Periodontitis: Systemic antimicrobials as an adjunct to non-surgical treatment

Periodontal disease
Periodontitis

This Cochrane review of the effects of systemic antimicrobials as an adjunct to scaling and root planing (SRP) for the non-surgical treatment of patients with periodontitis identified 45 RCTs. However the evidence is of very low certainty to inform tclinicians and patients if adjunctive antibiotics are beneficial.

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Periodontal treatment to prevent or manage cardiovascular disease

gum disease, scale and polish

Two small RCTs at high risk of bias were included in this Cochrane systematic review looking at the effects of periodontal therapy for primary or secondary prevention of CVD in people with chronic periodontitis.

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Guideline: Antibiotics for Dental Pain and Swelling

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This new guideline from the American Dental Association is about the the appropriate use of systemic antibiotics for the urgent management of symptomatic irreversible pulpitis with or without symptomatic apical pulpitis, pulp necrosis and symptomatic apical periodontitis and pulp necrosis and localized acute apical abscess.

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Dental implant placement: which antibiotic protocol?

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This review of the the effectiveness of different antibiotic protocols to prevent early dental implant failure includes 9 RCTs showing that antibiotics were protective against early implant failures.

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Diabetic patients: does periodontal treatment improve glycaemic control?

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91 diabetic patients were randomised to non-surgical scaling and root planing and amoxicillin or control. While periodontal status significantly improved at 3 months there was no no significant effects on
glycaemic control.

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Non-surgical periodontal therapy – which antibiotic regime?

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This review of amoxicillin & metronidazole as an adjunct to non-surgical periodontal treatment included 18 trials . A small benefit was seen with antibiotic use but no clinically meaningful difference between different doses or duration of amoxicillin-plus-metronidazole at 3 months post-treatment.

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Periodontal treatment- adjuvant antibiotics for diabetic patients?

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This review of adjuvant antibiotics for diabetics undergoing periodontal treatment included 13 small RCTs. While a statistically significant improvement in probing depth was seen the magnitude of this improvement is unlikely to be clinically significant.

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Amoxicillin and metronidazole as an adjunct to scaling and root planning for periodontitis?

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This review of the adjunctive use of amoxicillin and metronidazole with scaling and root planing for the management of periodontitis found improved clinical outcomes in terms of pocket depth and clinical attachment level with their use.

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Third molars: single dose of preoperative antibiotic reduced infection

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10 RCTs were included in this review of preoperative antibiotics for removal of third molars. The use of antibiotics significantly reduced the odds of surgical site infection or alveolar osteitis (OR = 0.30; 95% CI, 0.19 to 0.47; P≤.00001)

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Systemic antibiotics for aggressive periodontitis?

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This review of systemic antibiotics and non-surgical periodontal therapy for aggressive periodontitis included 13 RCTs and suggests a statistically significant benefit compared to non-surgical therapy alone.

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