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

8/3/2019 Antibiotics in the the Basis of a Decision to Use or Not to Use Antibiotics is Essentially a Balancing of Those Factors

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Antibiotics in the The basis of a decision to use or not to use antibioticsis 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 R E NOT innocuous drugs. Their use shouldbe justified on the basis of a clearly established needand 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 usewill 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 considerationof both the nature of the infection and the generalhealth of the patient. The following guidelines apply:

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

Acute Necrotizing Ulcerative Gingivitis

Acute necrotizing ulcerative girlgivitis (ANUG) isbelieved to have a relatively specific bacterial compo-nent and should be considered within the therapeuticcategory. However, it is well established that in ANUGall local irritants must be removed and that antibiotictherapy is adjunctive treatment required only in specialcases.

What are the special cases? According to Glickman,l"Antibiotics are administered systemically in patientswith toxic systemic complications or local adenopathy."Prichard2 states that antibiotics should be prescribed forANUG i f adequate local treatment cannot be provided

1. It is obvious that severe, acute, rapidly spreading immediately. He further states that the acute symptomsinfections should be treated with antibiotics. The less will be suppressed by antibiotic therapy but will recursevere, localized infections where drainage can be estab- unless adequate local therapy follows. Discussing thelished 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 generallyrequite antibiotic therapy. Examples of such systemicconditions are (a) uncontrolled diabetes, (b) leukemia,(c) agranulocytosis, (d) aplastic anemia, (e) Addison'sdisease, (f) depressed natural defense mechanisms as aresult of therapy with adrenal steroids and immunosup-pressive and cytotoxic drugs, (g) history of rheumaticor congenital heart disease, and (h) debilitation by ageor disease.

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

In general, antibiotics should not be used routinelyin the treatment of ANUG. They are seldom necessary,and their indiscriminate use is a highly undesirablepractice. Although antibiotics will suppress the acutesymptoms of ANUG, they are strictly adjunctive to lo-cal treatment and are indicated only in severe cases withsystemic involvement. As with other infections, the pa-tient's general health should be considered in determin-ing a need for these drugs. Some further justificationmay exist for the use of antibiotics in cases of ANUGthat are tenaciously resistant to local treatment." How-ever, in these instances one must determine the reasonfor the resistance to local treatment rather than insti-tute antibiotic therapy as a substitute for completeevaluation of the patient.

Penicillin, erythromycin, and the tetracyclines are ef-Commander, DC, US N; Head. Research and Sciences Depart- fective against ANUG. ~ l ~ h ~ ~ ~ hpecific studies havement, 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 t o be construed as offici al or asreflecting the views o f the Navy Department or the naval service dence that the antitrichromonal drug metronidazole mayat large. also be effective." 6


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Antibiotics in Periodontics 58 5

TABLESuggested Adult Dosage Schedules for Prevention of Bacterial

Endocarditis (Adapted from American Hea rt AssociationStatementl6) :

PARENTERAL SCHEDULE (Preferred)Day of Procedure (1 to 2 hours b efor e procedure)

600,000 units procaine penicillin G (IM) an d

600,000 units K penicillin G (IM)For 2 Days A fter Procedure600,000 units procaine penicillin G (IM) daily

ORAL SCHEDULEDay o f a nd 2 Days After Procedure

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

PENICILLIN ALLERGYDay o f and 2 Days A ft er Procedure

Erythromycin (250 mg every 6 hours)

'The American Heart Association and the American DentalAssociation are currently considering changes to these recom-mendations. Any changes that evolve should be promulgated inlate 1971.

It is not particularly surprising that the topical use ofvancomycin has been demonstrated to be effectiveagainst ANUG.'. However, the fact that an antibioticis applied locally rather than systemically does not ne-gate the previously stated objections to routine antibiotictherapy in ANUG. In actuality, the topical application ofany parenterally useful drug is open to some question.This is particularly true if the application is made rou-tinely. Although the parenteral use of vancomycinagainst 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 ofpatient allergies and bacterial resistance, complicate thetreatment of some life-threatening infections. Over thepast several years, staphylococci have appeared that arenot susceptible to the penicillinase-resistant penicillins.Fosterg stated in a 1969 issue of Medical Clinics ofNorth America, "Vancomycin is our most reliable singleagent against penicillin-resistant staphylococci, and itsvalue 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, itdoes indicate that there are physicians who rely heavilyon 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 isphysically or mentally incapable of adequate coopera-tion. At any rate, one should not apply vancomycin inthe routine treatment of ANUG.

Acute(Primary) H erpetic 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 associatedwith upper respiratory infection, pneumonia, and othersystemic disease, examination by a physician is fre-

quently indicated. Many pediatricians treat severe casesof herpetic gingivostornatitis prophylactically with anti-biotics. The value of this precautionary treatment is notestablished.

Recurrent Aphthous Stomatitis

It appears that a pleomorphic streptococcus may beinvolved in the pathogenesis of recurrent aphthous sto-matitis.ll-I* Graykowski et all1 reported that 69% ofthe cases of recurrent aphthae studied responded totetracycline in a 250 mg/5 ml suspension given fourtimes daily for five to seven days. The suspension (5 ml

for adults) was held in the mouth for two minutes andthen swallowed. Any advantage of holding the suspen-sion in the mouth for two minutes as opposed to the useof tetracycline capsules or tablets is not established.Tetracycline mouthwashes have also been reported to behelpful against recurrent aphthous stomatitis by Gug-genheimer and coworkers.]"

The prophylactic use of antibiotics anticipates thelikelihood of a new infection or the exacerbation of anexisting infection. A definitive indication for prophy-lactic antibiotic coverage is present when a patient withrheumatic 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 andgiving suggested dosage schedules (see Table 1 ) . It hasbeen suggested that antibiotic prophylaxis for patientswith heart prostheses should be much more extensivethan that which is considered adequate in patients withrheumatic or congenital heart disease. A regimen thathas 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 thesurgical 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


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586 Holroyd J. Periodont.September, 1971

150 surgical cases. They found a wound infection rateof 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 over1,000 cases of general surgery, Johnstone1g observedthat ". . . 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 prophylacticantibiotic therapy to prevent postoperative infections iswell documented in the medical literat~re.l~-~l nfortu-nately, similar dental evaluations are not available. Onemust view with some concern the philosophy of rou-tinely using antibiotics prophylactically in an attemptto prevent postsurgical infections. Unquestionably, con-cern for aseptic and atraumatic operating techniques isof great importance.

Most patients who undergo periodontal surgery arenot 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 apparentfrom medical studies that some individuals who wouldnot have developed a postoperative infection may doso if prophylactic antibiotics are used. The mechanismof this may be related to alterations in the normal florawhich were induced by the antibiotic. Thus, in the finalanalysis, one must balance the infections he preventswith 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 capacityto gain more than he loses from using antibiotics toprevent postsurgical infections is likely to be propor-tional to his ability to predict the likelihood of a post-operative infection in a particular case.

Enh ance men t of Surgical Re sults

Many practitioners use antibiotics routinely in bonegrafting procedures and when attempting to establish anew attachment a t a more coronal level. Although some

logic underlies such use, no significant research evidenceis available to indicate that antibiotics are necessary oreven helpful in obtaining the desired result.

In regard to healing generally, Stah132 reported thatrats receiving antibiotics showed more distinctive crestalbone repair than did control rats in the early stages ofhealing; however, ". . . he beneficial potential of thesedrugs 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 eportedthat an experimental group of protein-deprived ra ts,treated with antibiotics following gingival wounds, ex-hibited more crestal osteogenesis than did a controlgroup. Because of the superimposition of a nutritionaldeficiency, it is difficult to apply these results to thepresent discussion of the clinical use of antibiotics. Also

in 1964, Schafer and his associates36 reported a favor-able effect of antibiotics on healing following osseouscontouring in dogs.

In 1969, Stahl and co - w ~ r k e r s ~ ~eported the resultsof a clinical study of the effects of antibiotics in 48 pa-tients. All subjects received l Gm erythromycin stearateper day (four divided doses) for four days following agingivectomy. 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 ofthe tissues before and after gingivectomy. No compari-son was discussed between the inflammatory state ofthe postoperative biopsies taken from antibiotic treatedand non-antibiotic treated patients. Since all subjects inthis report received antibiotics, such a control compari-son would have had to be drawn from other studies.They further reported that the epithelialization of allwounds appeared to be complete within the first weekafter surgery. They contrasted this with epithelializa-tion obtained in only 61 % to 78% of biopsy specimensin earlier studies.38~ 9

Although the foregoing studies have made significantcontributions to the understanding of the effect of anti-biotics on wound healing, they cannot be consideredadequate 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 reportof a double-blind study which found that lincomycin(500 mg, q.6 h., two days before and four days aftersurgery) reduced the incidence of malaise, edema, ne-crosis and pain following periodontal surgery. This pa-per raises most interesting possibilities, and furtherstudies 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, buthe also found undesirable tissue reactions. In 1958,


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Volume 42Number 9 Antibiotics in Periodontics 5 8 7

Baer, et al49eported favorably on a dressing containingbacitracin, which was said to afford maximum patient-comfort with cleaner, less stained teeth and with lessassociated debris. They observed no allergic or fungalcomplications. In 1960, Baer and his co-workers43 de-scribed a hydrogenated fat-bacitracin pack, and againthe report was favorable. I n two years of study, they

observed only one case of infection with Candida al-bicans. Later, R ~ m a n o w ~ ~tudied the relationship be-tween moniliasis and periodontal packs containing anti-biotics. With tetracycline and oxytetracycline packs, heobserved both stomatitis and moniliasis. With bacitracinpacks, he found neither stomatitis nor any signs orsymptoms of moniliasis though he noted an increase inthe presence of C. albicans.

From the foregoing studies, it would seem that packscontaining tetracyclines are undesirable, whereas baci-tracin packs appear to offer certain advantages and tohave no clinically significant disadvantages. At this

point it should again be noted that the topical use of anyparenterally 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 periodontaldisease well established, it logically followed that effortswould be made to observe the effects of antibiotics ondental plaque, gingivitis and periodontitis. The additionof penicillin4j. 6 and chl~rtetracycline~~. g 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 therice rat.", Topical vancomycin has been reported toreduce plaque51 and to provide clinical improvement ingingivitis and various oral lesions in humans.52 A studyof children on extended systemic penicillin prophylaxisdid not reveal a significantly beneficial effect on gingivalscores;53 however, systemic spiramycin has been shownto have beneficial effects on periodontal disease in hu-mans.54 Lobene and co-workers" have reported that the

use of an erythromycin liquid suspension (25 0 mg q. 6h.) 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 statedthat there is insufficient evidence at present to justifythe general use of any antibiotic as a plaque controlagent in the prevention and treatment of gingivitis andperiodontitis. The literature indicates that although theuse of antibiotics in attempts to control plaque and toimprove nonspecific gingivitis and periodontitis appearsto 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 ultimatelybe the most effective approach to the prevention ofperiodontal 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 againstrecurrent aphthous stomatitis. In these cases, the anti-biotic is selected on the basis of the diagnosis.

Streptococcus viridans is the organism of primaryconcern in subacute bacterial endocarditis. Therefore, inpreventing subacute bacterial endocarditis, one is pri-marily concerned with S. viridans. Consequently, peni-cillin is the antibiotic of choice since it is highly effectiveagainst that organism. In this case, the drug is selectedon 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 accuratelypredicted 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 whatantibiotic is effective against the specific etiologic agent.For practical reasons, however, periodontal infectionsare usually treated without the benefit of sensitivitytests. Most bacteria that are causative agents in perio-dontal abscesses and postoperative infections are withinthe antibacterial spectra of penicillin, erythromycin, thetetracyclines, lincomycin and clindamycin. In all fair-ness, it should be said that sensitivity tests will show thatany of these antibiotics will be effective on the cultureplate against most bacteria sampled from periodontal in-fections. Thus, the periodontist is justified in startingtreatment with one of these drugs before obtaining theresults of sensitivity tests for an infection that requires anantibiotic. The primary advantage of sensitivi ty tests isthat they will let the clinician know whether he is dealingwith a bacterium that is insensitive to the most com-monly effective drugs.

When an antibiotic is selected without the benefit ofsensitivity tests, the choice is essentially between peni-cillin, erythromycin, the tetracyclines, and possibly lin-comycin and clindamycin. The selection of a specificantibiotic 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 bactericidalagent is required. However, the periodontist must alwaysremember that penicillin is the most allergenic drug incurrent use and should never be used arbitrarily; it

should be selected only on the basis of an established


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58 8 Holroyd J. Periodont.September, 1971

need fo r penici ll in . W hen such need exists but the use ofpenicill in is contraindicated because of patient allergy,erythromycin and sodium cephalothin are usual ly goodsubst i tutes . Th e pr incipal disadvantage of so dium ceph -alothin in dent is try is the fact that only paren teral formsare avai lable . However, th is ant ibiot ic may be of greatimportance in ser ious infect ions caused by organisms

that are no t affected by penici ll in . Cl indamy cin may alsobe effective in this regard. Where bacteriostatic actionwill suffice, the tetracyclines should be effective.

H o w frequently a p articular clinician will use peni-cillin instead of a bacter iosta t ic drug depends on hisphi losophy regarding the need for any ant ibiot ic . Theclinician who accepts a very narrow range of indicationsfor antibiotics will usually need a potent bactericidalagent if he feels that he needs any antibiotic. This in-dividual should use penicill in in most cases. Althoughhe would be using penici l l in a lmost exclusively, he

wo uld no t necessarily be using it indiscriminately. O nthe other hand, some cl inic ians accept a very broadrange of indicat ions for ant ibiot ics and use them inmany s i tuat ions where bacter iosta t ic drugs would beadequate. If these individuals use penicill in almost ex-clusively, they will be using it indiscriminately.

I n this l imited discussion of th e antibiotic of cho ice,no a t t empt has been made to reso lve the ques t ion o fwhich d rug to use bu t on ly to s t r ess the fac t tha t anant ibiot ic should not be chosen arbi t rar i ly but shouldbe selected to m eet the needs of th e case . This se lection

mus t be based upon a knowledge o f ( 1 ) the s ta te ofthe patient 's general health, (2 ) the nature of the spe-cific infection involved, and ( 3 ) the pharmacology ofthe drugs available.

SUMMARY

The use of antibiotics involves certain disadvantagesas wel l as advantages . Co nsequent ly, the decis ion to usethese d rugs shou ld be based on an es tab l i shed need .Points to b e considered in es tabl ishing the need a ndselect ing the proper drug have been presented.

REFERENCES

I . Glicknian, I.: Clinical Periodontology, ed. 3. Phila-delphia, W. B. Saunders C o., 1 964, p. 679.

2. Prichard, J. F.: Advanced Periodontal Disease: Sur-gical and P rosthetic M anagement. Philadelphia,W. B. Saun-ders Co., 196 5, pp. 377 -378.

3. Goldman, H. M. and Cohen, D. W.: Periodontal Ther-apy, ed. 4. St. Louis, C. V. Mosby Co., 196 8, p. 204.

4. Graykow ski, E. A. and Holroyd, S.V.: TherapeuticManagement of Primary Herpes, Recurrent Labial Herpes,Aphthous Stomatitis, and Vincent's Infection. Dent. Clin.N. Am er., 14:721, 1970.

5. Stephen, K. W., McLatchie, M. F., Mason, D. K .,

Noble, H. W. and Stevenson, D. M.: Treatment of Acuteulcerative Gingivitis (Vincent's Type). Brit. Dent. J., 121:313,1966.

6. Fletcher, 5. P. and P lant, C. G.: An Assessment ofMetronidazole in the Treatmen t of Acute U lcerative Pseudomenlbranous Gingivitis (Vincent's Disease). Oral Surg., 22739, 1966.

7. Mitchell, D. F. and Baker, B. R.: Topical AntibioticCo ntro l of Necro tizing Gingivitis. J. Periodon t., 39:S1, 1968.

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

9. Foster, F. P.: Emergency T reatmen t of Severe Bacte-rial Infection. Med. Clin. N . Amer., 53:4 37, 1969.

10. Burk et, L. W.: Oral Medicine, ed. 3. Philadelp hia,J.B. Lippincott Co., 1957 , p. 136.

11. Graykow ski, E. A., Barile, M. F. , Lee, W. B. andStanley, H. H.: Recurrent Aphthous Stonlatitis: ClinicalTherap eutic, Histopathologic, and Hypersensitivity AspectsJ.A.M.A., 196:637, 1966.

13. Barile, M .F. and Graykow ski, E. A.: P rimary Herpes,Recurrent Labial Herpes and Recurrent Aphthae and Periadenitis Aphthae: A Review with Some New ObservationsJ. Dist. Columbia D. Soc., 38:7, 1963.

13. Graykowski, E. A., Barile, M. F . and S tanley, H . R.:Periadenitis Aphthae, Clinical and Histopathological Aspects of Lesions in a Patient and of Lesions Produced inRabbit 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 Sectionof A phthous and Non-aphthous Lesions and Other Oral Tissues. Oral Surg., 18:335, 1964.

15. Guggenh eimer, J., Brightman, V. J. and Ship?I. I.:Effect of C hlortetracycline M outhrins es on the Healing oRecurrent Aphthous Ulcers: A Double-Blind ControlledTrial. J. Oral Ther., 4:406, 196 8.

16. Com mittee on Prevention of Rheum atic Fever andBacterial Endocarditis, Council on Rheumatic Fever andCongenital Heart Disease: Prevention of Bacterial Endocarditis (EM 113 A rev.). New York , Am erican Heart Asso-ciation, 196 5.

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

18. Ka rl, R. C., Mertz, J. J., Veith, F. J. and D ineen, P.:Prophylactic A ntin~icrob ialDrugs in Surgery. New Eng. J.Med., 275:305, 1966.

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

20. King, G. C.: Th e Case Against Antibiotic Prophylaxiin Major Head and Neck Surgery. Laryngoscope, 71:6471961.

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

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

23 . McKittrick, L. S. and Wheelock, F. C.: Th e RoutineUse of Antibio'tics in Elective Abdominal Surgery. SurgGynec. Obstet., 99:376, 1954.

24. Mar shall, A.: Prop hylactic An timicrobial Therap y inRetropubic Prostatectomy. Brit. J . U rol., 3 1 431 , 1959.

25. Editorial, New Eng.J. Med., 275:335, 1966.26. Petersdorf, R. G., Curtin, J. A. Hoeprick, P.D.,

Peeler, R. N. and Benn ett, I. L.: Study of A ntibiotic Prophy-laxis in U nconscious Patients. New Eng. J. Med., 257: 10011957.

27. Petersdorf, R. G. and Me rchant, R. K.: A Study ofAntibiotic Prophylaxis in Patients with Acute Heart FailureNew Eng. J. Med. , 265 565 , 1959.


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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 PeriodontalSurg. (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 thegery. Brit. Med. Bull., 16:51, 1960. Presence of Antibiotics in Periodontal Packs. Periodontics,

30. Weinstein, L.: Chemoprophylax is of Infec tion. Ann. 2:298, 1964.Intern. Med., 4328 7, 1955. 45. Mitchell, D. F. and Johnson, M.: The Natur e of the

31. Cole, W. R. and Bernard, H. R.: A Reappraisal of Gingival Plaque in the Hamster-Production, Prevention,

the Effects of Antimicrobial The rapy During the Course ofand 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. and32. 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. ofTissue. 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. Reatt achmen t Potentia l 177.of Soft and Calcified Tissues. J. Periodont., 34:166, 1963. 47. Rushton, M. A.: Denta l Effects of Dieta ry Aureomy-

34. Stahl, S. S.: The Influence of Antibiotics o n the Heal- cin. Brit. Dent. J., 98:313, 1955.

ing of Gingival Wound s in Rats. 111. Th e Influence of Pu lpal 48. Gressly, F. and Leung, S. W.: Preliminary Study ofNecrosis on Gingival Reattachment Potential. J. Periodont., Calculus Formation i n Rodents. I.A.D.R., 40:1S, 1 962 (Ab-

34:371, 1963. strac t).35. Stahl, S. S.: Th e 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 ~ dd ~ l ~~ t ~ ,ral 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. a nd Dor- 1169, 1957.man, H . L.: T he 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 Periodon tal 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

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Abstracts

MESIAL RIFT F TEETH N ADULT MONKEYS MACACA RUS)WHEN ORCES ROM THE CHEEKS N D TONGUE

HAD BEEN ELIMINATEDMoss. 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 anacryl ic dome to eliminate the effect of muscles and direct occlu-sal forces. The same teeth on the opposite side of the mouthwere used as controls. The opposing teeth on both sides wereextracted to eliminate the influence of occlusal forces. Toothcontacts were removed with a diamond disc allowing for move-ment of the teeth. From 6 to 17 weeks it was observed that thecontrols and the experimental sides both drifted mesially atabout the same rate, which led to a conclusion that the cheeksand tongue did not play a significant part in mesial drift in theseanimals. 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 synthetichydroxyapatite preparations, and then submitted for disc elec-trophoresis. It was found that high proline, high glutamic acidand high glycine levels made up about one-half of the totalamino acid residues. Significant (0.5 percent) quantities of hex-osamine were present, implying a glycoprotein nature for thecomponents. Parotid saliva samples that were taken showedbasically the same results. In addition there was significantly lessaspartic acid, threonine and isoleucine. Departnzent of Biochem-ist,-)., Tlze Royu l Derztal Ho spital , School of Dental Surger y, 32Leicestrr Sq uare, LolZdon, W.C. 2, England.

Documents

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