Literature Review | Chemotherapeutics
[PREVIOUS] | [NEXT]

Overview

Loesche, W.J. Chemotherapy of dental plaque infections. Oral Science Review. 9:65, 1976.

Rational for Chemotherapy

Nonspecific Plaque Hypothesis (NSPH): Based on mass of plaque as main factor. The patientıs oral hygiene is not efficient in decreasing mass plaque so chemical antimicrobials are used to control plaque mass.

Penicillin (PNC)
Topical

Animal studies: Mc Clure experimented with rats. Penicillin was placed in the water, resulting in inhibition of Gram + bacteria.

Human studies: Penicillin was placed in the dentifrice (100-1,000 Units) The studies were erratic, most of them unsupervised. Zander in 1950 completed a supervised study with school children. Tooth brushing was supervised using a dentrifice with PCN. This resulted in caries reduction 55% first year, 58% second year. Problem: Brushing with a dentrifice cause bacterial resistance.

Systemic

A Study with rheumatic fever children and glomerular nephritis that took PCN prophylaxis resulted in statistically significant reduction in caries. In Handelman study the patients were placed on PCN prophylaxis. The caries index was reduced 56-59%. When the patients were removed from the prophylaxis regimen the caries index increased. In conclusion, the use of PCN locally or systematically to decrease caries index is not recommended due to possible bacterial resistance.

Fluoride (Fl)

There is a Fl exchange with the apatite crystal forming a more stable compound, and also less soluble. A concentration of 10 ppm cause 50% reduction in synthesis of LPS. With 1-5 ppm there is 50% inhibition of synthesis of LPS by S. mutans. Topical application of Fl decreased 50% of caries. The SnFl (Crest) has a 20-25% DMFS compared to Colgate MFP which has a 10-37% decrease. In conclusion, an average tooth paste decrease caries 25%.

Fl gels

Flouride gels in high concentration levels caused 40% in caries reduction. In Cheektowagaıs study, school children were given NaF, and other group acidulated Fl. After 21 months, there was 75-80% caries reduction. Two years after treatment, there was 55-63% caries reduction. APF was better incorporated in the tooth.

Fl as antiplaque

Fluoride at high levels is bactericidal. The APF decrease caries, decrease plaque but will not eliminate S. mutans. The Fl could lower surface energy of tooth , thereby affecting bacterial attachment. In conclusion, Fluoride is a safe and effective cariostatic agent. It prevents caries even in suboptimal doses.

Chlorhexidine (CHX)

CHX has a high therapeutic index and appears to be one of the safest antiseptics. CHX 0.2% prevents plaque formation and gingivitis. There is 85-90% decrease in bacterial flora. CHX is not rapidly clear from the oral cavity. The data indicates that strong bacterial resistance to CHX is not likely to occur.

Metronidazole

Metronidazole is used for the treatment of trichomonas. It also helps in ANUG patients. Other uses include the treatment of protozoal infections.

Vancomycin

Vancomycin is effective against Gram+ bacteria. Studies showed a gross plaque reduction, also a decrease in gingivitis during antibiotic administration. Three weeks after therapy, plaque scores and gingivitis returned to baseline. It is effective in the treatment of infection but fails as a prophylactic agent.

Kanamycin

In a study, 25 days after paste treatment there was 57% plaque reduction. At 8 weeks there was no effect. This antibiotic may help in the treatment of retarded patient to try to control plaque. 
Back: Chemotherapeutic Articles
Menu: Literature Review Topics
Home: PIC Homepage
PERIODONTICS INFORMATION CENTER