The Use of Amoxicillin (500mg) Plus Metronidazole (500mg) For 7 Days Adds Adjunctive Benefits For Non-Surgical Periodontal Therapy, But Limited Evidence Supports Higher/Longer Dose


Summary

Selection Criteria:

The search was conducted through the electronic database of Embase and MEDLINE (via OvidSP) from 1946 to April 2017 for randomized clinical trials on different combinations and modifications of the key words, including periodontitis, amoxicillin, metronidazole, and randomized controlled clinical trial. The Cochrane Central Register and the WHO International Clinical Trials Registry Platform were also searched for relevant clinical trials. The reference lists of all included studies and relevant reviews were manually cross-referenced to ensure comprehensive data collection. Two reviewers conducted the screening, quality assessment, and selection of the articles.

Key Study Factor

The key study factor (intervention) was blinded, randomized placebo-controlled trials with nonsurgical periodontal therapy and adjunctive consumption of amoxicillin and metronidazole. However, there is heterogeneity of the length and dose of the antibiotics prescribed.

Main Outcome Measure

The primary outcomes assessed were periodontal pocket probing depth and clinical attachment level 3 months after a combination of nonsurgical periodontal therapy and use of the systematic antibiotics amoxicillin and metronidazole.

Main Results

Out of the 376 records identified, 18 studies were included for qualitative synthesis and 15 studies included for quantitative analysis. Meta-analysis showed a small beneficial effect of adjunctive amoxicillin plus metronidazole for an additional mean weighted pocket depth reduction of 0.36-0.38 mm. No clinically significant difference was found among the various doses and durations for the medication use.

Conclusions

Based on the studies reviewed, no recommendations for the optimal duration of the antibiotic course can be given. However, based on the principles of responsible antibiotics use, the highest dose with the shortest duration of time is recommended to reduce the risk of antibiotic resistance. Therefore, a 7-day regimen of 500/500 mg or 500/400 mg of amoxicillin and metronidazole would be most appropriate.
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Dentists’ prescribing of antibiotics and opioids to Medicare Part D beneficiaries: Medications of high impact to public health.

J Am Dent Assoc. 2018 Jun 18. pii: S0002-8177(18)30310-6. doi: 10.1016/j.adaj.2018.04.027. [Epub ahead of print]

Abstract

BACKGROUND:

Gaining a better understanding of dental prescribing can help identify opportunities for intervention regarding optimal medication use. The purpose of this study is to characterize opioid and antibiotic prescribing patterns of dentists in the United States for Medicare Part D beneficiaries.

METHODS:

The authors conducted a retrospective cross-sectional analysis of national 2014 Medicare Part D Prescriber Public Use File data. Providers in the data set with dental-related disciplines were included (n = 99,797). Outcomes of interest were mean days’ supply and mean number of claims reported per claim, beneficiary, and prescriber discipline.

RESULTS:

Of the 6,724,372 dental prescription claims submitted, 3,947,848 (58.7%) and 1,312,796 (19.5%) were for antibiotics and opioids, respectively. Sixty-nine percent of dentists in the highest quartile of opioid prescribers were also in the highest quartile of antibiotic prescribers (r2 = 0.7778; P < .01). The mean (standard deviation) days’ supply per claim was 6.9 (5.3) days (range, 1-90 days) for antibiotics and 3.6 (2.0) days (range, 1-44.5 days) for opioids. Of the 33,348 dental providers who prescribed opioids, 18,971 (56.9%) prescribed a mean opioid days per claim greater than the recommended duration of 3 days for acute pain.

CONCLUSION:

Opioids and antibiotics are the medications most prescribed by dentists. On the basis of national recommendations and results of studies from other countries, the length of therapy prescribed may be excessive. Further studies should be conducted to assess appropriateness of dental prescriptions.

PRACTICAL IMPLICATIONS:

Dentistry should be considered for antibiotic and opioid stewardship interventions along with medicine.

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American Academy of Periodontology releases proceedings from the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions


Updates include staging and grading system for periodontitis; classification of peri-implant disease
CHICAGO (June 21, 2018) — The American Academy of Periodontology (AAP) has published the official proceedings from the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. These proceedings provide a comprehensive update to the previous disease classification established at the 1999 International Workshop for a Classification of Periodontal Diseases and Conditions. Highlights from the 2017 proceedings include a recategorization of various forms of periodontitis, the development of a novel staging and grading system for periodontitis, and the inaugural classification for peri-implant diseases and conditions. The complete suite of review papers and consensus reports from the Workshop, which was co-presented by the European Federation of Periodontology (EFP), is available in the June 2018 print and online issues of the Journal of Periodontology.
The multi-dimensional staging and grading framework for periodontitis classification is among the 2017 Workshop’s major features. Staging levels indicate the severity of the disease and the complexity of disease management, while the grading structure considers supplemental biologic characteristics of the patient in estimating the rate and likelihood of periodontitis progression. This framework builds upon a notable change: Forms of periodontal disease are now defined as one of three distinct forms which include periodontitis (formerly aggressive and chronic), necrotizing periodontitis, and periodontitis as a manifestation of systemic conditions.
The four categories of periodontitis staging are determined by a number of variables and range from the least severe Stage I to most severe Stage IV. The three levels of periodontitis grading—which consider a patient’s overall health status and risk factors such as smoking and metabolic control of diabetes—indicate low risk of progression (Grade A), moderate risk of progression (Grade B), and high risk of progression (Grade C).
“The new staging and grading system provides a structure for treatment planning and for monitoring a patient’s response to therapy,” says Kenneth Kornman, DDS, PhD, editor-in-chief of the Journal of Periodontology and member of the Workshop’s organizing committee. “A personalized approach to patient care is essential for effective periodontal case management. The staging and grading system guides a clinician’s assessment of several dimensions beyond severity of past destruction, including specific elements that contribute to complexity of managing their patient’s case and the risk for future disease progression. The new classification system provides a paradigm similar to what is used in some fields of medicine, from which clinicians can develop a well-rounded treatment strategy based on a patient’s specific needs.”
The Workshop proceedings also include, for the first time, a new classification for peri-implant diseases and conditions. Peri-implant mucositis is characterized by bleeding on probing and visual signs of inflammation and peri-implantitis, a plaque-associated condition occurring in the tissue around dental implants, is indicated by inflammation of mucosal tissue and subsequent progressive loss of supporting bone. Peri-implant health is identified by the absence of visible inflammation and bleeding on probing.
“Implant dentistry has become a major component of patient treatment planning and care since the last Workshop in 1999. And just like tissues that support natural teeth, the bone and soft tissues surrounding dental implants are susceptible to inflammation-driven complications without proper care and management,” Dr. Kornman says. “The 2017 Workshop proceedings outline definitions of health and disease in this particular context, acknowledging that with a growing number of implant cases comes an increased need to identify and treat implant-related conditions.”
Hard and soft tissue implant site deficiencies (associated with healing after tooth loss, extraction trauma, endodontic infections, injury, and other causes) are also included within the implant condition classification.


“The updated proceedings align with what scientific literature has revealed about disease progression in the last 20 years. As greater understanding emerges, the Academy is committed to revisiting and modifying the classification as evidence dictates,” says Steven R. Daniel, DDS, president of the AAP. “The new classification will also lay the foundation for future research.”
Held Nov. 9-11, 2017, at Chicago’s Gleacher Center, the Workshop welcomed more than 100 experts from Europe, Asia, Australia, and the Americas who conducted literature reviews, established case definitions, and deliberated diagnostic considerations for the classification’s primary topic areas. “We assembled periodontal scholars whose commitment to evidence-based practice would inform their contributions,” Dr. Daniel says. “Because of its inclusion of international researchers, educators, and clinicians, the Workshop created a global consensus by which care can be standardized and modernized for patients and practitioners everywhere.”
Planning for the event began in 2015 with oversight from an organizing committee composed of AAP and EFP members. The Workshop proceedings are also published in the EFP’s Journal of Clinical Periodontology.
“The experts involved in this effort recognize the classification’s clinical salience and its likely influence on the improvement of patient outcomes around the world,” Dr. Daniel says. “Although its widespread adoption will take time, we hope that the updated classification model will be the primary paradigm for patient care around the globe.”
The AAP plans to develop resources that guide the integration of the updated classification within various facets of dentistry, including dental education, dental hygiene, third-party reimbursement, and general clinical practice.
The Workshop was presented with support from the AAP Foundation, Colgate-Palmolive Company, Johnson and Johnson Consumer Inc., Geistlich Biomaterials, SUNSTAR, and Procter and Gamble Professional Oral Health.
Visit perio.org/2017wwdc for the Workshop proceedings and more information.

About the American Academy of Periodontology
The American Academy of Periodontology (AAP) represents over 8,000 periodontists—specialists in the prevention, diagnosis, and treatment of inflammatory diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontics is one of the nine dental specialties recognized by the American Dental Association. Learn more at perio.org.

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Academy of Laser Dentistry Announces Call for Abstracts for ALD 2019 Annual Session

“The Laser-Systemic Connection: Lighting the Way to a Healthier Mouth and Body” will Take Place in Dallas on April 4-6, with Opening Keynote
by Leading Oral-Systemic Health Advocate, Charles Whitney, MD
Coral Springs, FL – June 18, 2018 – The Academy of Laser Dentistry (ALD), the only independent and unbiased non-profit association dedicated to improving patient care with the proper use of laser technology, recently issued a call for abstracts for its upcoming annual meeting.
Known internationally as “dentistry’s laser meeting”, ALD 2019 is at the Hilton Anatole in Dallas from April 4th – 6th. The meeting’s focus is “The Laser-Systemic Connection: Lighting the Way to a Healthier Mouth and Body.”
The ALD invites researchers, academicians, dentists and dental professionals from around the world to submit abstracts for presentation and welcomes topics that support the overarching theme of “The Laser-Systemic Connection: Lighting the Way to a Healthier Mouth and Body,” such as:
·       The use of lasers and light technology in today’s dental practice
·       Scientific research
·       Clinical tips and techniques
·       Future applications
·       Professional administration and growth for the entire team
This is an opportunity to share your research, knowledge and best practices with international colleagues passionate about the use of lasers in all areas of dentistry. For more details and to submit your abstract, visit http://bit.ly/2lb2GvE.
We’re very excited about the theme of ALD 2019,” said ALD executive director Gail Siminovsky, CAE.
“For decades, ALD members were the unsung heroes of oral-systemic health. First by applying laser
technology to treat periodontal disease and more recently, by applying light therapy to help patients
suffering from the oral mucositis side-effects of chemotherapy. ALD’s mission is being met as our CE meetings provide an open dialogue in improving patient care. Laser use in TMJ, sleep apnea and other medical conditions will all be included in the learning and discussion topics.”
Kicking off ALD 2019 will be keynote speaker Charles Whitney, MD, the nation’s leading physician advocate for bridging the oral-systemic gap. Dr. Whitney’s specialty of heart attack, stroke and dementia prevention relies heavily on collaborating the dental clinicians to accurately diagnose and effectively treat periodontal disease.
Dr. Whitney’s presentation will help ALD 2019 attendees connect the dots on how to bring the message of oral-systemic connections into their practices, “I love watching the lightbulb go on in the eyes of my audience when they learn how to take the oral-systemic message to the streets,” commented Whitney. “I hope I can help ALD members recognize that on a good day they can save a tooth and on a great day they can save a life! “
What’s more, Dr. Whitney has seen first-hand the beneficial effects of laser dentistry on his own patients. In fact, he recently referred one of his patients to ALD incoming president Dr. Mel Burchman, who successfully treated the patient’s chemo therapy-induced oral mucositis with photobiomodulation therapy.
“Securing Dr. Whitney as our opening keynote speaker will certainly set the tone for ALD 2019,” explains Siminovsky. “Our goal for this meeting is to be the world’s go-to event where the entire dental team can learn how to bridge the oral-systemic gap using laser technology. That’s why we’re currently building a conference curriculum to support this goal and our laser-systemic theme.”
Online registration for ALD 2019 will be open on July 15th by visiting http://bit.ly/2JPhAXp.
About the Academy of Laser Dentistry:  
The Academy of Laser Dentistry (ALD) is the only independent and unbiased non-profit association devoted to laser dentistry and includes clinicians, academicians and researchers in all laser wavelengths.  The Academy is devoted to clinical education, research, and the development of standards and guidelines for the safe and effective use of dental laser technology.  ALD was founded in 1993, with the merging of the International Academy of Laser Dentistry, the North American Academy of Laser Dentistry and the American Academy of Laser Dentistry.  For more information, visit www.LaserDentistry.org.
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