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Tratamento antibiĆ³tico da periodontite : o estado da arte
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Abstract(s)
A periodontite define-se como doenƧa inflamatĆ³ria crĆ³nica multifatorial associada com biofilme disbiĆ³tico e caracterizada pela destruiĆ§Ć£o progressiva do tecido suporte do dente. A periodontite afeta cerca de 35% da populaĆ§Ć£o de todo mudo e, segundo a OrganizaĆ§Ć£o Mundial de SaĆŗde, 50% dos adultos. A principal causa da doenƧa sĆ£o bactĆ©rias que estĆ£o associadas Ć placa bacteriana. Dependendo da gravidade de doenƧa o MĆ©dico Dentista pode escolher o tipo de tratamento: raspagem e alisamento radicular (consiste na raspagem de toda a placa bacteriana presente nas Ć”reas subgengivais), antibioterapia (antibiĆ³ticos com aĆ§Ć£o nos diferentes tipos de bactĆ©rias) ou cirurgia periodontal.
O uso de antibiĆ³ticos no tratamento da periodontite tem sido justificado pela necessidade de reduzir a carga bacteriana, o que contribuiria para a mais rĆ”pida resoluĆ§Ć£o da inflamaĆ§Ć£o na bolsa periodontal. Existem inĆŗmeras estratĆ©gias de tratamento antibiĆ³tico da periodontite, mas sĆ£o poucas as revisƵes sistemĆ”ticas e atuais desta modalidade terapĆŖutica. O objetivo desta revisĆ£o bibliogrĆ”fica foi perceber qual dos antibiĆ³ticos ou combinaƧƵes de antibiĆ³ticos existentes no mercado garante maior eficĆ”cia no tratamento da doenƧa periodontal e quais os determinantes da eficĆ”cia ou do insucesso terapĆŖutico.
A pesquisa bibliogrƔfica foi efectuada no Pubmed e Google AcadƩmico entre 2010 e 2019. O objeto de estudo foram pacientes, de todo o mundo, com periodontite de todas as faixas etƔrias e sexos. Na sua maioria os artigos analisados diziam respeito a ensaios randomizados com grupo de controlo e grupo de placebo.
Os resultados indicam que as combinaƧƵes de azitromicina com Lactobacillus rhamnosus, fibras de tetraciclina com Lactobacillus acidophilus e Lactobacillus rhamnosus, metronidazol com clorohexidina e minociclina com tinidazol apresentam melhores efeitos terapĆŖuticos e reduzem riscos da resistĆŖncia bacteriana e outros efeitos adversos. Em conclusĆ£o, a antibioterapia Ć© uma componente importante no tratamento da periodontite e contribui para eliminar os focos de inflamaĆ§Ć£o, diminuir a profundidade das bolsas periodontais e reestabelecer os nĆveis de inserĆ§Ć£o das fibras do tecido conjuntivo.
Periodontitis is a chronic multifactorial inflammatory disease associated with dysbiotic biofilm and characterized by the progressive destruction of tooth support tissue. Periodontitis affects about 35% of the world's population and, according to the World Health Organization, 50% of adults. Main cause of disease is bacteria that is associated with plaque. Considering the severity of the disease, the dentist can choose a type of treatment: scraping and root planing (consisting of scraping all plaque present in the infested areas), antibiotic therapy (antibiotics acting on different types of drugs) or periodontal surgery. The use of antibiotics in the treatment of periodontics was justified by the need to reduce the bacterial load, contributing to a faster resolution of inflammation in the periodontal pocket. There are several strategies for antibiotic treatment of periodontitis, but there are few current systematic studies of this therapy. The aim of this literature review was to detect which antibiotics or combinations of antibiotics on the market guarantee greater efficacy in the treatment of periodontal disease and what determines efficacy or therapeutic failure. A bibliographic search was performed at Pubmed and Google Scholar between 2010 and 2019. The objects of study were patients from all over the world, with periodontitis of all age groups and genders. Most of the articles analyzed concern randomized trials with control group and placebo group. Currently, combinations of azithromycin with Lactobacillus rhamnosus, tetracycline fibers with Lactobacillus acidophilus and Lactobacillus rhamnosus, metronidazole with chlorohexidine and minocycline with tinidazole, result in better therapeutic effects. These combinations reduce risks from bacterial resistance and other adverse effects. In conclusion, antibiotic therapy is an important part of treating periodontitis. Using the combinations mentioned in the previous paragraph, dentists can remove the foci of inflammation, decrease the depth of the periodontal pockets and re-establish connective tissue fiber insertion levels.
Periodontitis is a chronic multifactorial inflammatory disease associated with dysbiotic biofilm and characterized by the progressive destruction of tooth support tissue. Periodontitis affects about 35% of the world's population and, according to the World Health Organization, 50% of adults. Main cause of disease is bacteria that is associated with plaque. Considering the severity of the disease, the dentist can choose a type of treatment: scraping and root planing (consisting of scraping all plaque present in the infested areas), antibiotic therapy (antibiotics acting on different types of drugs) or periodontal surgery. The use of antibiotics in the treatment of periodontics was justified by the need to reduce the bacterial load, contributing to a faster resolution of inflammation in the periodontal pocket. There are several strategies for antibiotic treatment of periodontitis, but there are few current systematic studies of this therapy. The aim of this literature review was to detect which antibiotics or combinations of antibiotics on the market guarantee greater efficacy in the treatment of periodontal disease and what determines efficacy or therapeutic failure. A bibliographic search was performed at Pubmed and Google Scholar between 2010 and 2019. The objects of study were patients from all over the world, with periodontitis of all age groups and genders. Most of the articles analyzed concern randomized trials with control group and placebo group. Currently, combinations of azithromycin with Lactobacillus rhamnosus, tetracycline fibers with Lactobacillus acidophilus and Lactobacillus rhamnosus, metronidazole with chlorohexidine and minocycline with tinidazole, result in better therapeutic effects. These combinations reduce risks from bacterial resistance and other adverse effects. In conclusion, antibiotic therapy is an important part of treating periodontitis. Using the combinations mentioned in the previous paragraph, dentists can remove the foci of inflammation, decrease the depth of the periodontal pockets and re-establish connective tissue fiber insertion levels.
Description
DissertaĆ§Ć£o para obtenĆ§Ć£o do grau de Mestre no Instituto UniversitĆ”rio Egas Moniz
Keywords
Periodontite Tratamento com antibiĆ³ticos RevisĆ£o sistemĆ”tica