A New Controlled-Release Material Containing Metronidazole and Doxycycline for the Treatment of Periodontal and Peri-Implant Diseases: Formulation and In Vitro Testing

Anti-inflammatory activity of sappan wood extract cream (Caesalpinia sappan) in Porphyromonas gingivalis-induced gingivitis rats models

Background

Gingivitis is a dysbiotic condition characterized by persistent inflammation caused by a disease-associated multispecies bacterial population that has established itself in the subgingival region.

Aim

The objectives of this study are to analyze the anti-inflammatory activity of sappan wood extract cream (SWC) in Porphyromonas gingivalis induced-periodontitis rats model.

Methods

In this study, rats were infected with the gingiva with P. gingivalis as an inducer for gingivitis rats model for 14 days. The SWC were treated topically into the infected tissue. The inflammation and angiogenesis of gingival tissue was analyzed using histological examination. An immunohistochemistry (IHC) assay was used to analyze the nuclear factor kappa-B (NF-kB) protein expression. Masson Trichrome (MT) assay was used to analyze the histopathology of collagen Scores. The tumor necrosis factor-α (TNF-α), Interleukin-1 β (IL-1β), IL-6, and P38 genes expression were measured using quantitative real time-polymerase chain reaction.

Results

The induction of P. gingivalis-induced gingivitis in rats model was indicated by reddish gingiva and bacterial plaque. MT tests showed that SWC increased collagen density, and Haematoxylin and Eosin (H&E) test showed increased angiogenesis and in contrast, lowered inflammation score. IHC test showed that SWC decreased the expression of NF-kB protein. The TNF-α, IL-1β, IL-6, and P38 gene expression were also decreased due to the SWC treatment.

Conclusion

SWC proves that it has anti-inflammatory activity which has the potential to prevent or treat gingivitis.

Increasing fibroblasts and gingival collagen density in periodontitis rats by using cassava leaf extract

Objectives

Porphyromonas gingivalis, as the main etiology of periodontitis, causes inflammation in the periodontal tissue, which triggers the immune response, fibroblast decline, and collagen destruction, generating attachment loss. Fibroblasts and collagen perform a fundamental role in the repair process of periodontal tissue. This study examined the potential of cassava leaf extract in increasing the quantity of fibroblasts and collagen density in the gingiva of rats with periodontitis.

Methods

A posttest-only control group was used in this study. The experiment involved 24 male Wistar rats divided into four different groups: control group, group induced by P. gingivalis and given aquadest, group induced by P. gingivalis and given metronidazole, and group induced by P. gingivalis and given cassava leaf extract. Gingival tissue was taken after euthanasia, after which histological preparations were made, and fibroblasts and collagen were observed.

Results

One-way analysis of variance revealed that the collagen density and fibroblasts quantity showed a notable difference between each group (p < 0.05), and interestingly, there was no significant difference between metronidazole and cassava leaf extract in the least significant difference test results (p > 0.05).

Conclusion

Cassava leaf extract has the potential to increase fibroblast quantity and collagen density in the gingiva of periodontitis rat models.

Synthesis of Biocompatible Silver-Doped Carbonate Hydroxyapatite Nanoparticles Using Microwave-Assisted Precipitation and In Vitro Studies for the Prevention of Peri-Implantitis

A carbonate-hydroxyapatite-based antibacterial implant material with low cytotoxicity was synthesized. The silver ion (Ag⁺) was incorporated into CHA material, resulting in silver-doped carbonate hydroxyapatite (CHA-Ag). The microwave-assisted precipitation method was used to synthesize the CHA-Ag material. The amount of Ag⁺ was varied at 0.005, 0.010, and 0.015 mol fractions (χAg). The XRD results showed that the diffractograms corresponded with hydroxyapatite (ICSD 98-05-1414), without any additional phase. The presence of carbonate ions was indicated by vibrations at wavenumber of 871, 1411, and 1466 cm^-1 in the infrared spectra. The CHA-Ag materials were agglomerates of nanosized particles with low crystallinity. The particle size and crystallinity of the materials decreased due to the incorporation of CO₃^2- and Ag⁺. The incorporated Ag⁺ successfully inhibited peri-implant-associated bacterial growth. The antibacterial ability increased alongside the increase in the Ag⁺ amount. The pre-osteoblast MC3T3E1 cell could grow up to >70% in the MTT assay, despite the use of Ag⁺ as a dopant. The cell viability was higher in the CHA-Ag-containing media than in the CHA-containing media. The MTT assay also revealed that the CHA-Ag cytotoxicity decreased even though the Ag⁺ amount increased. The CHA-Ag-15 had the lowest cytotoxicity and highest antibacterial activity. Therefore, the optimal amount of Ag⁺ in the CHA-Ag formulation was χAg = 0.015.

Bench-to-bedside: Feasibility of nano-engineered and drug-delivery biomaterials for bone-anchored implants and periodontal applications

Nanotechnology and drug-release biomaterials have been thoroughly explored in the last few years aiming to develop specialized clinical treatments. However, it is rare to find biomaterials associated with drug delivery properties in the current dental market for application in oral bone- and periodontal-related procedures. The gap between basic scientific evidence and translation to a commercial product remains wide. Several challenges have been reported regarding the clinical translation of biomaterials with drug-delivery systems (BDDS) and nanofeatures. Therefore, processes for BDDS development, application in preclinical models, drug delivery doses, sterilization processes, storage protocols and approval requirements were explored in this review, associated with tentative solutions for these issues. The diversity of techniques and compounds/molecules applied to develop BDDS demands a case-by-case approach to manufacturing and validating a commercial biomaterial. Promising outcomes such as accelerated tissue healing and higher antibacterial response have been shown through basic and preclinical studies using BDDS and nano-engineered biomaterials; however, the adequate process for sterilization, storage, cost-effectiveness and possible cytotoxic effects remains unclear for multifunctional biomaterials incorporated with different chemical compounds; then BDDSs are rarely translated into products. The future benefits of BDDS and nano-engineered biomaterials have been reported suggesting personalized clinical treatment and a promising reduction in the use of systemic antibiotics. Finally, the launch of these specialized biomaterials with solid data and controlled traceability onto the market will generate strong specificity for healthcare treatments.

Evaluating Novel Agarose-Based Buccal Gels Scaffold: Mucoadhesive and Pharmacokinetic Profiling in Healthy Volunteers

Agarose (AG) forms hydrocolloid in hot water and possesses a noteworthy gel strength. However, no reasonable scientific work on investigating the mucoadhesive character of AG has been reported. Therefore, the current study was designed to develop AG and carbopol (CP) based buccal gel scaffold for simultaneous release of benzocaine (BZN) and tibezonium iodide (TIB). Gels’ scaffold formulations (F1−F12) were prepared with varied concentrations (0.5−1.25% w/v) of AG and CP alone or their blends (AG-CP) using homogenization technique. The prepared formulations were characterized for solid-state, physicochemical, in vitro, ex vivo, and in vivo mucoadhesive studies in healthy volunteers. The results showed that mucoadhesive property of AG was concentration dependent but improved by incorporating CP in the scaffolds. The ex vivo mucoadhesive time reached >36 h when AG was used alone or blended with CP at 1% w/v concentration or above. The optimized formulation (F10) depicted >98% drugs release within 8 h and was also storage stable up to six months. The salivary concentration of BZN and TIB from formulation F10 yielded a Cmax value of 9.97 and 8.69 µg/mL at 2 and 6 h (tmax), respectively. In addition, the FTIR, PXRD, and DSC results confirmed the presence of no unwanted interaction among the ingredients. Importantly, the mucoadhesive study performed on healthy volunteers did not provoke any signs of inflammation, pain, or swelling. Clearly, it was found from the results that AG-CP scaffold provided better mucoadhesive properties in comparison to pure AG or CP. Conclusively, the developed AG based mucoadhesive drug delivery system could be considered a potential alternative for delivering drugs through the mucoadhesive buccal route.

Combined Release of Antiseptic and Antibiotic Drugs from Visible Light Polymerized Biodegradable Nanocomposite Hydrogels for Periodontitis Treatment

The in situ application of the combination of different types of drugs revolutionized the area of periodontal therapy. The purpose of this study was to develop nanocomposite hydrogel (NCHG) as a pH-sensitive drug delivery system. To achieve local applicability of the NCHG in dental practice, routinely used blue-light photopolymerization was chosen for preparation. The setting time was 60 s, which resulted in stable hydrogel structures. Universal Britton–Robinson buffer solutions were used to investigate the effect of pH in the range 4–12 on the release of drugs that can be used in the periodontal pocket. Metronidazole was released from the NCHGs within 12 h, but chlorhexidine showed a much longer elution time with strong pH dependence, which lasted more than 7 days as it was corroborated by the bactericidal effect. The biocompatibility of the NCHGs was proven by Alamar-blue test and the effectiveness of drug release in the acidic medium was also demonstrated. This fast photo-polymerizable NCHG can help to establish a locally applicable combined drug delivery system which can be loaded with the required amount of medicines and can reduce the side effects of the systemic use of drugs that have to be used in high doses to reach an ideal concentration locally.

Local/Topical Antibiotics for Peri-Implantitis Treatment: A Systematic Review

Most studies indicate that the mechanical removal of the bacterial biofilm from the implant surface is the central goal of peri-implantitis therapy. However, controversial results in the treatment of peri-implantitis have led to the consideration of additional strategies that include surgical approaches and chemical adjuvants. Local/topical antibiotics, such as minocycline, azithromycin, tetracycline, amoxicillin, doxycycline, and metronidazole, may improve the efficacy of the definitive treatment of the disease, but the lack of conclusive findings prevents their use in clinical practice. This systematic review aimed to evaluate the effect of local/topical antibiotics for peri-implantitis treatment. Randomised controlled studies (RCT) on patients with peri-implantitis and comparing the efficacy of local/topical antibiotics vs. placebo or mechanical debridement were included. A systematic search strategy was carried out using three registered databases (PubMed, Web of Science, and Scopus). RoB2 was used to assess risk of bias. Five RCTs were identified (n = 250 patients and 333 implants). Contrast results emerged among the included studies, and a high heterogeneity level was observed. Risk of bias revealed some concerns for three studies out of five, while one study was judged at high risk. Only one study analysed the limitations of its findings. Overall, local antibiotic use can be considered a valid approach in the treatment of peri-implantitis. Therefore, future long-term clinical trials with standardised protocols and antibiotics with similar biological activity profiles should be tested to achieve a valid and definitive conclusion.

Development and optimization of tibezonium iodide and lignocaine hydrochloride containing novel mucoadhesive buccal tablets: A pharmacokinetic investigation among healthy humans

OBJECTIVE

It is clinically important to deliver sustained-release mucoadhesive dosage of local anesthetic and antimicrobial agent for pain control. The current study aimed to develop and evaluate chitosan (CHI) based buccal mucoadhesive delivery for local release of tibezonium iodide (TBN) and lignocaine hydrochloride (LGN).

METHODS

Direct compression technique was employed, aided by other mucoadhesive polymers like hydroxypropylmethylcellulose (HPMC) and sodium alginate (SA) and evaluated for physicochemical and in vivo character.

RESULTS

Fourier transform infrared spectral analysis (FTIR), powdered X-ray diffraction (XRPD), and differential scanning calorimetry (DSC) absence of physical interaction between ingredients. The physical parameters complied with USP specifications for all formulations. Optimum swellability (551.9%) was offered from formulation TL15, containing 30% SA. Highest ex vivo mucoadhesive strength (24.79 g) and time (18.39 h) was found with TL8. Formulation TL8 also exhibited maximum in vivo residence time (11.37 h). Almost complete drug release at 6 h was possessed by formulation TL5 (HPMC and CHI, 20% each) for TBN (99.98%) and LGN (99.06%). The optimized formulation TL5 exhibited dosage stability up to 6 months at 75% relative humidity and retained drug contents. TL5 was well tolerated by the volunteers with no inflammation, pain or irritation found. Almost 73% of volunteers reported an increase in salivary secretion. The first-order salivary C_max of TBN and LGN were found as 16.02 and 7.80 µg/mL within 4 h, respectively.

CONCLUSION

Therefore, the sustained release mucoadhesive dosage form of TBN and LGN can be an effective and alternative option to conventional delivery.

Local Drug Delivery Systems for Vital Pulp Therapy: A New Hope

Vital pulp therapy (VPT) is deliberated as an ultraconservative/minimally invasive approach for the conservation of vital pulpal tissues, preservation of dental structure, and maintenance of tooth function in the oral cavity. In VPT, following the exposure of the dental pulp, the environment is prepared for the possible healing and probable refunctionalisation of pulpal connective tissue. However, to succeed in VPT, specific biomaterials are used to cover and/or dress the exposed pulp, lower the inflammation, heal the dental pulp, provoke the remaining odontoblastic cells, and induce the formation of a hard tissue, i.e., the dentinal bridge. It can be assumed that if the employed biomaterial is transferred to the target site using a specially designed micro-/nanosized local drug delivery system (LDDS), the biomaterial would be placed in closer proximity to the connective tissue, may be released in a controlled and sustained pattern, could properly conserve the remaining dental pulp and might appropriately enhance hard-tissue formation. Furthermore, the loaded LDDS could help VPT modalities to be more ultraconservative and may minimise the manipulation of the tooth structure as well as pulpal tissue, which could, in turn, result in better VPT outcomes.

Methods of Topical Administration of Drugs and Biological Active Substances for Dental Implants-A Narrative Review

Dental implants are, nowadays, established surgical devices for the restoration of lost teeth. Considered as an alternative for traditional prosthetic appliances, dental implants surpass them in reliability and patient feedback. Local drug delivery around the implants promotes osseointegration and reduces peri-implantitis. However, there are currently no methods of a multiple, precise topical administration of drugs to the implant area. Engineering coatings on the implants, drug application on carriers during implantation, or gingival pockets do not meet all requirements of dental surgeons. Therefore, there is a need to create porous implants and other medical devices that will allow a multiple drug delivery at a controlled dose and release profile without traumatic treatment. Due to the growing demand for the use of biologically active agents to support dental implant treatment at its various stages (implant placement, long-term use of dental superstructures, treatment of the peri-implant conditions) and due to the proven effectiveness of the topical application of pharmacological biologically active agents to the implant area, the authors would like to present a review and show the methods and devices that can be used by clinicians for local drug administration to facilitate dental implant treatment. Our review concludes that there is a need for research in the field of inventions such as new medical devices or implants with gradient solid-porous structures. These devices, in the future, will enable to perform repeatable, controllable, atraumatic, and repeatable injections of active factors that may affect the improvement of osteointegration and the longer survival of implants, as well as the treatment of peri-implantitis.

An In Vitro Study to Determine the Physicochemical, Mechanical, and Antibacterial Properties of a Novel Spirulina Containing Controlled Release Intrapocket Drug Delivery System

Context:

Periodontitis is primarily an inflammatory condition caused by an array of microorganisms present in dental plaque. Elimination or adequate suppression of periodontal pathogens in the subgingival microflora is essential for adequate periodontal healing to take place. The development of subgingivally placed controlled delivery systems has provided the possibility of effective intrapocket concentration levels of antibacterial agents for an extended period of time, resulting in an altered subgingival flora and enhanced healing of the attachment apparatus. Although a number of synthetic antimicrobial agents are being used as local drug delivery, currently, pharmaceutical technology development has focused on the ingredients derived from nature. Natural phytochemicals have proven to be worthy substitutes of their synthetic and chemical-laden counterparts owing to their extensive natural activity, advanced safety margins, and inferior costs so that they can be of huge benefits, especially to the lower socioeconomic population around the world and spirulina platensis (SP) is one such emerging remedy.

Aims:

The aim of the study was to develop three controlled release drug delivery systems containing different concentrations of SP to be used inside the periodontal pockets. The study also aimed to determine the antimicrobial activity of all the three concentrations of SP drug delivery system against major periodontopathic microorganisms and to test the physicochemical properties of the delivery system that exhibited maximum antimicrobial efficacy so that the suitability of its use inside the periodontal pocket could be determined.

Settings and Design:

The study was an in vitro experimental design.

Subjects and Methods:

Three different controlled release SP hydrogels (4%, 6%, and 12%) to be used inside the periodontal pockets were developed and antibacterial properties against periodontal pathogens were assessed. The hydrogel exhibiting maximum antimicrobial efficacy was then tested of physicochemical and mechanical properties to determine its suitability of its use inside the periodontal pocket.

Statistical Analysis Used:

Data were analyzed using one-way analysis of variance. Post hoc Tukey honestly significant difference test was used for comparison within the group and between the different groups.

Results:

12% SP hydrogel was found to have maximum antimicrobial efficacy against major periodontal pathogens, and its physicochemical and mechanical properties were also optimum to be used inside the periodontal pocket.

Conclusions:

12% SP hydrogel can act as a promising adjunct to periodontal mechanical therapy and may also reduce the chances of more invasive periodontal surgical procedures.

Polysaccharide-Based Drug Delivery Systems for the Treatment of Periodontitis

Periodontal diseases are worldwide health problems that negatively affect the lifestyle of many people. The long-term effect of the classical treatments, including the mechanical removal of bacterial plaque, is not effective enough, causing the scientific world to find other alternatives. Polymer-drug systems, which have different forms of presentation, chosen depending on the nature of the disease, the mode of administration, the type of polymer used, etc., have become very promising. Hydrogels, for example (in the form of films, micro-/nanoparticles, implants, inserts, etc.), contain the drug included, encapsulated, or adsorbed on the surface. Biologically active compounds can also be associated directly with the polymer chains by covalent or ionic binding (polymer-drug conjugates). Not just any polymer can be used as a support for drug combination due to the constraints imposed by the fact that the system works inside the body. Biopolymers, especially polysaccharides and their derivatives and to a lesser extent proteins, are preferred for this purpose. This paper aims to review in detail the biopolymer-drug systems that have emerged in the last decade as alternatives to the classical treatment of periodontal disease.

Effect of Turmeric Concentrations on the Rate of Growth of Oral Bacteria-An In-Vitro Study

Background and Aim: The aim of this study was to evaluate the effect of varying concentrations of a turmeric solution on the growth rates of oral bacteria sampled from dental students. Methods: Bacterial cultures were grown overnight in aerobic conditions from plaque samples obtained from five test subjects. With the exception of the control, samples were exposed to different treatments; including chlorhexidine gluconate 2 mg/mL, prepared turmeric solution (TS) mouthwash: TS 0.25 mL (7.375 mg/mL), TS 0.5 mL (14.75 mg/mL), and TS 1 mL (29.50 mg/mL). Growth rate of the bacterial cultures were assessed by monitoring changes in optical density readings at 600 nm at hourly intervals for a six-hour period. The data were plotted and the exponential trend was used to calculate individual rates of growth. Data was analyzed using a one-way ANOVA with the significance confirmed using the Tukey-HSD test. Results: Growth observed in the bacteria exposed to the turmeric solution, was significantly greater (p < 0.05) when compared with the bacteria exposed to the medium alone. There was a significant difference found between the bacterial growth rate of the 1 mL turmeric solution against the growth rate of the bacteria in the 0.25 and 0.5 mL turmeric solutions. Conclusion: Comparison of growth rates of oral bacteria suggested that turmeric solutions of concentrations between 7.357 and 29.5 mg/mL (0.25–1 mL) were unlikely to exhibit bacteriostatic or bactericidal properties, and, conversely, increased bacterial growth. Considering this result, it is unlikely that turmeric mouthwash made from store-bought turmeric would have any antibacterial effects against oral bacteria, and may even promote bacterial growth.

Tailored Doxycycline Hyclate Loaded In Situ Gel for the Treatment of Periodontitis: Optimization, In Vitro Characterization, and Antimicrobial Studies

Currently, periodontitis is treated by oral dosage forms (antibiotics) which shows systemic side effects and failed to reach the therapeutic concentration (above minimum inhibitory concentration, MIC) in the periodontal pocket. The present study aimed to overcome the above issues, by designing tailored doxycycline hyclate laden in situ gel by Poloxamer 407, chitosan, and polyethylene glycol 600. The in situ gel-forming system has attracted attention owing to its ability of sustained drug release above MIC, easy administration (syringeability), and high drug retention (localization) in the periodontal cavity. The Box-Behnken design (BBD) was used to tailor and optimize the concentration of Poloxamer 407 (X₁ = 14.3%), chitosan (X₂ = 0.58%), and polyethylene glycol 600 (X₃ = 1.14%) to achieve sufficient syringeability (149 N), t_90% (1105 min), and viscosity at non-physiological condition (512 cps) and physiological condition (5415 cps). The optimized in situ gel was clear and isotonic (RBCs test). The gelation temperature of the optimized in situ was 34 ± 1°C with sufficient mucoadhesive strength (26 ± 2 dyn/cm²), gel strength (29 ± 2 sec), and texture profile for periodontal application. The in vitro drug release studies showed sustain release from optimized in situ gel (24h) in comparison to marketed gel (7h). The antimicrobial activity (cup plate technique) of the in situ gel was equivalent to the marketed doxycycline gel, which suggests that the doxycycline hyclate retained its antimicrobial efficacy when formulated as in situ gelling system. In conclusion, BBD was effectively utilized to optimize in situ gel with minimum level of polymers to achieve the required characteristics of the in situ gel for sustaining drug delivery to treat periodontitis.

Systemic and local effects of doxycycline and low-intensity laser treatment on periodontitis in rats

Purpose

This study evaluated the systemic and local effects of doxycycline (DOX) and low-intensity laser (LIL) treatment as adjuvants to scaling and root planing (SRP) in the treatment of experimental periodontitis in rats.

Methods

The sample consisted of 180 male rats (Rattus norvegicus albinus, Wistar), of which 30 did not receive induction of periodontal disease (negative control [NC] group) and 150 received induction of periodontal disease in the lower first molar. After 7 days, the ligature was removed, and the animals were divided into the following groups: NT (no treatment), SRP (SRP), DOX (SRP and DOX irrigation), LIL (SRP and laser irradiation), and DOX+LIL (SRP, DOX, and LIL). The animals were euthanized at 7, 15, and 30 days; thereafter, biochemical, radiographic, histological, and immunohistochemical analyses were performed.

Results

In the intragroup analysis, lower concentrations of α-1-glycoprotein acid (α-1-Ga) and complement 3 (C3) were observed in the DOX+LIL group than in all other groups at all time points, as well as lower levels of complement 4 (C4) at 15 and 30 days (P<0.001). Less bone loss was observed in the DOX, LIL, and DOX+LIL groups than in the NC and SRP groups at all time points (P<0.001). There was a smaller number of tartrate-resistant acid phosphatase (TRAP)-positive cells in the DOX+LIL group than in the other groups at all time points (P<0.001). Positive correlations were observed between the systemic levels of α-1-Ga, C3, and C4 and the number of TRAP-positive cells.

Conclusions

The combination of DOX with LIL as SRP adjuvants was effective both systemically and locally for the treatment of experimental periodontitis in rats.

Biological and Mechanical Properties of Denture Base Material as a Vehicle for Novel Hydroxyapatite Nanoparticles Loaded with Drug

Purpose: This study aimed to evaluate the biological and mechanical properties of the poly(methyl methacrylate) (PMMA) denture base material as a vehicle incorporating novel hydroxyapatite nanoparticles (HA-NP) loaded with metronidazole (MZ) drug.

Methods: HA-NP was prepared via wet-chemical-method, characterized by XRD, SEM/EDX, TEM, Fourier-transform infrared spectroscopy (FTIR), as well as the measurement of surface area and pore-size distribution. Four drug delivery formulas were prepared in the form of discs (10 x 2 mm) as follows: F1 (MZ/ HA-NP/PMMA), F2 (HA-NP/ PMMA), F3 (control-PMMA) and F4 (MZ/PMMA). Characterization of all formulas was performed using differential scanning calorimetry (DSC) and FTIR. MZ release rate, antimicrobial properties against three oral pathogens, cytotoxicity (MTT assay) and surface micro-hardness were also assessed. Statistical analysis of data was performed using one-way ANOVA test (P < 0.05).

Results: DSC thermograms showed compatibility among MZ, HA-NP and PMMA along with physical stability over 6 months storage period at room temperature. FTIR spectroscopy proved the absence of any possible chemical interaction with MZ. MZ-HA-NP/PMMA formula showed relatively better drug release compared to MZ-PMMA. Both formulas showed statistically significant antimicrobial potentials against two microbial strains. MTT demonstrated reduction in cell cytotoxicity after 96 hours with the least value for HA-NP. Surface micro-hardness revealed non-significant reduction compared with the control PMMA.

Conclusion: A novel biocompatible drug nanocarrier (HA-NP) was developed and incorporated in PMMA denture base material as a vehicle to allow prolonged sustained drug release to manage oral infections.

Current Evidence of Natural Agents in Oral and Periodontal Health

Oral and periodontal diseases, chewing disorders, and many destructive inflammatory diseases of the supporting tissues of the teeth are usually caused by an imbalance between host defense and environmental factors like smoking, poor nutrition, and a high percentage of periodontopathogenic bacteria. For these reasons, it is important also to focus attention on plaque control and also on improving host resistance through smoking and stress reduction, and a healthy diet. During the last decades, the importance of micronutrients has been extensively reviewed, and it was concluded that the prevention and treatment of periodontitis should include correct daily nutrition and a correct balance between antioxidants, probiotics, natural agents, vitamin D, and calcium. Recently, there has been growing interest in the literature on the impact of nutraceutical dietary aliments on oral and general health. This Special Issue provides a current and thoughtful perspective on the relationship of diet and natural agents on oral and periodontal diseases through a correct clinical approach with the last and most important evidence that may determine good oral conditions and high quality of life.

Antibiotics in Dentistry: A Narrative Review of Literature and Guidelines Considering Antibiotic Resistance

Background:

Antibiotic resistance is an important issue for public health.

Objective:

The aim of this work is to investigate the clinical situations which require the administration of antibiotics in dentistry.

Methods:

The authors want to do a review of the literature and a comparison of guidelines in dentistry among different countries. The research method was based on the use of Pubmed and the research of indexed articles and documents published by authorities and boards about the antibiotic prescription in dentistry. The paper is an analysis deep inside the physiological and pathological situations that, according to different guidelines, require the use of antimicrobics. The spirit is a clinical one because this paper wants to be a guide for dentists, especially before the administration, in order to moderate the use of antimicrobials. We must remember that the World Health Organisation organizes each year the World Antibiotic Awareness Week, in order to fight against the improper administration of antibiotics in medicine, dentistry, veterinary medicine, and industrial livestock.

Results:

Different guidelines converge on a very calibrate and proper administration of antibiotics. Antibiotics should be used only in recommended situations for risk patients. The authorities and boards should investigate the habits of antibiotic administration, which according to some papers seem to be large and diffused use, not only limited to situations described in guidelines.

Conclusion:

Dentists, together with the General Practitioners and Paediatricians, should be cautious and accurate and should administrate antibiotics only if recommended by guidelines and effective and safe.