Antibiotics prescribing habits of Brazilian general dental practitioners during periodontal treatments

Hábitos de prescrição de antibióticos de dentistas brasileiros durante tratamentos periodontais

Abstract

Introduction

Periodontal treatment involves procedures aimed to reduce bacterial load, involving or not the use of local or systemic antibiotics.

Objective

The purpose of this study was to assess Brazilian dentists’ knowledge about antibiotics prescription during periodontal treatment.

Material and method

An online questionnaire was available asking for systemic application of local or systemic antibiotics prescription (frequency, and sequence with mechanical periodontal treatment) and in relation to different periodontal diseases. The use of microbial diagnostic services and volunteers’ demographic data were also elucidated. Data were statistically analyzed (Binomial Test, p<0.05).

Result

Three hundred and ninety-three volunteers answered the questionnaire. Twenty-three percent males and 76.2% females. Average age was 27.7 years. Minority (19.2%) of the volunteers reported to indicate systemic antibiotics to treat gingivitis or periodontitis stages I and II (old slight and moderate chronic periodontitis). Majority of the professionals indicate it to treat periodontal abscess, necrotizing ulcerative gingivitis or periodontitis, periodontitis in severe immunodeficiencies, old aggressive periodontitis, and periodontitis stages III and IV (old severe chronic periodontitis). Rarely (2.5%) the prescription was without the combination with mechanical therapy. Microbiological tests as an auxiliary diagnostic method are rarely (3.1%) requested due to lack of information or cost. Most frequent answers about the number of times professionals reported prescribing systemic antibiotics as part of periodontal treatment per trimester was “at least once”, followed by “2 times”.

Conclusion

It can be concluded that Brazilian dentists have knowledge about the correct prescription of antibiotics in periodontal therapy.

Descriptors:
Dentistry; periodontics; antibiotics; questionnaire

Resumo

Introdução

O tratamento periodontal envolve procedimentos que visam reduzir a carga bacteriana, envolvendo ou não o uso de antibióticos locais ou sistêmicos.

Objetivo

O objetivo deste estudo foi avaliar o conhecimento dos cirurgiões-dentistas brasileiros sobre a prescrição de antibióticos durante o tratamento periodontal.

Material e método

Foi disponibilizado um questionário online solicitando aplicação sistêmica de prescrição de antibióticos locais ou sistêmicos (frequência e sequência com tratamento periodontal mecânico) e em relação a diferentes doenças periodontais. A utilização de serviços de diagnóstico microbiano e dados demográficos dos voluntários também foram elucidados. Os dados foram analisados estatisticamente (Teste Binomial, p<0,05).

Resultado

Trezentos e noventa e três voluntários responderam ao questionário. Vinte e três por cento do sexo masculino e 76,2% do sexo feminino. A idade média foi de 27,7 anos. A minoria (19,2%) dos voluntários relatou indicar antibióticos sistêmicos para tratamento de gengivite ou periodontite estágios I e II (antiga periodontite crônica leve e moderada). A maioria dos profissionais indica para tratar abscesso periodontal, gengivite ou periodontite ulcerativa necrosante, periodontite em imunodeficiências graves, periodontite agressiva antiga e periodontite estágios III e IV (periodontite crônica grave antiga). Raramente (2,5%) a prescrição foi sem a associação com terapia mecânica. Os exames microbiológicos como método auxiliar de diagnóstico raramente (3,1%) são solicitados por falta de informação ou custo. As respostas mais frequentes sobre o número de vezes que os profissionais relataram prescrever antibióticos sistêmicos como parte do tratamento periodontal por trimestre foram “pelo menos uma vez”, seguido de “2 vezes”.

Conclusão

Pode-se concluir que os cirurgiões-dentistas brasileiros possuem conhecimento sobre a correta prescrição de antibióticos na terapia periodontal.

Descritores:
Odontologia; periodontia; antibióticos; questionário

INTRODUCTION

Periodontium consists of tissues adjacent to the tooth: gingiva, periodontal ligament, root cementum and alveolar bone. Its role is to play the union between the tooth and the alveolar bone, protecting against masticatory forces, preserving the entire mucosa of the oral cavity¹. In pathological cases such as occlusal trauma, periodontal diseases (PD) and pulpoperiapical lesions, periodontal tissues may be destroyed².

PD correspond to an inflammatory tissue response to the presence of subgingival and supragingival biofilms. Anaerobic bacteria of the species Prevotella intermedia, Porphyromonas gingivalis and Fusobacterium nucleatum are the main etiological agents of the diseases, causing rupture of periodontal fibers and loss of bone support³. First clinical signs of PD are gingivitis, generating a red appearance in the gums, edema, and bleeding, without loss of attachment tissues⁴. If an adequate treatment is not carried out after the clinical manifestation of gingivitis, the disease may progress to periodontitis when the loss of connective tissue attachment, periodontal pocket formation and alveolar bone resorption, which can lead to tooth loss, will be observed⁵. Periodontitis can progress slowly or quickly and affect few (localized or incisor-molar pattern) or several teeth (generalized)⁶. It may also be associated with factors that accelerate its progression, such as diabetes and smoking.

With therapeutic basis, there are two types of periodontal treatment, in addition to the guidance of oral hygiene, which are conventional treatment and surgical one. The conventional treatment of periodontal diseases begins with a mechanical removal of bacterial plaque through scaling and root planing (SRP). If there is persistence of the biofilm, the use of an adjuvant antibiotic can be associated with the SRP. It has been shown that SRP combined with amoxicillin and metronidazole results in an improvement in clinical parameters when compared to SRP alone, reducing the depth of the medium and deep pockets⁷,⁸. Surgical treatment, on the other hand, should be indicated considering it can facilitate removal of subgingival deposits, the patient's infection control and, thus, increase the preservation of the periodontium in the long term¹.

In this context, it is important to emphasize that some dentists anticipate the prescription of antibiotics during the mechanical removal of bacterial plaque, even before the aggravation of these pockets so that there is no advanced periodontal disease and, consequently, lead to a surgical procedure, such as gingivectomy, original or modified Widman flap and mucogingival surgery¹,⁹. Antibiotics for periodontal diseases can be applied either systemically or locally. Systemic administration is more commonly used in periodontics when microorganisms are restrictedly distributed throughout the mucosa, namely, penicillin, amoxicillin, doxycycline, tetracycline, clindamycin and metronidazole¹⁰,¹¹. In local administration, on the other hand, it acts better on bacteria associated with the local biofilm and has a faster absorption at levels that cannot be reached by the systemic route; they are applied directly to the pockets in the form of gel or ointment, such as doxycycline gel and metronidazole gel¹¹.

Dentistry professionals should have a broad knowledge of drugs, especially antibiotics, as irrational use can cause bacterial resistance, causing undesired consequences for the patient and hindering treatment results¹². Scientific studies have evaluated the knowledge of dentists from Germany, Australia and the United Kingdom about the prescription of antibiotics during periodontal treatment¹³-¹⁶. To our knowledge, no study has been carried out in Brazil. Considering that the indiscriminate use of antibiotics can cause bacterial resistance, clinical relevance of the present study lies in to assess the knowledge of professionals about their proper prescription.

The purpose of the present study was to assess the knowledge of Brazilian dentists about the prescription of antibiotics during periodontal treatment. The hypothesis is professionals have knowledge about the correct use of these antimicrobials.

MATERIAL AND METHOD

Study design and ethical aspects

A cross-sectional study was carried out with Brazilian dentists through an online questionnaire. The professionals involved only participated in the research after a thorough explanation of their objectives and after reading the Informed Letter to the patient and signing the Informed Consent Form (FICF). This term included the description of how the dentist will be analyzed, ensuring the confidentiality of information, and disallowing any form of coercion or pressure for their voluntary participation.

Sample Calculation

For the sample calculation, a confidence level of 95% was considered, a proportion of 50% to obtain the highest possible n considered parameters and a sampling error equal to 5%. Thus, a minimum sample of 384 volunteers was obtained. Students in their final year of undergraduate Dentistry were also invited to participate in the research.

Inclusion and Exclusion Criteria

Questionnaire was carried out electronically through a website. Final year undergraduate students and general practitioner dentists who perform periodontal treatment in their clinical activities were invited to answer the questionnaire by means of an invitation via email and via social networks.

We included 1) final-year undergraduate students of a bachelor’s degree in Dentistry, 2) dentists with full graduation 3) dentists who despite having some specialty, they act as general practitioners.

Questionnaire

Questionnaire was previously validated, having been carried out in Germany and published by Falkenstein et al.¹⁵ Here, it was applied online and was designed to be a mix of qualitative and quantitative questions. Table 1 show the questions about local and systemic application of antimicrobials (substance, dose, frequency, and sequence with mechanical periodontal treatment), in relation to different periodontal diseases. In addition, the use of microbial diagnostic services was elucidated. Finally, participants were asked to provide personal information including age, gender, length of practice in Dentistry (in years) and participation in classes / courses / training in recent years.

Table 1
Questionnaire

1. Do you offer periodontal treatment in your office?
	Yes
	No, I do refer to the specialist (please, go to the question number 10)
2. For which of the following diseases do you usually recommend systemic use of antibiotics? (It is possible to select more than one option)
Diseases
	Biofilm-induced gingivitis in normal periodontium
	Biofilm-induced gingivitis in reduced periodontitis (old refractory periodontitis)
	Periodontitis stage I (old slight chronic periodontitis)
	Periodontitis stage II (old moderate chronic periodontitis)
	Periodontitis stages III and IV (old severe chronic periodontitis)
	Old aggressive periodontitis
	Periodontal abscess (pericoronary, gingival or periodontal)
	Necrotizing ulcerative gingivitis
	Necrotizing ulcerative periodontitis
	Periodontitis in severe immunodeficiencies (HIV, leukemia, etc.)
	Health in normal or reduced periodontal
3. Do you administer antibiotics (systemic) to perform periodontal treatment, as the sole therapeutic agent (without mechanical therapy)?
	Yes
	No, I do refer to the specialist (please, go to the question number 10)
4. At what point do you administer (systemic) antibiotics as adjuvants to mechanical therapy? (NOTE: refers to the treatment of periodontal disease and does not include cases of prophylactic antibiotic therapy)
	Before starting mechanical therapy
	During mechanical therapy
	After starting mechanical therapy
5. Do you use local antibiotics?
	No (please, go to the question number 7)
	Yes, for the following diseases: (it is possible to select more than one option)
			Chronic events (Ex: periodontitis)
			Acute events (Ex: periodontal abscess)
			Recurrent diseases (Ex: Biofilm-induced gingivitis in reduced periodontium (old refractory periodontitis)
			Others:
6. Which local antimicrobials do you prefer to use? (It is possible to select more than one option)
	Doxycycline
	Chlorhexidine
	Tetracycline
	Others:
7. Do you sometimes use microbiological tests to aid in the diagnosis of periodontitis?
	No (please, go to the question number 10)
	Yes
8. What microbiological tests do you use?
9. Why do you use microbiological tests? (It is possible to select more than one option)
	To choose the appropriate antibiotic therapy
	Suspicion of Aggregatibacter actinomycetemcomitans
	Improve patient motivation with poor oral hygiene
	For patients who have a private health plan
	To control therapy success
	Residual pockets
	Routinely in the following diseases:
	Others:
Please, go to the question number 11
10. Why you do not you use microbiological tests? (It is possible to select more than one option)
	High cost
	Lack of information
	I don't see advantages
	Bad experiences in the past
	Others:
11. How many years have you been practicing Dentistry?
12. How old are you?
13. What is your gender?
	Female
	Male
14. Over the past two years, I have participated in classes / courses / training on the use of antibiotics in the treatment of periodontitis
	Yes
	No
15. The number of times I prescribe (systemic) antibiotics as part of periodontal treatment, per trimester is:
	1
	2
	3
	4
	5
	More than 5

Analysis of the Results

The collected data were tabulated and submitted to an exploratory analysis. The binomial statistical test of questions number 1, 3, 4, 7 and 14 was performed, with a significance level of 5%.

RESULT

Demographics

Three hundred and ninety-three volunteers agreed to participate of the research and answered the questionnaire (16.6% students and 83.4% professionals). Twenty-three percent were male and 76.2% female. Average age was 27.7 years. The majority (84.7%) reported to offer periodontal treatment in the office, while 15.3% reported refer to a specialist. Half (51.7%) of the volunteers reported not having participated in classes, courses, or training on the use of antibiotics during periodontal treatment in the last two years.

Prescription Antibiotics and Microbiological Tests Asking

Fifty-one volunteers (almost 13%) reported to indicate systemic antibiotics to treat gingivitis or periodontitis stages I and II (old slight and moderate chronic periodontitis). Majority of the professionals indicate it to treat periodontal abscess, necrotizing ulcerative gingivitis or periodontitis, periodontitis in severe immunodeficiencies, old aggressive periodontitis, and periodontitis stages III and IV (old severe chronic periodontitis). Rarely (2.5%) the prescription was without the combination with mechanical therapy. Regarding the time when systemic antibiotics are indicated, the majority (60.2%) reported indicate it “before” or “after” mechanical therapy. The most frequent answers about the number of times professionals reported prescribing systemic antibiotics as part of periodontal treatment per trimester was “at least once”, followed by “2 times”. Figure 1 show frequencies of systemic antibiotic prescriptions.

Figure 1
Frequency of systemic antibiotic prescription.

Most professionals (59.8%) also reported the use of local agents. They usually indicate its use in chronic or acute events and recurrent diseases. Most used products were tetracycline (35.9%) and chlorhexidine (75.3%).

Microbiological tests as an auxiliary diagnostic method are rarely (3.1%) requested due to lack of information or cost.

Correlation between Answers and Classes/Courses/Training

For frequency of systemic antibiotics prescription “more than 5 times”, 21 volunteers reported have participated and 18 volunteers reported have not attended to classes/courses/training about the use of antibiotics during periodontal treatment.

Fifty-five percent of the 51 volunteers reported to indicate systemic antibiotics to treat gingivitis or periodontitis stages I and II did not attend to class/courses/training on this topic.

Table 2 show frequencies of systemic antibiotic prescriptions in different periodontal diseases (with or without generally accepted recommendation for antibiotic prescription).

Table 2
Percentages of systemic antibiotic prescriptions in different periodontal diseases

%	Periodontal diseases
Diseases without generally accepted recommendation for antibiotic prescription
0.3	Biofilm-induced gingivitis in normal periodontium
2.2	Biofilm-induced gingivitis in reduced periodontitis (old refractory periodontitis)
3.6	Periodontitis stage I (old slight chronic periodontitis)
12.5	Periodontitis stage II (old moderate chronic periodontitis)
0.6	Health in normal or reduced periodontal
Diseases with generally accepted recommendation for antibiotic prescription
39	Periodontitis stages III and IV (old severe chronic periodontitis)
46	Old aggressive periodontitis
84.1	Periodontal abscess (pericoronary, gingival or periodontal)
52.9	Necrotizing ulcerative gingivitis
67.7	Necrotizing ulcerative periodontitis
50.1	Periodontitis in severe immunodeficiencies (HIV, leukemia, etc.)
13.6	For cases where periodontal surgery is contraindicated

DISCUSSION

The hypothesis of the present study was Brazilian dentists have knowledge about the prescription of antibiotics during periodontal treatment. Hypothesis was partially accepted.

Only 13% of the volunteers reported to indicate systemic antibiotics to treat diseases without generally accepted recommendation for antibiotic prescription, such as gingivitis or periodontitis stages I and II (old slight and moderate chronic periodontitis). So, majority indicate it to diseases with generally accepted recommendation for antibiotic prescription (severe chronic periodontitis, aggressive periodontitis, periodontal abscess, necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis, periodontitis with underlying immunodeficiency and refractory periodontitis.

The importance of carrying out this study can be evidenced by other studies that demonstrated that the incorrect prescription of these drugs can lead to more serious complications such as microbial resistance¹⁷. The importance of combining antimicrobial substitutes for antibiotics has also been discussed recently in the literature. For example, antimicrobial photodynamic therapy (aPDT) has been suggested as a possible and effective complementary antimicrobial therapy¹⁸,¹⁹.

Antibiotics are drugs that kill or block the multiplication of bacteria at concentrations that are relatively innocuous to host tissues and can be used to treat infections caused by bacteria¹. Due to the difficulty of completely eliminating microorganisms by mechanical instrumentation alone during treatment periodontal disease, the use of antibiotics may be suggested as an additional therapy¹.

Several recent systematic reviews, with or without meta-analysis, were carried out evaluating the effectiveness of the combination of systemic antibiotics with non-surgical periodontal therapy (scaling and root planing)²⁰-²³. Although the results are still controversial, there seems to be a benefit from using of these drugs as a complementary therapy to conventional mechanical periodontal therapy¹⁹,²⁰,²⁴.

In the present study, it was observed that different types of antibiotics are indicated in periodontal therapy, and the most suggested was tetracycline. In this context, it is important to consider that the professionals also indicated that this prescription should be applied locally and not systemically. Regarding the systemic use of antibiotics during periodontal therapy, the most effective and recommended prescription is amoxicillin combined with metronidazole¹. However, studies have also evaluated other drugs as a possibility of complementary therapy. Kaufmann et al.¹⁹ evaluated the effectiveness of amoxicillin combined with metronidazole or azithromycin. The two prescriptions seem to have promoted the same clinical results, suggesting that azithromycin may also be indicated in periodontal treatment.

The correct or incorrect performance of periodontal therapy can have an impact on the general health of patients. For example, the glycemic control of diabetic patients can be influenced by their periodontal condition²³-²⁵. It has been shown that patients' glycated hemoglobin levels have been significantly reduced after periodontal treatment²³. The use of antibiotics complementary to scaling in the treatment outcome of these patients also was evaluated²⁴,²⁵. Yap et al.²⁴ and Cao et al.²⁵ observed that doxycycline therapy in addition to mechanical therapy resulted in considerable improvement in periodontal indices.

Regarding the time when antibiotics should be suggested, most indicated that they should be prescribed before or after mechanical therapy (scraping). In addition, they rarely indicate the drug prescription without its realization. These results are also in line with what the literature suggests about the benefits of combination therapies. Since the amount of medication that reaches the gingival sulcus is very small and the biofilm formed on the surface of the teeth can resist the presence of antimicrobials, the use of antibiotics without performing the debridement of the area is not indicated to disorganize the tooth. biofilm¹.

Around the world, the results observed regarding the prescription of antibiotics were controversial. Cope et al.¹⁴ assessed the extent to which antibiotic prescribing in general dental practice conforms to clinical guidelines and to describe factors associated with antibiotic prescription in the absence of spreading infection or systemic involvement. A cross-sectional study of the management of adult patients with acute dental conditions was performed. The authors observed in United Kingdom a high level of inappropriate antibiotic prescribing was observed amongst the 45 general dental practitioners. Features of the healthcare environment, such as clinical time pressures, and patient-related characteristics, such as expectations for antibiotics and refusal of operative treatment, are associated with antibiotic prescribing in the absence of infection. They concluded that individuals responsible for the commissioning and delivery of dental services should seek to develop targeted interventions addressing these issues to ensure optimal antimicrobial stewardship within dentistry. Ong et al.¹³ observed through an online questionnaire surveyed to 38 Australian periodontists that systemic antibiotics are widely used by the group of professionals with varying rates and patterns for different periodontal and peri-implant conditions. The authors concluded there is need for recommendations and guidelines in the prescription of antibiotics for periodontal and peri-implant conditions. Falkenstein et al.¹⁵ obtained 407 reports in German to its survey that was the reference to the present study. They found positive trends regarding position-paper conform prescribing habits after applying the questionnaire to dental practitioners. The results corroborate those observed here. Twenty for percent of the professionals prescribed antibiotics prior to mechanical therapy, while most dentists followed the recommended sequence. They concluded continuing educational campaigns and strictly expressed real guidelines are needed once inappropriate prescriptions of antibiotics still remain conspicuous. Jaunay et al.¹⁶ evaluated the prescribing habits of fifty-six general dental practitioners of South Australian. They have found appropriate level of knowledge of antibiotic prescription. However, there was a tendency toward over-prescription and a demonstrated lack of knowledge of the incidence of adverse reactions, development of multiresistant strains and prophylaxis against bacterial endocarditis. Conclusion was these issues must be discussed and the profession is urged to reconsider and re-educate itself on these challenges.

Considering the small number of studies carried out around the world and the controversial results among these studies, it is important to turn the attention of universities and dental schools to reinforce the importance of correct prescription of antibiotics and the clinical consequences of not doing so. Even in the studies concluded that professionals have adequate knowledge, the number of professionals evaluated was very small. Further research in this area may provide more information on the topic.

CONCLUSION

Within the limits of the present study, it can be concluded that Brazilian dentists have knowledge about the correct prescription of antibiotics in periodontal therapy.

• How to cite: Ceribelli AO, Alves BSB, Tajima TMN, Martins CM, Batista VES, Santinoni CS. Antibiotics prescribing habits of Brazilian general dental practitioners during periodontal treatments. Rev Odontol UNESP. 2023;52:e20230026. https://doi.org/10.1590/1807-2577.02623

REFERENCES

• ¹
  Berglundh T, Giannobile WV, Lang NP, Sanz M. Clinical periodontology and implant dentistry. 7th ed. Hoboken: Wiley-Blackwell; 2021.
• ²
  Mortazavi H, Baharvand M. Review of common conditions associated with periodontal ligament widening. Imaging Sci Dent. 2016 Dec;46(4):229-37. http://dx.doi.org/10.5624/isd.2016.46.4.229 PMid:28035300.
  » http://dx.doi.org/10.5624/isd.2016.46.4.229
• ³
  Kinane DF, Stathopoulou PG, Papapanou PN. Periodontal diseases. Nat Rev Dis Primers. 2017 Jun;3(1):17038. http://dx.doi.org/10.1038/nrdp.2017.38 PMid:28805207.
  » http://dx.doi.org/10.1038/nrdp.2017.38
• ⁴
  Murakami S, Mealey BL, Mariotti A, Chapple ILC. Dental plaque-induced gingival conditions. J Periodontol. 2018 Jun;89(Suppl 1):S17-27. http://dx.doi.org/10.1002/JPER.17-0095 PMid:29926958.
  » http://dx.doi.org/10.1002/JPER.17-0095
• ⁵
  Highfield J. Diagnosis and classification of periodontal disease. Aust Dent J. 2009 Sep;54(Suppl 1):S11-26. http://dx.doi.org/10.1111/j.1834-7819.2009.01140.x PMid:19737262.
  » http://dx.doi.org/10.1111/j.1834-7819.2009.01140.x
• ⁶
  Albandar JM. Aggressive periodontitis: case definition and diagnostic criteria. Periodontol 2000. 2014 Jun;65(1):13-26. http://dx.doi.org/10.1111/prd.12014 PMid:24738584.
  » http://dx.doi.org/10.1111/prd.12014
• ⁷
  Nibali L, Koidou VP, Hamborg T, Donos N. Empirical or microbiologically guided systemic antimicrobials as adjuncts to non-surgical periodontal therapy? A systematic review. J Clin Periodontol. 2019 Oct;46(10):999-1012. http://dx.doi.org/10.1111/jcpe.13164 PMid:31254278.
  » http://dx.doi.org/10.1111/jcpe.13164
• ⁸
  Keestra JA, Grosjean I, Coucke W, Quirynen M, Teughels W. Non-surgical periodontal therapy with systemic antibiotics in patients with untreated chronic periodontitis: a systematic review and meta-analysis. J Periodontal Res. 2015 Jun;50(3):294-314. http://dx.doi.org/10.1111/jre.12221 PMid:25142259.
  » http://dx.doi.org/10.1111/jre.12221
• ⁹
  Amorim AG, Gurgel BCV. Uso de antibióticos sistêmicos adjuntos à raspagem e alisamento radicular no tratamento da periodontite crônica e periodontite agressiva: uma revisão integrativa da literatura. Periodontia. 2016;26(1):39-48.
• ¹⁰
  Pretzl B, Sälzer S, Ehmke B, Schlagenhauf U, Dannewitz B, Dommisch H, et al. Administration of systemic antibiotics during non-surgical periodontal therapy-a consensus report. Clin Oral Investig. 2019 Jul;23(7):3073-85. http://dx.doi.org/10.1007/s00784-018-2727-0 PMid:30374830.
  » http://dx.doi.org/10.1007/s00784-018-2727-0
• ¹¹
  Krayer JW, Leite RS, Kirkwood KL. Non-surgical chemotherapeutic treatment strategies for the management of periodontal diseases. Dent Clin North Am. 2010 Jan;54(1):13-33. http://dx.doi.org/10.1016/j.cden.2009.08.010 PMid:20103470.
  » http://dx.doi.org/10.1016/j.cden.2009.08.010
• ¹²
  Davies J, Davies D. Origins and evolution of antibiotic resistance. Microbiol Mol Biol Rev. 2010 Sep;74(3):417-33. http://dx.doi.org/10.1128/MMBR.00016-10 PMid:20805405.
  » http://dx.doi.org/10.1128/MMBR.00016-10
• ¹³
  Ong A, Kim J, Loo S, Quaranta A, Rincon AJC. Prescribing trends of systemic antibiotics by periodontists in Australia. J Periodontol. 2019 Sep;90(9):982-92. http://dx.doi.org/10.1002/JPER.18-0586 PMid:30825215.
  » http://dx.doi.org/10.1002/JPER.18-0586
• ¹⁴
  Cope AL, Francis NA, Wood F, Chestnutt IG. Antibiotic prescribing in UK general dental practice: a cross-sectional study. Community Dent Oral Epidemiol. 2016 Apr;44(2):145-53. http://dx.doi.org/10.1111/cdoe.12199 PMid:26507098.
  » http://dx.doi.org/10.1111/cdoe.12199
• ¹⁵
  Falkenstein S, Stein JM, Henne K, Conrads G. Trends in antibiotic use and microbial diagnostics in periodontal treatment: comparing surveys of German dentists in a ten-year period. Clin Oral Investig. 2016 Nov;20(8):2203-10. http://dx.doi.org/10.1007/s00784-016-1722-6 PMid:26795626.
  » http://dx.doi.org/10.1007/s00784-016-1722-6
• ¹⁶
  Jaunay T, Sambrook P, Goss A. Antibiotic prescribing practices by South Australian general dental practitioners. Aust Dent J. 2000 Sep;45(3):179-86, quiz 214. http://dx.doi.org/10.1111/j.1834-7819.2000.tb00554.x PMid:11062935.
  » http://dx.doi.org/10.1111/j.1834-7819.2000.tb00554.x
• ¹⁷
  Abdallaoui-Maan L, Bouziane A. Effects of timing of adjunctive systemic antibiotics on the clinical outcome of periodontal therapy: a systematic review. J Clin Exp Dent. 2020 Mar;12(3):e300-9. http://dx.doi.org/10.4317/jced.56324 PMid:32190202.
  » http://dx.doi.org/10.4317/jced.56324
• ¹⁸
  Khattri S, Kumbargere Nagraj S, Arora A, Eachempati P, Kusum CK, Bhat KG, et al. Adjunctive systemic antimicrobials for the non-surgical treatment of periodontitis. Cochrane Database Syst Rev. 2020 Nov;11(11):CD012568. http://dx.doi.org/10.1002/14651858.CD012568.pub2 PMid:33197289.
  » http://dx.doi.org/10.1002/14651858.CD012568.pub2
• ¹⁹
  Kaufmann ME, Lenherr P, Walter C, Wiedemeier DB, Attin T, Schmidlin PR. Systemically administered amoxicillin/ metronidazole versus azithromycin as adjuncts to subgingival instrumentation during non-surgical periodontal therapy. A systematic review. Swiss Dent J. 2020 Jul;130(7-8):572-83. PMid:32515568.
• ²⁰
  Munasur SL, Turawa EB, Chikte UME, Musekiwa A. Mechanical debridement with antibiotics in the treatment of chronic periodontitis: effect on systemic biomarkers-a systematic review. Int J Environ Res Public Health. 2020 Aug;17(15):5601. http://dx.doi.org/10.3390/ijerph17155601 PMid:32756461.
  » http://dx.doi.org/10.3390/ijerph17155601
• ²¹
  Souza EQM, da Rocha TE, Toro LF, Guiati IZ, Ervolino E, Garcia VG, et al. Antimicrobial photodynamic therapy compared to systemic antibiotic therapy in non-surgical treatment of periodontitis: systematic review and meta-analysis. Photodiagn Photodyn Ther. 2020 Sep;31:101808. http://dx.doi.org/10.1016/j.pdpdt.2020.101808 PMid:32413509.
  » http://dx.doi.org/10.1016/j.pdpdt.2020.101808
• ²²
  Zhao Y, Pu R, Qian Y, Shi J, Si M. Antimicrobial photodynamic therapy versus antibiotics as an adjunct in the treatment of periodontitis and peri-implantitis: A systematic review and meta-analysis. Photodiagn Photodyn Ther. 2021 Jun;34:102231. http://dx.doi.org/10.1016/j.pdpdt.2021.102231 PMid:33621702.
  » http://dx.doi.org/10.1016/j.pdpdt.2021.102231
• ²³
  Jain A, Gupta J, Bansal D, Sood S, Gupta S, Jain A. Effect of scaling and root planing as monotherapy on glycemic control in patients of Type 2 diabetes with chronic periodontitis: a systematic review and meta-analysis. J Indian Soc Periodontol. 2019 Jul-Aug;23(4):303-10. http://dx.doi.org/10.4103/jisp.jisp_417_18 PMid:31367125.
  » http://dx.doi.org/10.4103/jisp.jisp_417_18
• ²⁴
  Yap KCH, Pulikkotil SJ. Systemic doxycycline as an adjunct to scaling and root planing in diabetic patients with periodontitis: a systematic review and meta-analysis. BMC Oral Health. 2019 Sep;19(1):209. http://dx.doi.org/10.1186/s12903-019-0873-7 PMid:31488125.
  » http://dx.doi.org/10.1186/s12903-019-0873-7
• ²⁵
  Cao R, Li Q, Wu Q, Yao M, Chen Y, Zhou H. Effect of non-surgical periodontal therapy on glycemic control of type 2 diabetes mellitus: a systematic review and Bayesian network meta-analysis. BMC Oral Health. 2019 Aug;19(1):176. http://dx.doi.org/10.1186/s12903-019-0829-y PMid:31387569.
  » http://dx.doi.org/10.1186/s12903-019-0829-y

Publication Dates

• Publication in this collection
  27 Nov 2023
• Date of issue
  2023

History

• Received
  19 Oct 2023
• Accepted
  23 Oct 2023