Does the use of omega-3 fatty acids as an adjunct to non-surgical periodontal therapy provide additional benefits in the treatment of periodontitis? A systematic review and meta-analysis.

This review aimed to assess the impact of dietary omega-3 fatty acids as an adjunct to non-surgical periodontal treatment when compared with periodontal treatment alone on periodontal clinical parameters of periodontitis patients. We included only randomized clinical trials (RCTs) with at least 3-months follow-up of non-surgical periodontal therapy, in combination with dietary omega-3 fatty acids. The MEDLINE, EMBASE, and LILACS databases were searched for articles published up to October 2021. Random-effects meta-analyses were conducted to determine the change in clinical attachment level (CAL), probing pocket depth (PPD), bleeding on probing (BOP), and gingival index (GI) after therapy. Of the eight hundred eighty-four potentially relevant papers retrieved from the electronic databases, 10 RCTs were selected for qualitative analysis, and of these, 8 RCTs were included in meta-analysis. RCTs showed a significant PPD reduction/CAL gain associated with the use of omega-3 fatty acids. The pooled estimates revealed significant overall PPD reduction of 0.42 mm (95% CI 0.15, 0.68) and CAL gain 0.58 mm (95% CI 0.24, 0.92). In individuals with periodontitis, the use of omega-3 fatty acid dietary supplementation as an adjunct to non-surgical periodontal treatment can provide additional benefits in CAL gain and PPD reduction, compared with non-surgical periodontal treatment alone.

Antimicrobial photodynamic therapy against metronidazole-resistant dental plaque bactéria.

The antimicrobial photodynamic therapy (aPDT) has stood out as an alternative and promising method of disinfection and has been exploited for the treatment of oral bacteria. In this study, we evaluate in vitro the action of aPDT, mediated by methylene blue, chlorin-e6, and curcumin against clinical subgingival plaques that were resistant to metronidazole. The sensitivity profile of the samples to metronidazole was analyzed by the agar dilution method. Cell viability in the planktonic and biofilm phase was assessed by CFU / mL. The composition of the biofilm was evaluated by the checkboard DNA-DNA Hibrydization technique. Photosensitizers internalization was qualitatively assessed by confocal fluorescence microscopy (CLSM). The aPDT mediated by the three photosensitizers tested was able to reduce the totality of the planktonic microbial load and partially reduce the biofilm samples. The analysis performed by CLSM showed that the photosensitizers used in the application of aPDT were able to permeate the interior of the biofilm. The aPDT has been shown to be useful in a supportive and effective approach to the treatment of periodontal disease.

Metronidazole alone or with amoxicillin as adjuncts to non-surgical treatment of chronic periodontitis: a 1-year double-blinded, placebo-controlled, randomized clinical trial.

AIM: To evaluate the effects of the adjunctive use of metronidazole (MTZ) or MTZ + amoxicillin (AMX) in the treatment of generalized chronic periodontitis (ChP). A secondary aim was to examine a possible added effect of chlorhexidine to these therapies. METHODS: One hundred and eighteen subjects received scaling and root planing (SRP) only or with MTZ [400 mg/thrice a day (TID)] or MTZ+AMX (500 mg/TID) for 14 days. Half of the subjects in each group rinsed with 0.12% chlorhexidine twice a day (BID) for 2 months. Subjects were clinically monitored at baseline, 3, 6 and 12-months post-therapy. RESULTS: The two antibiotic groups showed lower mean number of sites with probing depth (PD) ≥5 mm and fewer subjects exhibiting ≥9 of these sites at 1-year post-treatment. Logistic regression analysis showed that antibiotics were the only significant predictors of subjects presenting ≤4 sites with PD ≥5 mm at 1 year (MTZ+AMX: OR, 13.33; 95%CI, 3.75-47.39/p = 0.0000; MTZ: OR, 7.26; 95%CI, 2.26-23.30/p = 0.0004). The frequency of adverse events did not differ between the two antibiotic treatments (p > 0.05). The chlorhexidine subgroups showed a trend (p > 0.05) to present fewer residual sites ≥5 mm compared with the placebo subgroups at 1 year. CONCLUSION: Treatment of generalized ChP is significantly improved by the adjunctive use of MTZ+AMX and MTZ.

Clinical and microbiological benefits of metronidazole alone or with amoxicillin as adjuncts in the treatment of chronic periodontitis: a randomized placebo-controlled clinical trial.

AIM: To evaluate the effects of the adjunctive use of metronidazole (MTZ) or MTZ+amoxicillin (AMX) in the treatment of generalized chronic periodontitis (ChP). MATERIALS AND METHODS: Fifty-one subjects (n=17/group) were randomly assigned to receive scaling and root planing (SRP) only or combined with MTZ (400 mg t.i.d.) or MTZ+AMX (500 mg t.i.d.) for 14 days. Clinical and microbiological examinations were performed at baseline and 3 months post-SRP. Nine plaque samples/subject were analysed by checkerboard DNA-DNA hybridization for 40 bacterial species. RESULTS: Subjects receiving MTZ+AMX exhibited a greater mean gain of clinical attachment, reduction in probing depth (PD) in intermediate and deep sites and a lower percentage of sites with PD5 mm at 3 months, in comparison with those treated with SRP only (p<0.05). The major benefit from the adjunctive use of MTZ was a greater reduction in PD in deep sites. SRP+MTZ+AMX was the only treatment that significantly reduced the levels and proportions of all red complex pathogens and elicited a significantly greater beneficial change in the microbial profile in comparison with SRP only. CONCLUSION: The adjunctive use of MTZ+AMX offers short-term clinical and microbiological benefits, over SRP alone, in the treatment of non-smokers subjects with generalized ChP. The added benefits of MTZ were less evident.

Phenomenon of laser power loss during curettage of infected periodontal pockets.

OBJECTIVE: The purpose of this study was to evaluate the reduction in laser power output (PO) at the optical fiber tip during laser curettage of infected periodontal pockets. BACKGROUND DATA: The combination of mechanical debridement with laser therapy has been used successfully in the treatment of periodontitis. METHODS: The study group consisted of 28 teeth selected in 12 patients with chronic periodontitis. The teeth were treated with scaling and root planing (SRP), and infected pocket epithelium was removed with an 810-nm diode laser operating at a laser power of 1.7 W in continuous-wave mode (CW). Laser power was set to 1.0 W at the control panel before each measurement to facilitate mathematical analysis, and PO at the optical fiber tip was measured using a power meter. Four laser applications were performed per tooth (duration, 10-15 sec per application; total duration, 40-60 sec per tooth). The fiber tip was cleaved every four applications. Also, 28 irradiations (four PO measurements per irradiation) were performed in non-contact mode and used as controls. RESULTS: There were significant PO losses between applications in the study group. PO losses of 20.89%, 30.39%, and 40.26% were found between the first and second, first and third, and first and fourth applications, respectively. A low transmission loss of the optical fiber was observed in the control measurements (mean PO loss of 1.58% between the first and fourth irradiations). CONCLUSIONS: Our results indicated that optical fiber tips need to be cleaved frequently during laser curettage to minimize PO loss.

In vitro antimicrobial activity of plant extracts and propolis in saliva samples of healthy and periodontally-involved subjects.

The aim of the present study was to determine, in vitro, the antimicrobial effect of plant extracts and propolis in saliva samples of 25 periodontally healthy subjects and 25 subjects with chronic periodontitis. One saliva sample from each subject was collected and spread on the surface of trypticase soy agar plates. Paper filter discs containing clove, sage, propolis, chlorhexidine 0.12% (positive control) and distilled water (negative control) were placed onto the plates, and incubated anaerobically for 72 hours. Significant differences in the antimicrobial effects of the different substances were tested using paired t-tests and the Spearman correlation coefficient, while differences in the effects of the extracts in periodontally healthy and diseased subjects were tested using Student's t-test. The highest means, in terms of size of microbial inhibition zones (cm) were obtained with chlorhexidine, followed by pure propolis, clove, and sage in subjects with periodontal health (1.35 +/- 0.22, 1.20 +/- 0.20, 0.94 +/- 0.14 and 0.44 +/- 0.38, respectively) or disease (1.38 +/- 0.23, 1.17 +/- 0.21, 0.94 +/- 0.07 and 0.78 +/- 0.07, respectively). There was a positive correlation between the inhibitory action of 11% propolis (w/v) and chlorhexidine (rho = 0.735, p < 0.001) in diseased subjects. The antimicrobial effects of clove and sage, particularly the latter, were less marked in comparison to propolis and chlorhexidine in both groups of subjects. In conclusion, propolis showed significant antimicrobial properties in saliva samples from periodontally healthy and diseased subjects, suggesting that this substance may be used therapeutically in the future to inhibit oral microbial growth.

Ação antimicrobiana de extratos vegetais sobre a microbiota da placa dentária e saliva: estudo in vitro / Antimicrobial activity of plant extracts on the microbiota of saliva and dental plaque: an in vitro study

Introdução - O objetivo do presente estudo foi comparar, in vitro, a ação antimicrobiana dos extratos de cravo-da-índia (Syzygium aromaticum), sálvia (Salvia officinalis) e própolis sobre a microbiota da placa dentária supragengival e saliva não estimulada de 25 indivíduos com periodontite crônica. Métodos - Utilizou-se como controle positivo clorexidina a 0,12 por cento e, como controle negativo, água destilada. Em placas de Ágar TSA avaliou-se a ação antimicrobiana de cada substância pura e em diluições seriadas (1 :2, 1 :4, 1 :8). Resultados - Os resultados foram avaliados utilizando-se os testes Post Hoc, ANOVA e Coeficiente de correlação de Pearson (p < 0,05). As maiores médias de tamanho de halos de inibição foram obtidas com a clorexidina, seguida da própolis, cravo-da-índia e sálvia. Conclusão - A própolis apresentou correlação com a clorexidina tanto na inibição de amostras de placa dentária como da saliva. Além disso, também demonstrou propriedades antimicrobianas significativas e exibiu maior ação antimicrobiana sobre a microbiota da placa dentária supragengival quando comparada à microbiota da saliva