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      Detection of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans after Systemic Administration of Amoxicillin Plus Metronidazole as an Adjunct to Non-surgical Periodontal Therapy: A Systematic Review and Meta-Analysis

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          Abstract

          Objective: To evaluate the variations in the detection of Porphyromonas gingivalis and/or Aggregatibacter actinomycetemcomitans before and after systemic administration of amoxicillin plus metronidazole in association with non-surgical periodontal therapy (NSPT).

          Background: The adjunctive use of antibiotics has been advocated to improve the clinical outcomes of NSPT. However, no systematic review has investigated the microbiological benefit of this combination.

          Materials and Methods: An electronic search was conducted up to December 2015. Randomized clinical trials comparing the number of patients testing positive for P. gingivalis and/or A. actinomycetemcomitans before and after NSPT with (test group) or without (control group) amoxicillin plus metronidazole were included. The difference between groups in the variation of positive patients was calculated using the inverse variance method with a random effects model.

          Results: The frequency of patients positive for A. actinomycetemcomitans was decreased by 30% ( p = 0.002) and by 25% ( p = 0.01) in the test group compared to the control group at 3- and 6-month follow-up, respectively. Similar findings were observed when considering the frequency of patients positive for Porphyromonas gingivalis, with a reduction by 28% ( p < 0.0001), 32% ( p < 0.0001), and 34% ( p = 0.03) in the test group compared to the control group at 3-, 6-, and 12-month follow-up, respectively.

          Conclusion: The systemic administration of amoxicillin plus metronidazole as an adjunct to NSPT significantly decreased the number of patients positive for P. gingivalis and A. actinomycetemcomitans compared with periodontal therapy alone or with a placebo.

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          Periodontitis: a polymicrobial disruption of host homeostasis.

          Periodontitis, or gum disease, affects millions of people each year. Although it is associated with a defined microbial composition found on the surface of the tooth and tooth root, the contribution of bacteria to disease progression is poorly understood. Commensal bacteria probably induce a protective response that prevents the host from developing disease. However, several bacterial species found in plaque (the 'red-complex' bacteria: Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola) use various mechanisms to interfere with host defence mechanisms. Furthermore, disease may result from 'community-based' attack on the host. Here, I describe the interaction of the host immune system with the oral bacteria in healthy states and in diseased states.
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            Oral multispecies biofilm development and the key role of cell-cell distance.

            Growth of oral bacteria in situ requires adhesion to a surface because the constant flow of host secretions thwarts the ability of planktonic cells to grow before they are swallowed. Therefore, oral bacteria evolved to form biofilms on hard tooth surfaces and on soft epithelial tissues, which often contain multiple bacterial species. Because these biofilms are easy to study, they have become the paradigm of multispecies biofilms. In this Review we describe the factors involved in the formation of these biofilms, including the initial adherence to the oral tissues and teeth, cooperation between bacterial species in the biofilm, signalling between the bacteria and its role in pathogenesis, and the transfer of DNA between bacteria. In all these aspects distance between cells of different species is integral for oral biofilm growth.
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              Systemic antibiotics in the treatment of periodontitis.

              Despite the fact that several clinical studies have shown additional benefits when certain systemic antibiotics are used as adjuncts to periodontal treatment, clear guidelines for the use of these agents in the clinical practice are not yet available. Basic questions concerning the use of systemic antibiotics to treat periodontitis remain unanswered, such as: which drug(s) should be used; which patients would most benefit from treatment; which are the most effective protocols (i.e. doses and durations); and in which phase of the mechanical therapy should the drug(s) be administered? Although not all of those questions have been directly addressed by controlled randomized clinical trials, recent concepts related to the ecology of periodontal diseases, as well as the major advances in laboratory and clinical research methods that have occurred in the past decade, have significantly broadened our knowledge in this field. This article endeavored to provide a 'state of the art' overview on the use of systemic antibiotics in the treatment of periodontitis, based on the most recent literature on the topic as well as on a compilation of data from studies conducted at the Center of Clinical Trials at Guarulhos University (São Paulo, Brazil) from 2002 to 2012.
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                Author and article information

                Contributors
                Journal
                Front Microbiol
                Front Microbiol
                Front. Microbiol.
                Frontiers in Microbiology
                Frontiers Media S.A.
                1664-302X
                19 August 2016
                2016
                : 7
                : 1277
                Affiliations
                [1] 1Department of Periodontology, Service of Odontology, U.F.R. of Odontology, Rothschild Hospital, AP-HP, Paris Diderot University Paris, France
                [2] 2UMS 011, Population-based Epidemiologic Cohorts Unit, Institut National de la Santé et de la Recherche Médicale Villejuif, France
                [3] 3Department of Nutrition, Hôpital Européen Georges Pompidou, AP-HP, Paris Descartes University Paris, France
                [4] 4EA 2496, U.F.R. of Odontology, Paris Descartes University Montrouge, France
                Author notes

                Edited by: Ying Zhang, Johns Hopkins University, USA

                Reviewed by: Haider Abdul-Lateef Mousa, University of Basrah, Iraq; Li Xu, Cornell University, USA; Jiazhen Chen, Fudan University, China

                *Correspondence: Philippe Bouchard phbouch@ 123456noos.fr

                This article was submitted to Infectious Diseases, a section of the journal Frontiers in Microbiology

                †These authors have contributed equally to this work.

                Article
                10.3389/fmicb.2016.01277
                4990718
                5a6e9e37-6c98-4204-a809-dfb6876e7862
                Copyright © 2016 Dakic, Boillot, Colliot, Carra, Czernichow and Bouchard.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 12 May 2016
                : 02 August 2016
                Page count
                Figures: 3, Tables: 2, Equations: 0, References: 46, Pages: 10, Words: 6303
                Categories
                Microbiology
                Original Research

                Microbiology & Virology
                porphyromonas gingivalis,aggregatibacter actinomycetemcomitans,periodontitis/therapy,amoxicillin,metronidazole,meta-analysis

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