotic use in periodontal management and to compare them to recently suggested alternatives. Evidence from in vitro, observational and clinical trial studies suggests efficacy in the use of adjunctive antimicrobials in patients with grade C periodontitis of young age or where the associated risk factors are inconsistent with the amount of bone loss present. Meanwhile, alternative approaches such as photodynamic therapy, bacteriophage therapy and probiotics showed limited supportive evidence, and more studies are warranted to validate their efficiency.

Comparison of Clinical Attachment Level Gain Using Scaling Root Planing Versus Adjunctive Azithromycin on Chronic Periodontitis

Objective: The objective of the study was to compare the mean clinical attachment gain in patients of chronic periodontitis after scaling and root alone versus Azithromycin as an adjunct to scaling and root. Study Design Comparative study Place and Duration: Conducted at Operative Dentistry Department, Azra Naheed Dental College, Lahore for a duration of 4 months from December 2019 to March 2020. Methodology: Total Sixty patients fulfilling the selection criteria were randomly allocated to SRP and SRP+Az groups. In both groups, conventional scaling and root planing was done. In the SRP group placebo capsules were prescribed, while in the SRP+Az group, Azithromycin (500mg) once daily was prescribed for 3 days. Clinical attachment level (CAL) was measured initially and after 5 weeks. Data was analyzed in SPSS version 19.0 using independent sample t-test. Results: Both groups showed gain in CAL compared to baseline. However, SRP+Az group showed significantly more gain in CAL in comparison to SRP group (P value < 0.05). Conclusion: Use of Azithromycin adjunctive to SRP is an effective treatment modality in chronic periodontitis patients. Keywords: Anti‐Bacterial Agents, Azithromycin, Chronic periodontitis, Clinical attachment level, Periodontal Debridement, Scaling and root planing,

The Manufacture and Characterization of Silver Diammine Fluoride and Silver Salt Crosslinked Nanocrystalline Cellulose Films as Novel Antibacterial Materials

There is an unmet need for biocompatible, anti-infective, and mechanically strong hydrogels. This study investigated the use of poly vinyl alcohol (PVA), polysaccharides, and nanocrystalline cellulose (CNC) to deliver silver in a controlled manner for possible use against oral or wound bacteria. Silver was included in solvent cast films as silver diammine fluoride (SDF) or as nitrate, sulphate, or acetate salts. Hydrogel formation was assessed by swelling determinations and silver release was measured using inductively coupled plasma methods. Antibacterial studies were performed using Gram-positive and negative bacteria turbidity assays. PVA formed homogenous, strong films with SDF and swelled gently (99% hydrolyzed) or vigorously with dissolution (88% hydrolyzed) and released silver slowly or quickly, respectively. CNC-SDF films swelled over a week and formed robust hydrogels whereas CNC alone (no silver) disintegrated after two days. SDF loaded CNC films released silver slowly over 9 days whereas films crosslinked with silver salts were less robust and swelled and released silver more quickly. All silver loaded films showed good antibacterial activity. CNC may be crosslinked with silver in the form of SDF (or any soluble silver salt) to form a robust hydrogel suitable for dental use such as for exposed periodontal debridement areas.

Gold Standards in Periodontics: A Review

The field of dentistry has evolved where people expect the best oral health care from specialists. Periodontics is that specialty of dentistry which deals with prevention, diagnosis, and treatment of diseases of the supporting tissues of the teeth. Almost half of the world's population is suffering from periodontal diseases. Periodontitis is the sixth most common chronic diseases in the world and along with dental caries, the most common cause of tooth loss. Through the effort of various professional organisations and research, various reliable products and treatment modalities have been developed. A gold standard is a benchmark which has been thoroughly tested and has reputation as a reliable modality. Some of established gold standards in periodontics include: periodontal probing, measurement of clinical attachment loss, bone loss, cone beam computed tomography, quantitative polymerase chain reaction tests, biopsies as investigative techniques; periodontal debridement, subepithelial connective tissue graft for recession coverage, lasers, autogenous bone in alveolar ridge augmentation prior to oral implantation, dental implant as reconstruction of missing dentition, and chlorhexidine mouth wash as treatment options. The objective of the review is to provide critical evaluation of the data available from existing studies in Periodontics which can help identify potential research areas to explore.

Comparison of the Effect of Er,Cr:YSGG Laser and Halita Mouthwash on Oral Malodor in Patients With Chronic Periodontitis: A Randomized Clinical Trial

Introduction: Periodontal disease and tongue coatings are among the major factors associated with oral malodor. The present study, comparatively evaluated the effects of the Er,Cr:YSGG laser and Halita mouthwash as adjunctive treatments to nonsurgical periodontal debridement on oral malodor reduction in chronic periodontitis patients. Methods: Sixty patients with stage II and III chronic periodontitis and bad breath. The patients were randomly divided into two groups (n=30). After conventional scaling and root planing, patients in group 1 underwent Er,Cr:YSGG laser (Waterlase; Biolase, San Clemente, CA, USA) irradiation of the internal surface of the pockets ( 1.5 W, 30 Hz, 20% A, 40% W) and the dorsum of the tongue (1 W, 30 Hz, 20% A, 40% W) immediately after SRP and on the third and seventh days. Group 2 patients were asked to use Halita mouthwash twice daily for one week. Baseline, 1 and 3-month post-treatment measurements of plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), gingival index (GI), bleeding on probing (BOP) and organoleptic assessment of Halitosis severity were performed. Results: Significant improvement in all parameters was noted in both groups after 1 and 3 months, compared with baseline (P<0.05). The two groups had significant reductions which occurred in PPD, CAL and BOP levels and the organoleptic score in 1 and 3 months after the intervention (P<0.05). Conclusion: Er,Cr:YSGG laser irradiation and Halita mouthwash as adjuncts to non-surgical periodontal therapy are both effective in the treatment of oral malodor and improvement of periodontal parameters.

Effect of Periodontal Debridement Plus Systemic Azithromycin v/s Periodontal Debridement as Unique Therapy in Subjects with Periodontitis: A Randomized Controlled Clinical Trial.

The authors have requested that this preprint be withdrawn due to erroneous posting.

Effect of Periodontal Debridement Plus Systemic Azithromycin v/s Periodontal Debridement as Unique Therapy in Subjects with Periodontitis: A Randomized Controlled Clinical Trial.

Background: Recently, it has been suggested that azithromycin (AZM) may be a useful adjunct to non-surgical periodontal therapy (NSPT). However, current scientific evidence is still not conclusive as to its efficacy as an adjunct of NSPT. This study aimed to evaluate the effect of the systemic administration of AZM as an adjunct to NSPT on the clinical and microbiological variables of patients with periodontitis.Methods: Eighteen volunteers with Periodontitis received NSPT combined with placebo or AZM (500 mg/day) for 3 days (n=9/group). They were monitored clinically for probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI) and bleeding on probing (BoP) at baseline and during the first, third and sixth month and monitored microbiologically at baseline and at 3 and 6 months after therapy. The microbiological variables were detected by conventional polymerase chain reaction tests. The normality was checked using the Shapiro-Wilk test. The level of statistical significance was measured by the unpaired t-test, Mann-Whitney U, Fisher’s exact and Chi-Square tests.Results: Fourteen patients completed the study (n=7/group). The group receiving NSPT + AZM presented with a significantly lower mean PPD at 3 (p = 0.05) and 6 months (p = 0.04) with a greater probing depth reduction (p = 0.02). Moreover, at the third month post NSPT, there was a significant increase in the number of sites with a PPD 1–3 mm (p < 0.001) and a decrease in the number of sites with a PPD 4–6 mm (p < 0.001). In addition, a significant decrease in the mean number of sites with a PPD ≥ 7 mm (p = 0.04) was detected at 6 months post treatment. There was also a significant decrease in BoP at 1 (p = 0.01), 3 (p < 0.001) and 6 (p = 0.01) months post intervention. Conclusions: AZM as an adjuvant to NSPT provides additional beneficial effects for PPD and BoP compared to NSPT alone. This could be related to its anti-inflammatory properties more than to its antibiotic characteristics.Trial registration: ClinicalTrials.gov: NCT03629288. https://clinicaltrials.gov/ct2/show/NCT03629288Retrospectively registered on August 14, 2018.