Dentistry is Medicine

In the previous blog, we discussed that the use of systemic antibiotics, for high-risk patients may currently be the most effective method to treat the systemic impact of translocated periodontal pathogens. As periodontal treatment plans are formatted, utilizing a MyPerioPath test assists in determining the pathogen profile of the periodontal infection and provides  evidence- based systemic antibiotic selection. If dentistry is medicine, then utilizing a test to confirm the presence of bacteria is similar to how a medical doctor would confirm strep throat by taking a culture before administering a systemic antibiotic

With the oral systemic movement in dentistry on the rise, clinician accountability has been elevated. A responsible approach to antibiotic stewardship and an action to reduce translocated high-risk periodontal pathogens must be taken.

As a profession we need to consider the following:

  1. The antibiotic stewardship movement is credible and deserves serious consideration.[1] [2] [3]
  2. Good studies exist which show that the adjunctive use of systemic antibiotics does improve local outcomes.
  3. Very few studies have shown before and after pathogen concentration levels relative to specific adjunctive therapy [laser, peroxide, ozone].
  4. There is very little research on the effect of systemic antibiotics on translocated microbiomes. [4] [5]
  5. Currently there are very few discussions on analyzing the risk-benefit potential when systemic antibiotics are selected as adjunctive therapy.

As a clinician views these and other related studies, it is evident that the traditional reduction of clinical signs are being used as the barometer of what successful therapy looks like. There has been little attempt made to test or show pathogen concentrations present before or after treatment. A post-salivary diagnostic test can provide an objective result of the therapy applied locally. This is how dentistry is medicine; a medical doctor will test first, apply therapy and then retest to confirm resolution. As a profession, we need to mirror this medical model to best serve our patients.

[1] Guerro A, Griffiths GS, Nibali L, Suvan J, Moles DR, Laurell L, Tonetti MS; Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive periodontitis: a randomized placebo-controlled clinical trial, J Clin Periodontol 2005; 32: 1096-1107

[2] Slots J; Systemic Antibiotics in Periodontics; J periodontal, 2004 Nov; 75[11]: 1553-65

[3] Soares GM, Mendes JA, Silva MP, Faveri M, Teles R, Socransky SS, Wang X, Figueiredo LC, Feres M; Metronidazole alone or with amoxicillin as adjuncts to non-surgical treatment of chronic periodontitis: a secondary analysis of microbiological results from a randomized clinical trial; J Clin Periodontol 2014, Apr; 41[4]: 366-75

[4] Lockhart, PB, Brennan MT, Sasser HC, Fox PC, Paster BJ, Bahrani-mougeot FK; Bacteremia Associated with Tooth Brushing and Dental Extraction, Cirulation 2008, Jun 17: 117[24] 3118-312

[5] Lockhart PB, Loven B, Brennan MT, Fox PC; The evidence for the efficacy of antibiotic prophylaxis in dental

practice; JADA, 2007 Apr; 138[4]: 458-74

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John Kempton DDS