Cachovan G, Böger RH, Giersdorf I, et al. Efficacy and safety of moxifloxacin and clindamycin in the treatment of odontogenic abscesses and inflammatory infiltrates: a phase II, double-blind, randomized trial. Antimicrob Agents Chemother. 2010. doi: 10.1128/AAC.01267-10.
Dental infections can spread to proximate anatomical structures. This event is an indication for antibiotic therapy. Odontogenic infections are composed of 3–6 different species of several bacterial types—aerobic, facultative, and strict anaerobes—which may be dominant. The first line antibiotics are the penicillins (bacteriocidal) and the macrolides.
This research shed some light, but just a glimmer, on the comparison of 2 antibiotics, moxifloxacin and clindamycin, in the treatment of dental abscesses and gingival infections. Moxifloxacin (Avelox), a fluoroquinolone, may be more appropriate for treatment of a dental abscess after failure of first line antibiotics as compared to clindamycin. Broad spectrum antibiotics such as the fluoroquinolones may be used after unsuccessful treatment with a penicillin or a macrolide. Oral administration of clindamycin, a lincosamide, is also used frequently to medically treat dental abscesses by dentists. A penicillin type antibiotic may be more appropriate for pericoronitis. Moxifloxacin and clindamycin performed equally here. This small study demonstrated that moxifloxacin may be more effective than clindamycin for treatment of dental abscesses. Patients in this study reported faster pain resolution with moxifloxacin than clindamycin. However, side effects with both of these drugs may be serious. Nevertheless, the normal antibiotic first line treatment sequence can be instituted, but when the infection does not respond, there may now be another choice that may be effective, especially for debilitated patients.
Dennis Flanagan, DDS, FAAID, DABOI/ID, DABGD, DICOI
Petković AB, Matić NV, Stamatović NV, et al. Proinflammatory cytokines (IL-1b and TNF-a) and chemokines (IL-8 and MIP-1a) as markers of peri-implant tissue condition. Int J Oral Maxillofac Surg. 2010; 39: 478–485.
As an evaluation of whether proinflammatory cytokines and chemokines can be utilized as prognostic markers of implant failures, the authors evaluated the correlation between patients with non-manifesting inflammation and the peri-implant crevicular fluid (PICF) levels of the inflammatory biomarkers interleukin-1beta (IL-1b), tumor necrosis factor alpha (TNF-a), interleukin-8 (IL-8), and macrophage inflammatory protein-1alpha (MIP-1a). A total of 90 adults (49 considered healthy control, 30 early peri-implantitis, and 11 advanced peri-implantitis) were evaluated and classified based on gingival index, bleeding on probing, and radiographic evaluation taken on 4 sites (mesial, buccal, distal, and lingual). Cytokine and chemokine concentrations were then evaluated within the PICF using an enzyme-linked immunoassay kit composed of monoclonal antibodies, and demonstrated that healthy patients had significantly lower (P < .01) concentrations of all tested cytokine and chemokines relative to both the early peri-implantitis groups and mucositis group. Additionally, the early peri-implantitis group had significantly lower (P < .01) concentrations of all tested cytokines and chemokines relative to the advanced peri-implantitis group. This convincing immunoassay result demonstrates the severity of implantitis directly correlated with these inflammatory biomarkers, and demonstrates the utility of this application towards a future use of a biological diagnostic marker that may indicate the presence of disease before extensive clinical damage occurs. Future evaluations should continue the present work by determining the cellular mechanism of action between inflammatory cytokine and chemokine production during the various stages of peri-implantitis, as a way of enabling novel treatment paradigms of inflammatory-mediated implants.
Nicholas M. Radio, PhD
Pharmacology & Toxicology