Antibiotics in the The basis of a decision to use or not to use antibiotics is essentially a balancing of those factors that tend to

Practice of Periodontics require their use against those factors that tend to ob- viate the need for them.

ANTIBIOTICS ARE NOT innocuous drugs. Their use should be justified on the basis of a clearly established need and should not be substituted for adequate local treat- ment. The purpose of this paper is to review the funda- mental considerations that form the basis for the ad- ministration of antibiotics in the practice of periodon- tics. Indications for therapeutic and prophylactic use will be discussed separately.

Therapeutic indications for the use of antibiotics pre- suppose an existing infection. The decision to use anti- biotics therapeutically must be based on a consideration of both the nature of the infection and the general health of the patient. The following guidelines apply:

Certain special considerations should be discussed relative to acute necrotizing ulcerative gingivitis, acute (primary) herpetic gingivostomatitis, and recurrent aph- thous stomatitis.

Acute Necrotizing Ulcerative Gingivitis

Acute necrotizing ulcerative girlgivitis (ANUG) is believed to have a relatively specific bacterial compo- nent and should be considered within the therapeutic category. However, it is well established that in ANUG all local irritants must be removed and that antibiotic therapy is adjunctive treatment required only in special cases.

What are the special cases? According to Glickman,l "Antibiotics are administered systemically in patients with toxic systemic complications or local adenopathy." Prichard2 states that antibiotics should be prescribed for ANUG if adequate local treatment cannot be provided 1. It is obvious that severe, acute, rapidly spreading immediately. He further states that the acute symptoms infections should be treated with antibiotics. The less will be suppressed by antibiotic therapy but will recur

severe, localized infections where drainage can be estab- unless adequate local therapy follows. Discussing the lished will, in most cases, be resolved without the use of use of antibiotics in ANUG, Goldman and CohenS say,

antibiotics. "A case can be made for their use in acute fulminating

2. Evidences of systemic involvement, such as an cases in conjunction with local therapy, but the adminis- elevated temperature, general malaise, and lymphaden- tration must be carried out with caution and close Super- opathy, frequently indicate a need for antibiotics. vision."

3. Infections in patients with certain systemic condi- tions that predispose to the spread of infection generally requite antibiotic therapy. Examples of such systemic conditions are (a ) uncontrolled diabetes, (b) leukemia, (c) agranulocytosis, (d) aplastic anemia, (e) Addison's disease, (f) depressed natural defense mechanisms as a result of therapy with adrenal steroids and immunosup- pressive and cytotoxic drugs, (g) history of rheumatic or congenital heart disease, and (h) debilitation by age or disease.

4. Infections involving the region of the upper lip and nose can be serious because of venous drainage into the cavernous sinus. Antibiotics may be advantageous for combating infections in this region that would other- wise not require antibiotic therapy.

In general, antibiotics should not be used routinely in the treatment of ANUG. They are seldom necessary, and their indiscriminate use is a highly undesirable practice. Although antibiotics will suppress the acute symptoms of ANUG, they are strictly adjunctive to lo- cal treatment and are indicated only in severe cases with systemic involvement. As with other infections, the pa- tient's general health should be considered in determin- ing a need for these drugs. Some further justification may exist for the use of antibiotics in cases of ANUG that are tenaciously resistant to local treatment." How- ever, in these instances one must determine the reason for the resistance to local treatment rather than insti- tute antibiotic therapy as a substitute for complete evaluation of the patient.

Penicillin, erythromycin, and the tetracyclines are ef- Commander, DC, U S N ; Head. Research and Sciences Depart- fective against ANUG. ~ l ~ h ~ ~ ~ h specific studies have

ment, Naval Dental School, National Naval Medical Center, Bethesda, Md. not been reported, it is likely that lincomycin and clinda-

The opinions or assertions contained herein are the private mycin would also be useful. There is some recent evi- ones of the writer and are not to be construed as official or as reflecting the views o f the Navy Department or the naval service dence that the antitrichromonal drug metronidazole may at large. also be effective." 6

Volume 42 Number 9 Antibiotics in Periodontics 585

TABLE 1 Suggested Adult Dosage Schedules for Prevention of Bacterial

Endocarditis (Adapted from American Heart Association Statementl6) :'

PARENTERAL SCHEDULE (Preferred) Day of Procedure (1 to 2 hours before procedure)

600,000 units procaine penicillin G (IM) and 600,000 units K penicillin G (IM)

For 2 Days After Procedure 600,000 units procaine penicillin G (IM) daily

ORAL SCHEDULE Day o f and 2 Days After Procedure

Penicillin V or phenethicillin (250 mg every 6 hours) or K penicillin G (300 mg every 6 hours) also: an extra dose 1 hour before procedure

PENICILLIN ALLERGY Day o f and 2 Days Af ter Procedure

Erythromycin (250 mg every 6 hours) 'The American Heart Association and the American Dental

Association are currently considering changes to these recom- mendations. Any changes that evolve should be promulgated in late 1971.

It is not particularly surprising that the topical use of vancomycin has been demonstrated to be effective against ANUG.'. However, the fact that an antibiotic is applied locally rather than systemically does not ne- gate the previously stated objections to routine antibiotic therapy in ANUG. In actuality, the topical application of any parenterally useful drug is open to some question. This is particularly true if the application is made rou- tinely. Although the parenteral use of vancomycin against serious staphylococcic infection has declined since the advent of the penicillinase-resistant penicillins,

' its widespread use against a rather simply treated condi- tion such as ANUG may, through the development of patient allergies and bacterial resistance, complicate the treatment of some life-threatening infections. Over the past several years, staphylococci have appeared that are not susceptible to the penicillinase-resistant penicillins. Fosterg stated in a 1969 issue of Medical Clinics of North America, "Vancomycin is our most reliable single agent against penicillin-resistant staphylococci, and its value happily extends over much of the rest of the gram- positive spectrum as does that of penicillin." Although this may not represent a universally accepted view, it does indicate that there are physicians who rely heavily on this drug for certain severe infections. It would ap- pear that the topical use of vancomycin might be justi- fied in severe cases of ANUG or where the patient is physically or mentally incapable of adequate coopera- tion. At any rate, one should not apply vancomycin in the routine treatment of ANUG.

Acute(Primary) Herpetic Gingivostomatitis Since this infection is of viral etiology, antibiotic ther-

apy is helpful only in case of secondary infection. How- ever, some patients are said to experience relief follow-

ing the use of tetracyclines.10 It is possible that some "herpetic" lesions that respond to tetracyclines are ac- tually recurrent aphthae or are secondarily infected. Since acute herpetic gingivostomatitis may be associated with upper respiratory infection, pneumonia, and other systemic disease, examination by a physician is fre- quently indicated. Many pediatricians treat severe cases of herpetic gingivostornatitis prophylactically with anti- biotics. The value of this precautionary treatment is not established.

Recurrent Aphthous Stomatitis It appears that a pleomorphic streptococcus may be

involved in the pathogenesis of recurrent aphthous sto- matitis.ll-I* Graykowski et all1 reported that 69% of the cases of recurrent aphthae studied responded to tetracycline in a 250 mg/5 ml suspension given four times daily for five to seven days. The suspension (5 ml for adults) was held in the mouth for two minutes and then swallowed. Any advantage of holding the suspen- sion in the mouth for two minutes as opposed to the use of tetracycline capsules or tablets is not established. Tetracycline mouthwashes have also been reported to be helpful against recurrent aphthous stomatitis by Gug- genheimer and coworkers.]"

The prophylactic use of antibiotics anticipates the likelihood of a new infection or the exacerbation of an existing infection. A definitive indication for prophy- lactic antibiotic coverage is present when a patient with rheumatic or congenital heart disease is to undergo pro- cedures that may precipitate a bacteremia. The Amer- ican Heart Association has published a statement16 dis- cussing the rationale for prophylactic coverage and giving suggested dosage schedules (see Table 1 ) . It has been suggested that antibiotic prophylaxis for patients with heart prostheses should be much more extensive than that which is considered adequate in patients with rheumatic or congenital heart disease. A regimen that has been employed at the National Heart Institute, Na- tional Institutes of Health, has been reported.li Unfor- tunately, most prophylactic indications are not so defi- nite as these instances in which prophylaxis against sub- acute bacterial endocarditis is required.

Some practitioners routinely provide antibiotic cover- age for surgical patients on the premise that such pro- phylaxis may avert postsurgical infection, enhance the surgical results, and/or reduce postoperative discomfort.

Prevention of Postsurgical Infections The use of antibiotics to prevent postsurgical infec-

tions has been challenged in medical practice. In 1966, Karl and co-workersls reported a double-blind study of

586 Holroyd J. Periodont. September, 1971

150 surgical cases. They found a wound infection rate of 18.5 % in those patients receiving antibiotics prophy- lactically and 12.9% in the control group. In an assess- ment of the prophylactic value of antibiotics in over 1,000 cases of general surgery, Johnstone1g observed that ". . . prophylactic antibiotics not only failed to pre- vent but also were in fact associated with an increase in the infections of all types." The failure of prophylactic antibiotic therapy to prevent postoperative infections is well documented in the medical l i t e ra t~re . l~-~l Unfortu- nately, similar dental evaluations are not available. One must view with some concern the philosophy of rou- tinely using antibiotics prophylactically in an attempt to prevent postsurgical infections. Unquestionably, con- cern for aseptic and atraumatic operating techniques is of great importance.

Most patients who undergo periodontal surgery are not going to develop a postoperative infection. Infec- tions that do evolve might have been prevented by pro- phylactic antibiotics if the invading organism was sus- ceptible to the pasticular drug selected. It is apparent from medical studies that some individuals who would not have developed a postoperative infection may do so if prophylactic antibiotics are used. The mechanism of this may be related to alterations in the normal flora which were induced by the antibiotic. Thus, in the final analysis, one must balance the infections he prevents with antibiotics against the infections he causes with anti- biotics. If the medical literature on this subject accu- rately reflects the situation in periodontal surgery, the gains and losses in using antibiotics to prevent postsur- gical infection are approximately equal. One's capacity to gain more than he loses from using antibiotics to prevent postsurgical infections is likely to be propor- tional to his ability to predict the likelihood of a post- operative infection in a particular case.

Enhancement of Surgical Results Many practitioners use antibiotics routinely in bone

grafting procedures and when attempting to establish a new attachment at a more coronal level. Although some logic underlies such use, no significant research evidence is available to indicate that antibiotics are necessary or even helpful in obtaining the desired result.

In regard to healing generally, Stah132 reported that rats receiving antibiotics showed more distinctive crestal bone repair than did control rats in the early stages of healing; however, ". . . the beneficial potential of these drugs did not, under our experimental conditions, influ- ence ultimate repair levels.'' In further studies with rats, Stahl concluded that antibiotics enhanced connective tis- sue reattachment,33 but he later reported that the bene- fits noted had been the result of an effect of the anti- biotic on pulpal repair rather than on the reattachment

potential of the soft tissue." In 1964, StahlY5 reported that an experimental group of protein-deprived rats, treated with antibiotics following gingival wounds, ex- hibited more crestal osteogenesis than did a control group. Because of the superimposition of a nutritional deficiency, it is difficult to apply these results to the present discussion of the clinical use of antibiotics. Also in 1964, Schafer and his associates36 reported a favor- able effect of antibiotics on healing following osseous contouring in dogs.

In 1969, Stahl and c o - w ~ r k e r s ~ ~ reported the results of a clinical study of the effects of antibiotics in 48 pa- tients. All subjects received l Gm erythromycin stearate per day (four divided doses) for four days following a gingivectomy. Histologic analyses were made of the tis- sues removed by gingivectomy and biopsies taken at 1, 2, 3, 4, 6, and 8 weeks after surgery.

They showed differences in the inflammatory state of the tissues before and after gingivectomy. No compari- son was discussed between the inflammatory state of the postoperative biopsies taken from antibiotic treated and non-antibiotic treated patients. Since all subjects in this report received antibiotics, such a control compari- son would have had to be drawn from other studies. They further reported that the epithelialization of all wounds appeared to be complete within the first week after surgery. They contrasted this with epithelializa- tion obtained in only 61 % to 78% of biopsy specimens in earlier studies.38~ 39

Although the foregoing studies have made significant contributions to the understanding of the effect of anti- biotics on wound healing, they cannot be considered adequate justification for the use of antibiotics to en- hance the results of periodontal surgery. In this area, the use of antibiotics continues to be highly speculative.

Reduction o f Postoperative Discomfort The reduction of postoperative discomfort is inti-

mately related to the rate of wound healing. As previ- ously stated, antibiotic-wound healing studies are in- conclusive. However, AriaudodO has published a report of a double-blind study which found that lincomycin (500 mg, q.6 h., two days before and four days after surgery) reduced the incidence of malaise, edema, ne- crosis and pain following periodontal surgery. This pa- per raises most interesting possibilities, and further studies in this area are indicated.

Periodontal Dressings Antibiotics have been used in periodontal dressings.

In 1956, Fraleigh4I reported that he had observed cer- tain advantages in a pack containing a tetracycline, but he also found undesirable tissue reactions. In 1958,

Volume 42 Number 9 Antibiotics in Periodontics 587

Baer, et al49eported favorably on a dressing containing bacitracin, which was said to afford maximum patient

- comfort with cleaner, less stained teeth and with less associated debris. They observed no allergic or fungal complications. In 1960, Baer and his co-workers43 de- scribed a hydrogenated fat-bacitracin pack, and again the report was favorable. In two years of study, they observed only one case of infection with Candida al- bicans. Later, R ~ m a n o w ~ ~ studied the relationship be- tween moniliasis and periodontal packs containing anti- biotics. With tetracycline and oxytetracycline packs, he observed both stomatitis and moniliasis. With bacitracin packs, he found neither stomatitis nor any signs or symptoms of moniliasis though he noted an increase in the presence of C. albicans.

From the foregoing studies, it would seem that packs containing tetracyclines are undesirable, whereas baci- tracin packs appear to offer certain advantages and to have no clinically significant disadvantages. At this point it should again be noted that the topical use of any parenterally useful antibiotic is subject to question. Bacitracin is primarily a topical antibiotic and is there- fore relatively free from this disadvantage.

Bacterial Plaque and Gingivitis With a relationship between bacteria and periodontal

disease well established, it logically followed that efforts would be made to observe the effects of antibiotics on dental plaque, gingivitis and periodontitis. The addition of penicillin4j. 46 and chl~rtetracycline~~. 4g to the diet of rodents has been shown to reduce plaque formation. Dietary penicillin, erythromycin, polymyxin B, and oxy- tetracycline have been shown to be effective in the pre- vention or treatment of the periodontal syndrome in the rice rat.", Topical vancomycin has been reported to reduce plaque51 and to provide clinical improvement in gingivitis and various oral lesions in humans.52 A study of children on extended systemic penicillin prophylaxis did not reveal a significantly beneficial effect on gingival scores;53 however, systemic spiramycin has been shown to have beneficial effects on periodontal disease in hu- mans.54 Lobene and co-workers" have reported that the use of an erythromycin liquid suspension (250 mg q. 6 h.) for seven days reduced plaque formation by 35% and was particularly impressive in decreasing or elim- inating spirochetes for 5 to 18 weeks after administra- tion.

In a recent article, Bowers and co-workers56 stated that there is insufficient evidence at present to justify the general use of any antibiotic as a plaque control agent in the prevention and treatment of gingivitis and periodontitis. The literature indicates that although the use of antibiotics in attempts to control plaque and to improve nonspecific gingivitis and periodontitis appears to be a promising line of research, it is too early for

antibiotics to be generally used for these purposes. How- ever, this line of research represents what may ultimately be the most effective approach to the prevention of periodontal disease; that is, plaque control by pharma- cologic means.

In certain oral infections, such as ANUG and recur- rent aphthous stomatitis, the etiologic agents are rela- tively predictable on the basis of the diagnosis. As pre- viously stated, penicillin, erythromycin, and the tetra- cyclines are all effective against ANUG, and the tetra- cyclines appear to be effective to some degree against recurrent aphthous stomatitis. In these cases, the anti- biotic is selected on the basis of the diagnosis.

Streptococcus viridans is the organism of primary concern in subacute bacterial endocarditis. Therefore, in preventing subacute bacterial endocarditis, one is pri- marily concerned with S. viridans. Consequently, peni- cillin is the antibiotic of choice since it is highly effective against that organism. In this case, the drug is selected on the basis of what is known about the infection. Un- fortunately, periodontists must also treat many infec- tions in which the etiologic agents cannot be accurately predicted on the basis of the symptomatology. Ideally, in such cases, material from the infection should be cul- tured and sensitivity tests carried out to determine what antibiotic is effective against the specific etiologic agent. For practical reasons, however, periodontal infections are usually treated without the benefit of sensitivity tests. Most bacteria that are causative agents in perio- dontal abscesses and postoperative infections are within the antibacterial spectra of penicillin, erythromycin, the tetracyclines, lincomycin and clindamycin. In all fair- ness, it should be said that sensitivity tests will show that any of these antibiotics will be effective on the culture plate against most bacteria sampled from periodontal in- fections. Thus, the periodontist is justified in starting treatment with one of these drugs before obtaining the results of sensitivity tests for an infection that requires an antibiotic. The primary advantage of sensitivity tests is that they will let the clinician know whether he is dealing with a bacterium that is insensitive to the most com- monly effective drugs.

When an antibiotic is selected without the benefit of sensitivity tests, the choice is essentially between peni- cillin, erythromycin, the tetracyclines, and possibly lin- comycin and clindamycin. The selection of a specific antibiotic should be based on a knowledge of the phar- macology of the individual drugs. Unquestionably, peni- cillin is the drug of choice when a potent bactericidal agent is required. However, the periodontist must always remember that penicillin is the most allergenic drug in current use and should never be used arbitrarily; it should be selected only on the basis of an established

588 Holroyd J. Periodont. September, 1971

need for penicillin. When such need exists but the use of penicillin is contraindicated because of patient allergy, erythromycin and sodium cephalothin are usually good substitutes. The principal disadvantage of sodium ceph- alothin in dentistry is the fact that only parenteral forms are available. However, this antibiotic may be of great importance in serious infections caused by organisms that are not affected by penicillin. Clindamycin may also be effective in this regard. Where bacteriostatic action will suffice, the tetracyclines should be effective.

How frequently a particular clinician will use peni- cillin instead of a bacteriostatic drug depends on his philosophy regarding the need for any antibiotic. The clinician who accepts a very narrow range of indications for antibiotics will usually need a potent bactericidal agent if he feels that he needs any antibiotic. This in- dividual should use penicillin in most cases. Although he would be using penicillin almost exclusively, he would not necessarily be using it indiscriminately. O n the other hand, some clinicians accept a very broad range of indications for antibiotics and use them in many situations where bacteriostatic drugs would be adequate. If these individuals use penicillin almost ex- clusively, they will be using it indiscriminately.

I n this limited discussion of the antibiotic of choice, no attempt has been made to resolve the question of which drug to use but only to stress the fact that an antibiotic should not be chosen arbitrarily but should be selected to meet the needs of the case. This selection must be based upon a knowledge of (1) the state of the patient's general health, (2) the nature of the spe- cific infection involved, and (3) the pharmacology of the drugs available.

SUMMARY The use of antibiotics involves certain disadvantages

as well as advantages. Consequently, the decision to use these drugs should be based on an established need. Points to be considered in establishing the need and selecting the proper drug have been presented.

REFERENCES I . Glicknian, I.: Clinical Periodontology, ed. 3. Phila-

delphia, W. B. Saunders Co., 1964, p. 679. 2. Prichard, J. F.: Advanced Periodontal Disease: Sur-

gical and Prosthetic Management. Philadelphia, W. B. Saun- ders Co., 1965, pp. 377-378.

3. Goldman, H. M. and Cohen, D. W.: Periodontal Ther- apy, ed. 4. St. Louis, C. V. Mosby Co., 1968, p. 204.

4. Graykowski, E. A. and Holroyd, S. V.: Therapeutic Management of Primary Herpes, Recurrent Labial Herpes, Aphthous Stomatitis, and Vincent's Infection. Dent. Clin. N. Amer., 14:721, 1970.

5. Stephen, K. W., McLatchie, M. F., Mason, D. K., Noble, H. W. and Stevenson, D. M.: Treatment of Acute ulcerative Gingivitis (Vincent's Type). Brit. Dent. J., 121: 313,1966.

6. Fletcher, 5. P. and Plant, C. G.: An Assessment of Metronidazole in the Treatment of Acute Ulcerative Pseudo- menlbranous Gingivitis (Vincent's Disease). Oral Surg., 22: 739, 1966.

7. Mitchell, D. F. and Baker, B. R.: Topical Antibiotic Control of Necrotizing Gingivitis. J. Periodont., 39:S 1, 1968.

8. Collins, J. F. and Hood, H. M.: Topical Antibiotic Treatment of Acute Necrotizing Ulcerative Gingivitis. J. Oral Med., 22.59, 1967.

9. Foster, F. P.: Emergency Treatment of Severe Bacte- rial Infection. Med. Clin. N. Amer., 53:437, 1969.

10. Burket, L. W.: Oral Medicine, ed. 3. Philadelphia, J. B. Lippincott Co., 1957, p. 136.

11. Graykowski, E. A., Barile, M. F., Lee, W. B. and Stanley, H. H.: Recurrent Aphthous Stonlatitis: Clinical, Therapeutic, Histopathologic, and Hypersensitivity Aspects. J.A.M.A., 196:637, 1966.

13. Barile, M. F. and Graykowski, E. A.: Primary Herpes, Recurrent Labial Herpes and Recurrent Aphthae and Peri- adenitis Aphthae: A Review with Some New Observations. J. Dist. Columbia D. Soc., 38:7, 1963.

13. Graykowski, E. A., Barile, M. F. and Stanley, H. R.: Periadenitis Aphthae, Clinical and Histopathological As- pects of Lesions in a Patient and of Lesions Produced in Rabbit Skin. J. Amer. Dent. Ass., 69:118, 1964.

14. Stanley: H. R., Graykowski, E. A. and Barile, M. F.: The Occurrence of Microorganisms in Microscopic Sections of Aphthous and Non-aphthous Lesions and Other Oral Tis- sues. Oral Surg., 18:335, 1964.

15. Guggenheimer, J., Brightman, V. J. and Ship? I. I.: Effect of Chlortetracycline Mouthrinses on the Healing of Recurrent Aphthous Ulcers: A Double-Blind Controlled Trial. J. Oral Ther., 4:406, 1968.

16. Committee on Prevention of Rheumatic Fever and Bacterial Endocarditis, Council on Rheumatic Fever and Congenital Heart Disease: Prevention of Bacterial Endo- carditis (EM 113A rev.). New York, American Heart Asso- ciation, 1965.

17. Archard, H. 0 . and Roberts, W. C.: Bacterial Endo- carditis after Dental Procedures in Patients with Aortic Valve Prosthesis. J. Amer. Dent. Ass., 72:648, 1966.

18. Karl, R. C., Mertz, J. J., Veith, F. J. and Dineen, P.: Prophylactic Antin~icrobial Drugs in Surgery. New Eng. J. Med., 275:305, 1966.

19. Johnstone, F. R. C.: An Asssessment of Prophylactic Antibiotics in General Surgery. Surg. Gynec. and Obstet., 116:1, 1963.

20. King, G. C.: The Case Against Antibiotic Prophylaxis in Major Head and Neck Surgery. Laryngoscope, 71:647, 1961.

21. Hognian, C. F. and Sahlin, 0.: Infections Complicat- ing Gastric Surgery. Acta. Chir. Scand. 112271, 1957.

22. Pulaski, E. J.: Antibiotics in Surgical Cases. Arch. Surg., 82:545, 1961.

23. McKittrick, L. S. and Wheelock, F. C.: The Routine Use of Antibio'tics in Elective Abdominal Surgery. Surg. Gynec. Obstet., 99:376, 1954.

24. Marshall, A.: Prophylactic Antimicrobial Therapy in Retropubic Prostatectomy. Brit. J. Urol., 3 1 :43 1, 1959.

25. Editorial, New Eng. J. Med., 275:335, 1966. 26. Petersdorf, R. G., Curtin, J. A. Hoeprick, P. D.,

Peeler, R. N. and Bennett, I. L.: Study of Antibiotic Prophy- laxis in Unconscious Patients. New Eng. J. Med., 257: 1001, 1957.

27. Petersdorf, R. G. and Merchant, R. K.: A Study of Antibiotic Prophylaxis in Patients with Acute Heart Failure. New Eng. J. Med., 265565, 1959.

Volume 42 Number 9 Antibiotics in Periodontics 589

28. Lachdjiam, M. 0 . and Compere, E. C.: Postopera- 43. Baer, P. N., Sumner, C. F. I11 and Scigliano, J.: Stud- tive Wound Infections in Orthopedic Surgery. J. Int. Coll. ies on a Hydrogenated Fat-Zinc Bacitracin Periodontal Surg. (Now Int. Surg.), 28:797, 1957. Dressing. Oral Surg., 13:494, 1960.

29. Laylor, G. W.: Preventive Use of Antibiotics in Sur- 44. Romanow, I.: The Relationship of Moniliasis to the gery. Brit. Med. Bull., 16:51, 1960. Presence of Antibiotics in Periodontal Packs. Periodontics,

30. Weinstein, L.: Chemoprophylaxis of Infection. Ann. 2:298, 1964. Intern. Med., 43287, 1955. 45. Mitchell, D. F. and Johnson, M.: The Nature of the

31. Cole, W. R. and Bernard, H. R.: A Reappraisal of Gingival Plaque in the Hamster-Production, Prevention, the Effects of Antimicrobial Therapy During the Course of and Removal. J. Dent. Res., 35:651, 1956. Appendicitis in Children. Amer. Surg., 27:29, 1961. 46. Keyes, P. H., Fitzgerald, R. J., Jordan: H. V. and

32. Stahl: S. S.: The Influence of Antibiotics on the Heal- White, C. L.: The Effect of Various Drugs on Caries and ing of Gingival Wounds in Rats. I. Alveolar Bone and Soft Periodontal Disease in Albino Hamsters. ORCA (Proc. of Tissue. J. Periodont., 33261, 1962. the Congress of the European Organization for Research

33. Stahl, S. S.: The Influence of Antibiotics on the Heal- on Fluorine and Dental Caries Prevention), 1962. pp. 159- ing of Gingival Wounds in Rats. 11. Reattachment Potential 177. of Soft and Calcified Tissues. J. Periodont., 34:166, 1963. 47. Rushton, M. A.: Dental Effects of Dietary Aureomy-

34. Stahl, S. S.: The Influence of Antibiotics on the Heal- cin. Brit. Dent. J., 98:313, 1955. ing of Gingival Wounds in Rats. 111. The Influence of Pulpal 48. Gressly, F. and Leung, S. W.: Preliminary Study of Necrosis on Gingival Reattachment Potential. J. Periodont., Calculus Formation in Rodents. I.A.D.R., 40:1S, 1962 (Ab- 34:371, 1963. stract).

35. Stahl, S. S.: The Healing of a Gingival Wound in 49. Gupta, 0 . P., Auskaps, A. M. and Shaw, J. H.: Perio- protein-~eprived, ~ ~ ~ i b i ~ ~ i ~ - ~ ~ , ~ ~ l ~ ~ ~ ~ ~ t ~ d ~ d ~ l ~ ~ ~ t ~ , Oral dontal Disease in the Rice Rat. IV. The Effects of Antibiotics Surg., 17:443, 1964. on the Incidence of Periodontal Lesions. Oral Surg., 10:

36. Schafer, T. J., Collings, C. K., Bishop, J. G. and Dor- 1169, 1957. man, H. L.: The Effect of Antibiotics on Healing Following 50. Shaw, J. H., Griffiths, D. and Auskaps, A. M.: The Osseous Contouring in Dogs. Periodontics, 2243, 1964. Influence of Antibiotics on the Periodontal Syndrome in the

37. Stahl, S. S., Soberman, A. and De Cesare, A,: Gingi- Rice Rat. J. Dent. Res., 40:511, 1961. 51. Mitchell, D. F. and Holmes, L. A.: Topical Anti- val Healing. V. The Effect of Antibiotics Administered Dur- biotic Control of Dentogingival Plaque, J. Periodont,, 36: ing the Early Stages of Repair. J. Periodont., 40:521, 1969. 202,1965. 38. Stahl, S. S., Witkin, G. J., Cantor, M. and Brown, R.: 52. Scopp, I. W., Gillette, W., Kumar, V. and Larato, D.: Gingival Healing. 11. Clinical and Histologic Repair Se- Treatment of Oral Lesions with Topically Applied Vanco- quences Following Gingivectomy. J. Periodont. 39:109, nlycin Hydrochloride. Oral Surg,, 24:703, 1967. 1968. 53. Littleton, N. W. and White, C. L.: Dental Findings

39. ~ t a h l , S. S., Witkin, G. J., Heller, A. and Brown, R.: from a Preliminary Study of Children Receiving Extended Gingival Healing. 1V. The Effects of Homecare on Gingivec- ~ ~ ~ i b i ~ ~ i ~ T - , ~ ~ ~ ~ ~ . J. A ~ ~ ~ . D ~ ~ ~ . A ~ ~ . , 68:520, 1964.

tomy Repair. J. Periodont., 40:264, 1969. 54. Winer, R. A., Cohen, M. M. and Chauncey, H. H.: 40. Ariaudo, A. A.: The Efficacy of Antibiotics in Perio- Antibiotic Therapy in Periodontal Disease. J. Oral Ther.,

dontal Surgery: A Controlled Study with Lincomyin and 2:403, 1966. Placebo in 68 Patients. J. Periodont., 40:150, 1969. 55. Lobene, R. R., Brion, M. and Socransky, S. S.: Effect

41. Fraleigh, C. M.: An Evaluation of Topical Terramy- of Erythromycin on Dental Plaque and Plaque Forming cin in Postgingivectomy Pack. J. Periodont., 27:201, 1956. Microorganisms of Man. J. Periodont., 40:287, 1969.

42. Baer, P. N., Goldman, H. M. and Scigliano, J.: 56. Bowers, G. M., Hardin, J. F. and Moffitt, W. C.: Studies on a Bacitracin Periodontal Dressing. Oral Surg., Chemotherapy of Dental Plaque Infections. Dent. Clin. N. 11:712, 1958. Amer., 14:855, 1970.

Abstracts MESIAL DRIFT OF TEETH IN ADULT MONKEYS (MACACA IRUS)

WHEN FORCES FROM THE CHEEKS AND TONGUE HAD BEEN ELIMINATED

Moss. J. P. and Picton, D. C. A. Arch. Oral Biol. 15:979, October, 1970

Cheek teeth on one side of the mouth were covered by an acrylic dome to eliminate the effect of muscles and direct occlu- sal forces. The same teeth on the opposite side of the mouth were used as controls. The opposing teeth on both sides were extracted to eliminate the influence of occlusal forces. Tooth contacts were removed with a diamond disc allowing for move- ment of the teeth. From 6 to 17 weeks it was observed that the controls and the experimental sides both drifted mesially at about the same rate, which led to a conclusion that the cheeks and tongue did not play a significant part in mesial drift in these animals. University College Hospital Dental Sclzool, Londorz, W.C. I , England.

Armstrong, W. G. Arch. Oral Biol. 15: 1001, October, 1970

Samples of whole human saliva were stirred with synthetic hydroxyapatite preparations, and then submitted for disc elec- trophoresis. It was found that high proline, high glutamic acid and high glycine levels made up about one-half of the total amino acid residues. Significant (0.5 percent) quantities of hex- osamine were present, implying a glycoprotein nature for the components. Parotid saliva samples that were taken showed basically the same results. In addition there was significantly less aspartic acid, threonine and isoleucine. Departnzent of Biochem- ist,-)., Tlze Royul Derztal Hospital, School of Dental Surgery, 32 Leicestrr Square, LolZdon, W.C. 2, England.

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