Local Oxygen Therapy for Treating Acute Necrotizing Periodontal Disease in Smokers

Topical Oxygenation Improves Microvascularity in a Human Ex Vivo Palatal Tissue Model: A Histological Analysis

Background: Several therapies involving the use of oxygen have been developed; however, the literature to date has poorly addressed the effects of Topical Oxygen Therapy (TOT) on oral tissues. The aim of the present pilot study was to histologically evaluate the response to TOT in epithelial-connective samples harvested from the palate. Methods: In eight patients selected for a free gingival graft (FGG) procedure, the lateral portions of the graft were randomly assigned to receive TOT (test) or no treatment (control). Both the portions were stained with hematoxylin-eosin for the evaluation of histomorphological changes and with Picrosirius for the study of collagen. Immunohistochemical staining was performed with antibodies for the characterization of the inflammatory infiltrate and neoangiogenesis. Results: The analysis failed to show morphological variations in both groups, demonstrating that there was no tissue damage due to TOT. The prevalence of type I collagen in both samples supported this finding. Immune cells were present in low levels and mainly consisted of CD3+ T lymphocytes. The histomorphometric analysis showed an increased average vessel area (7607.95 μm2 ± 3983.24 vs. 4038.42 μm2 ± 1823.52), an increased number and caliber of vessels (49.82 ± 20.55 vs. 32.35 ± 16.64), and a higher microvessel density (7.89 ± 3.25 vessels/0.26 mm2 vs. 5.13 ± 2.63 vessels/0.26 mm2) in the test group. Conclusions: Although further investigations are needed, TOT could improve and speed up oral wound healing through the local condition of hyperoxia.

The Management of Necrotizing Gingivitis in Paediatric Patients: A Scoping Review and Two Case Reports

Necrotizing gingivitis (NG) is an acute inflammatory process with an estimated prevalence of less than 1%. The treatment of choice is usually antibiotics in addition to periodontal treatment. This scoping review aims to detail extent and type of proof related to NG in paediatric patient; moreover, a decision tree protocol was developed to define NG management in paediatric patients based on the presence or absence of systemic compromission. In addition, we also propose the use of ozone treatment as an adjuvant therapy. Seven papers (3 case reports, 2 guidelines, and 2 reviews) were selected for evaluation by reading the full texts. This review outlines the lack of research on the treatment of NG in paediatric patients; we, however, demonstrate the efficacy of the decision tree protocol by describing two case reports in which patients were treated with antibiotics according to the presence or absence of systemic involvement through the implementation of an individualized therapeutic approach, with periodontal ozone therapy. Moreover, the supportive use of this molecule in the management of NG can be a valuable tool in the healing of gingival tissues.

Acute periodontal lesions

This review provides updates on acute conditions affecting the periodontal tissues, including abscesses in the periodontium, necrotizing periodontal diseases and other acute conditions that cause gingival lesions with acute presentation, such as infectious processes not associated with oral bacterial biofilms, mucocutaneous disorders and traumatic and allergic lesions. A periodontal abscess is clinically important because it is a relatively frequent dental emergency, it can compromise the periodontal prognosis of the affected tooth and bacteria within the abscess can spread and cause infections in other body sites. Different types of abscesses have been identified, mainly classified by their etiology, and there are clear differences between those affecting a pre-existing periodontal pocket and those affecting healthy sites. Therapy for this acute condition consists of drainage and tissue debridement, while an evaluation of the need for systemic antimicrobial therapy will be made for each case, based on local and systemic factors. The definitive treatment of the pre-existing condition should be accomplished after the acute phase is controlled. Necrotizing periodontal diseases present three typical clinical features: papilla necrosis, gingival bleeding and pain. Although the prevalence of these diseases is not high, their importance is clear because they represent the most severe conditions associated with the dental biofilm, with very rapid tissue destruction. In addition to bacteria, the etiology of necrotizing periodontal disease includes numerous factors that alter the host response and predispose to these diseases, namely HIV infection, malnutrition, stress or tobacco smoking. The treatment consists of superficial debridement, careful mechanical oral hygiene, rinsing with chlorhexidine and daily re-evaluation. Systemic antimicrobials may be used adjunctively in severe cases or in nonresponding conditions, being the first option metronidazole. Once the acute disease is under control, definitive treatment should be provided, including appropriate therapy for the pre-existing gingivitis or periodontitis. Among other acute conditions affecting the periodontal tissues, but not caused by the microorganisms present in oral biofilms, infectious diseases, mucocutaneous diseases and traumatic or allergic lesions can be listed. In most cases, the gingival involvement is not severe; however, these conditions are common and may prompt an emergency dental visit. These conditions may have the appearance of an erythematous lesion, which is sometimes erosive. Erosive lesions may be the direct result of trauma or a consequence of the breaking of vesicles and bullae. A proper differential diagnosis is important for adequate management of the case.

Novel and often bizarre strategies in the treatment of periodontal disease

Treatment of periodontal disease involves complex mechanical, surgical, and medical modalities. Some of the treatment regimens are patient centered, some involve a great amount of technical expertise and competence from a practitioner, and often involve complex procedures like use of tissue-engineered products. In spite of several advances, treatment of periodontal disease depends on scaling and root planing and various surgical procedures as the mainstay, but results of treatment are not always predictable and are often frustrating. The ultimate aim of periodontal treatment is regeneration of periodontal tissues and more particularly lost alveolar bone support. The treatment options include a myriad of approaches and scientists and researchers have tried various tools and agents to improve alveolar bone status and improve periodontal health. These approaches vary from simple monotherapy with systemic antibiotic usage to exotic and novel procedures like shock wave therapy, photodynamic therapy and application.

The clinical effect of scaling and root planing and the concomitant administration of systemic amoxicillin and metronidazole: a systematic review

BACKGROUND

The treatment of periodontitis frequently begins with a non-surgical phase that includes scaling and root planing (SRP) and, on occasion, the use of systemic antibiotics. The goal of this review is to systematically evaluate the data concerning the effect of the concomitant administration of amoxicillin and metronidazole adjunctive to SRP in adults who are otherwise healthy.

METHODS

The PubMed-MEDLINE, Cochrane-Central, and EMBASE databases were searched to April 1, 2012, to identify appropriate studies. Probing depth (PD), clinical attachment level (CAL), bleeding on probing, and plaque index were selected as outcome variables. Based on the extracted mean values and number of individuals, changes in weighted means were calculated and a meta-analysis conducted.

RESULTS

The search yielded 526 unique titles and abstracts. Ultimately, 35 studies were selected, describing 28 clinical trials meeting the eligibility criteria. The full-mouth weighted mean change for PD showed an improvement of 1.41 mm. The full-mouth weighted mean change for CAL showed a gain of 0.94 mm.

CONCLUSION

Systemic antimicrobial therapy using a combination of amoxicillin and metronidazole as an adjunct to SRP can enhance the clinical benefits of non-surgical periodontal therapy in adults who are otherwise healthy.

Novel mechanism for conditional aerobic growth of the anaerobic bacterium Treponema denticola

Treponema denticola, a periodontal pathogen, has recently been shown to exhibit properties of a facultative anaerobic spirochete, in contrast to its previous recognition as an obligate anaerobic bacterium. In this study, the capacity and possible mechanism of T. denticola survival and growth under aerobic conditions were investigated. Factors detrimental to the growth of T. denticola ATCC 33405, such as oxygen concentration and hydrogen sulfide (H(2)S) levels as well as the enzyme activities of gamma-glutamyltransferase, cysteinylglycinase, and cystalysin associated with the cells were monitored. The results demonstrated that T. denticola grew only at deeper levels of broth (>or=3 ml in a 10-ml tube), high inoculation ratios (>or=20% of culture in medium), and short cultivation times ( Collapse

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MESH Headings

• Aerobiosis
• Anaerobiosis
• Anti-Bacterial Agents/metabolism
• Culture Media/chemistry
• Cystathionine gamma-Lyase/metabolism
• Dipeptidases/metabolism
• Hydrogen Sulfide/metabolism
• Oxygen/metabolism
• Time Factors
• Treponema denticola/growth & development
• Treponema denticola/metabolism
• gamma-Glutamyltransferase/metabolism

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Grants

• R01 DE013819 NIDCR NIH HHS
• R56 DE013819 NIDCR NIH HHS
• DE-13819 NIDCR NIH HHS

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Affiliation(s)

Yanlai Lai Department of Orthodontics, University of Texas Health Science Center, San Antonio, TX 78229, USA
Lianrui Chu

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