Antibiotics in the Practice of Periodontics

The basis of a decision to use or not to use antibiotics is essentially a balancing of those factors that tend to require their use against those factors that tend to obviate the need for them. Certain special considerations should be discussed relative to acute necrotizing ulcerative gingivitis, acute (primary) herpetic gingivostomatitis, and recurrent aphthous stomatitis.

ARE ANTIBIOTICS NOT innocuous drugs. Their use should be justified on the basis of a clearly established need and should not be substituted for adequate local treatment. The purpose of this paper is to review the fundamental considerations that form the basis for the administration of antibiotics in the practice of periodontics. Indications for therapeutic and prophylactic use will be discussed separately.

Acute Necrotizing Ulcerative Gingivitis Acute necrotizing ulcerative girlgivitis (ANUG) is believed to have a relatively specific bacterial component and should be considered within the therapeutic category. However, it is well established that in ANUG all local irritants must be removed and that antibiotic therapy is adjunctive treatment required only in special cases. What are the special cases? According to Glickman,l "Antibiotics are administered systemically in patients with toxic systemic complications or local adenopathy." Prichard2 states that antibiotics should be prescribed for ANUG if adequate local treatment cannot be provided immediately. He further states that the acute symptoms will be suppressed by antibiotic therapy but will recur unless adequate local therapy follows. Discussing the use of antibiotics in ANUG, Goldman and CohenS say, "A case can be made for their use in acute fulminating cases in conjunction with local therapy, but the administration must be carried out with caution and close Supervision." In general, antibiotics should not be used routinely in the treatment of ANUG. They are seldom necessary, and their indiscriminate use is a highly undesirable practice. Although antibiotics will suppress the acute symptoms of ANUG, they are strictly adjunctive to local treatment and are indicated only in severe cases with systemic involvement. As with other infections, the patient's general health should be considered in determining a need for these drugs. Some further justification may exist for the use of antibiotics in cases of ANUG that are tenaciously resistant to local treatment." However, in these instances one must determine the reason for the resistance to local treatment rather than institute antibiotic therapy as a substitute for complete evaluation of the patient. Penicillin, erythromycin, and the tetracyclines are effective against ANUG. ~ l ~ specific studies~have h ~ ~ h not been reported, it is likely that lincomycin and clindamycin would also be useful. There is some recent evidence that the antitrichromonal drug metronidazole may also be effective." 6

Therapeutic indications for the use of antibiotics presuppose an existing infection. The decision to use antibiotics therapeutically must be based on a consideration of both the nature of the infection and the general health of the patient. The following guidelines apply:

1. It is obvious that severe, acute, rapidly spreading infections should be treated with antibiotics. The less severe, localized infections where drainage can be established will, in most cases, be resolved without the use of antibiotics. 2. Evidences of systemic involvement, such as an elevated temperature, general malaise, and lymphadenopathy, frequently indicate a need for antibiotics.
3. Infections in patients with certain systemic conditions that predispose to the spread of infection generally requite antibiotic therapy. Examples of such systemic conditions are ( a ) uncontrolled diabetes, (b) leukemia, (c) agranulocytosis, (d) aplastic anemia, (e) Addison's disease, (f) depressed natural defense mechanisms as a result of therapy with adrenal steroids and immunosuppressive and cytotoxic drugs, (g) history of rheumatic or congenital heart disease, and (h) debilitation by age or disease.

4. Infections involving the region of the upper lip and nose can be serious because of venous drainage into the cavernous sinus. Antibiotics may be advantageous for combating infections in this region that would otherwise not require antibiotic therapy.
Commander, DC, U S N ; Head. Research and Sciences Department, Naval Dental School, National Naval Medical Center, Bethesda, Md. The opinions or assertions contained herein are the private ones of the writer and are not to be construed as official or as reflecting the views o f the Navy Department or the naval service at large.

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TABLE 1 Suggested Adult Dosage Schedules for Prevention of Bacterial Endocarditis (Adapted from American Heart Association Statementl6) :'
PARENTERAL SCHEDULE (Preferred) Day of Procedure (1 to 2 hours before procedure) 600,000 units procaine penicillin G (IM) and 600,000 units K penicillin G (IM) For 2 Days After Procedure 600,000 units procaine penicillin G (IM) daily ORAL SCHEDULE Day o f and 2 Days After Procedure Penicillin V or phenethicillin (250 mg every 6 hours) or K penicillin G (300 mg every 6 hours) also: an extra dose 1 hour before procedure PENICILLIN ALLERGY Day o f and 2 Days A f t e r Procedure Erythromycin (250 mg every 6 hours) ' T h e American Heart Association and the American Dental Association are currently considering changes to these recommendations. Any changes that evolve should be promulgated in late 1971.

ing the use of tetracyclines.10 It is possible that some "herpetic" lesions that respond to tetracyclines are actually recurrent aphthae or are secondarily infected. Since acute herpetic gingivostomatitis may be associated with upper respiratory infection, pneumonia, and other systemic disease, examination by a physician is frequently indicated. Many pediatricians treat severe cases of herpetic gingivostornatitis prophylactically with antibiotics. The value of this precautionary treatment is not established.

Recurrent Aphthous Stomatitis

It appears that a pleomorphic streptococcus may be involved in the pathogenesis of recurrent aphthous stomatitis.ll-I* Graykowski et all1 reported that 69% of the cases of recurrent aphthae studied responded to tetracycline in a 250 mg/5 ml suspension given four times daily for five to seven days. The suspension (5 ml for adults) was held in the mouth for two minutes and then swallowed. Any advantage of holding the suspension in the mouth for two minutes as opposed to the use of tetracycline capsules or tablets is not established. Tetracycline mouthwashes have also been reported to be helpful against recurrent aphthous stomatitis by Guggenheimer and coworkers.]"

'

It is not particularly surprising that the topical use of vancomycin has been demonstrated to be effective against ANUG.'. However, the fact that an antibiotic is applied locally rather than systemically does not negate the previously stated objections to routine antibiotic therapy in ANUG. In actuality, the topical application of any parenterally useful drug is open to some question. This is particularly true if the application is made routinely. Although the parenteral use of vancomycin against serious staphylococcic infection has declined since the advent of the penicillinase-resistant penicillins, its widespread use against a rather simply treated condition such as ANUG may, through the development of patient allergies and bacterial resistance, complicate the treatment of some life-threatening infections. Over the past several years, staphylococci have appeared that are not susceptible to the penicillinase-resistant penicillins. Fosterg stated in a 1969 issue of Medical Clinics of North America, "Vancomycin is our most reliable single agent against penicillin-resistant staphylococci, and its value happily extends over much of the rest of the grampositive spectrum as does that of penicillin." Although this may not represent a universally accepted view, it does indicate that there are physicians who rely heavily on this drug for certain severe infections. It would appear that the topical use of vancomycin might be justified in severe cases of ANUG or where the patient is physically or mentally incapable of adequate cooperation. At any rate, one should not apply vancomycin in the routine treatment of ANUG.

The prophylactic use of antibiotics anticipates the likelihood of a new infection or the exacerbation of an existing infection. A definitive indication for prophylactic antibiotic coverage is present when a patient with rheumatic or congenital heart disease is to undergo procedures that may precipitate a bacteremia. The American Heart Association has published a statement16 discussing the rationale for prophylactic coverage and giving suggested dosage schedules (see Table 1 ) . It has been suggested that antibiotic prophylaxis for patients with heart prostheses should be much more extensive than that which is considered adequate in patients with rheumatic or congenital heart disease. A regimen that has been employed at the National Heart Institute, National Institutes of Health, has been reported.li Unfortunately, most prophylactic indications are not so definite as these instances in which prophylaxis against subacute bacterial endocarditis is required. Some practitioners routinely provide antibiotic coverage for surgical patients on the premise that such prophylaxis may avert postsurgical infection, enhance the surgical results, and/or reduce postoperative discomfort.

Acute(Primary) Herpetic Gingivostomatitis

Since this infection is of viral etiology, antibiotic therapy is helpful only in case of secondary infection. However, some patients are said to experience relief follow-

Prevention of Postsurgical Infections

The use of antibiotics to prevent postsurgical infections has been challenged in medical practice. In 1966, Karl and co-workersls reported a double-blind study of

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150 surgical cases. They found a wound infection rate of 18.5% in those patients receiving antibiotics prophylactically and 12.9% in the control group. In an assessment of the prophylactic value of antibiotics in over 1,000 cases of general surgery, Johnstone1g observed that ". . . prophylactic antibiotics not only failed to prevent but also were in fact associated with an increase in the infections of all types." The failure of prophylactic antibiotic therapy to prevent postoperative infections is -~l well documented in the medical l i t e r a t ~ r e . l ~Unfortunately, similar dental evaluations are not available. One must view with some concern the philosophy of routinely using antibiotics prophylactically in an attempt to prevent postsurgical infections. Unquestionably, concern for aseptic and atraumatic operating techniques is of great importance. Most patients who undergo periodontal surgery are not going to develop a postoperative infection. Infections that do evolve might have been prevented by prophylactic antibiotics if the invading organism was susceptible to the pasticular drug selected. It is apparent from medical studies that some individuals who would not have developed a postoperative infection may do so if prophylactic antibiotics are used. The mechanism of this may be related to alterations in the normal flora which were induced by the antibiotic. Thus, in the final analysis, one must balance the infections he prevents with antibiotics against the infections he causes with antibiotics. If the medical literature on this subject accurately reflects the situation in periodontal surgery, the gains and losses in using antibiotics to prevent postsurgical infection are approximately equal. One's capacity to gain more than he loses from using antibiotics to prevent postsurgical infections is likely to be proportional to his ability to predict the likelihood of a postoperative infection in a particular case. Enhancement of Surgical Results Many practitioners use antibiotics routinely in bone grafting procedures and when attempting to establish a new attachment at a more coronal level. Although some logic underlies such use, no significant research evidence is available to indicate that antibiotics are necessary or even helpful in obtaining the desired result. In regard to healing generally, Stah132 reported that rats receiving antibiotics showed more distinctive crestal bone repair than did control rats in the early stages of healing; however, ". . . the beneficial potential of these drugs did not, under our experimental conditions, influence ultimate repair levels.'' In further studies with rats, Stahl concluded that antibiotics enhanced connective tissue reattachment,33 but he later reported that the benefits noted had been the result of an effect of the antibiotic on pulpal repair rather than on the reattachment

reported potential of the soft tissue." In 1964, StahlY5 that an experimental group of protein-deprived rats, treated with antibiotics following gingival wounds, exhibited more crestal osteogenesis than did a control group. Because of the superimposition of a nutritional deficiency, it is difficult to apply these results to the present discussion of the clinical use of antibiotics. Also in 1964, Schafer and his associates36 reported a favorable effect of antibiotics on healing following osseous contouring in dogs. In 1969, Stahl and c o - w ~ r k e r s ~ ~ reported the results of a clinical study of the effects of antibiotics in 48 patients. All subjects received l Gm erythromycin stearate per day (four divided doses) for four days following a gingivectomy. Histologic analyses were made of the tissues removed by gingivectomy and biopsies taken at 1, 2, 3, 4, 6, and 8 weeks after surgery. They showed differences in the inflammatory state of the tissues before and after gingivectomy. No comparison was discussed between the inflammatory state of the postoperative biopsies taken from antibiotic treated and non-antibiotic treated patients. Since all subjects in this report received antibiotics, such a control comparison would have had to be drawn from other studies. They further reported that the epithelialization of all wounds appeared to be complete within the first week after surgery. They contrasted this with epithelialization obtained in only 61 % to 78% of biopsy specimens in earlier studies.38~ 39 Although the foregoing studies have made significant contributions to the understanding of the effect of antibiotics on wound healing, they cannot be considered adequate justification for the use of antibiotics to enhance the results of periodontal surgery. In this area, the use of antibiotics continues to be highly speculative. Reduction o f Postoperative Discomfort The reduction of postoperative discomfort is intimately related to the rate of wound healing. As previously stated, antibiotic-wound healing studies are inconclusive. However, AriaudodOhas published a report of a double-blind study which found that lincomycin (500 mg, q.6 h., two days before and four days after surgery) reduced the incidence of malaise, edema, necrosis and pain following periodontal surgery. This paper raises most interesting possibilities, and further studies in this area are indicated. Periodontal Dressings Antibiotics have been used in periodontal dressings. In 1956, Fraleigh4I reported that he had observed certain advantages in a pack containing a tetracycline, but he also found undesirable tissue reactions. In 1958,

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Baer, et al49eported favorably on a dressing containing bacitracin, which was said to afford maximum patient comfort with cleaner, less stained teeth and with less associated debris. They observed no allergic or fungal complications. In 1960, Baer and his co-workers43 described a hydrogenated fat-bacitracin pack, and again the report was favorable. In two years of study, they observed only one case of infection with Candida albicans. Later, R ~ m a n o w ~ ~ the relationship bestudied tween moniliasis and periodontal packs containing antibiotics. With tetracycline and oxytetracycline packs, he observed both stomatitis and moniliasis. With bacitracin packs, he found neither stomatitis nor any signs or symptoms of moniliasis though he noted an increase in the presence of C. albicans. From the foregoing studies, it would seem that packs containing tetracyclines are undesirable, whereas bacitracin packs appear to offer certain advantages and to have no clinically significant disadvantages. At this point it should again be noted that the topical use of any parenterally useful antibiotic is subject to question. Bacitracin is primarily a topical antibiotic and is therefore relatively free from this disadvantage.

antibiotics to be generally used for these purposes. However, this line of research represents what may ultimately be the most effective approach to the prevention of periodontal disease; that is, plaque control by pharmacologic means.

In certain oral infections, such as ANUG and recurrent aphthous stomatitis, the etiologic agents are relatively predictable on the basis of the diagnosis. As previously stated, penicillin, erythromycin, and the tetracyclines are all effective against ANUG, and the tetracyclines appear to be effective to some degree against recurrent aphthous stomatitis. In these cases, the antibiotic is selected on the basis of the diagnosis.

Bacterial Plaque and Gingivitis

With a relationship between bacteria and periodontal disease well established, it logically followed that efforts would be made to observe the effects of antibiotics on dental plaque, gingivitis and periodontitis. The addition 4g to of penicillin4j.46 and chl~rtetracycline~~. the diet of rodents has been shown to reduce plaque formation. Dietary penicillin, erythromycin, polymyxin B, and oxytetracycline have been shown to be effective in the prevention or treatment of the periodontal syndrome in the Topical vancomycin has been reported to rice rat.", reduce plaque51 and to provide clinical improvement in gingivitis and various oral lesions in humans.52A study of children on extended systemic penicillin prophylaxis did not reveal a significantly beneficial effect on gingival scores;53 however, systemic spiramycin has been shown to have beneficial effects on periodontal disease in humans.54 Lobene and co-workers" have reported that the use of an erythromycin liquid suspension (250 mg q. 6 h.) for seven days reduced plaque formation by 35% and was particularly impressive in decreasing or eliminating spirochetes for 5 to 18 weeks after administration.

Streptococcus viridans is the organism of primary concern in subacute bacterial endocarditis. Therefore, in preventing subacute bacterial endocarditis, one is primarily concerned with S. viridans. Consequently, penicillin is the antibiotic of choice since it is highly effective against that organism. In this case, the drug is selected on the basis of what is known about the infection. Unfortunately, periodontists must also treat many infections in which the etiologic agents cannot be accurately predicted on the basis of the symptomatology. Ideally, in such cases, material from the infection should be cultured and sensitivity tests carried out to determine what antibiotic is effective against the specific etiologic agent. For practical reasons, however, periodontal infections are usually treated without the benefit of sensitivity tests. Most bacteria that are causative agents in periodontal abscesses and postoperative infections are within the antibacterial spectra of penicillin, erythromycin, the tetracyclines, lincomycin and clindamycin. In all fairness, it should be said that sensitivity tests will show that any of these antibiotics will be effective on the culture plate against most bacteria sampled from periodontal infections. Thus, the periodontist is justified in starting treatment with one of these drugs before obtaining the results of sensitivity tests for an infection that requires an antibiotic. The primary advantage of sensitivity tests is that they will let the clinician know whether he is dealing with a bacterium that is insensitive to the most commonly effective drugs.
When an antibiotic is selected without the benefit of sensitivity tests, the choice is essentially between penicillin, erythromycin, the tetracyclines, and possibly lincomycin and clindamycin. The selection of a specific antibiotic should be based on a knowledge of the pharmacology of the individual drugs. Unquestionably, penicillin is the drug of choice when a potent bactericidal agent is required. However, the periodontist must always remember that penicillin is the most allergenic drug in current use and should never be used arbitrarily; it should be selected only on the basis of an established

In a recent article, Bowers and co-workers56 stated that there is insufficient evidence at present to justify the general use of any antibiotic as a plaque control agent in the prevention and treatment of gingivitis and periodontitis. The literature indicates that although the use of antibiotics in attempts to control plaque and to improve nonspecific gingivitis and periodontitis appears to be a promising line of research, it is too early for

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need for penicillin. When such need exists but the use of penicillin is contraindicated because of patient allergy, erythromycin and sodium cephalothin are usually good substitutes. T h e principal disadvantage of sodium cephalothin in dentistry is the fact that only parenteral forms are available. However, this antibiotic may be of great importance in serious infections caused by organisms that are not affected by penicillin. Clindamycin may also be effective in this regard. Where bacteriostatic action will suffice, the tetracyclines should be effective. H o w frequently a particular clinician will use penicillin instead of a bacteriostatic drug depends on his philosophy regarding the need for any antibiotic. T h e clinician who accepts a very narrow range of indications for antibiotics will usually need a potent bactericidal agent if he feels that he needs any antibiotic. This individual should use penicillin in most cases. Although he would be using penicillin almost exclusively, he would not necessarily be using it indiscriminately. O n the other hand, some clinicians accept a very broad range of indications for antibiotics and use them in many situations where bacteriostatic drugs would be adequate. If these individuals use penicillin almost exclusively, they will be using it indiscriminately. I n this limited discussion of the antibiotic of choice, n o attempt has been made to resolve the question of which drug to use but only to stress the fact that an antibiotic should not be chosen arbitrarily but should be selected to meet the needs of the case. This selection must be based upon a knowledge of (1) the state of the patient's general health, (2) the nature of the specific infection involved, and ( 3 ) the pharmacology of the drugs available.

SUMMARY
The use of antibiotics involves certain disadvantages as well as advantages. Consequently, the decision to use these drugs should be based o n a n established need. Points to be considered in establishing the need and selecting the proper drug have been presented. REFERENCES
I. Glicknian, I.: Clinical Periodontology, ed. 3. Philadelphia, W. B. Saunders Co., 1964, p. 679. 2. Prichard, J. F.: Advanced Periodontal Disease: Surgical and Prosthetic Management. Philadelphia, W. B. Saunders Co., 1965, pp. 377-378. 3. Goldman, H. M. and Cohen, D. W.: Periodontal Therapy, ed. 4. St. Louis, C. V. Mosby Co., 1968, p. 204. 4. Graykowski, E. A. and Holroyd, S. V.: Therapeutic Management of Primary Herpes, Recurrent Labial Herpes, Aphthous Stomatitis, and Vincent's Infection. Dent. Clin. N. Amer., 14:721, 1970. 5. Stephen, K. W., McLatchie, M. F., Mason, D. K., Noble, H. W. and Stevenson, D. M.: Treatment of Acute ulcerative Gingivitis (Vincent's Type). Brit. Dent. J., 121: 313,1966.

6. Fletcher, 5. P. and Plant, C. G.: An Assessment of Metronidazole in the Treatment of Acute Ulcerative Pseudomenlbranous Gingivitis (Vincent's Disease). Oral Surg., 22: 739, 1966. 7. Mitchell, D. F. and Baker, B. R.: Topical Antibiotic Control of Necrotizing Gingivitis. J. Periodont., 39:S 1, 1968. 8. Collins, J. F. and Hood, H. M.: Topical Antibiotic Treatment of Acute Necrotizing Ulcerative Gingivitis. J. Oral Med., 22.59, 1967. 9. Foster, F. P.: Emergency Treatment of Severe Bacterial Infection. Med. Clin. N. Amer., 53:437, 1969. 10. Burket, L. W.: Oral Medicine, ed. 3. Philadelphia, J. B. Lippincott Co., 1957, p. 136. 11. Graykowski, E. A., Barile, M. F., Lee, W. B. and Stanley, H. H.: Recurrent Aphthous Stonlatitis: Clinical, Therapeutic, Histopathologic, and Hypersensitivity Aspects. J.A.M.A., 196:637, 1966. 13. Barile, M. F. and Graykowski, E. A.: Primary Herpes, Recurrent Labial Herpes and Recurrent Aphthae and Periadenitis Aphthae: A Review with Some New Observations. J. Dist. Columbia D. Soc., 38:7, 1963. 13. Graykowski, E. A., Barile, M. F. and Stanley, H. R.: Periadenitis Aphthae, Clinical and Histopathological Aspects of Lesions in a Patient and of Lesions Produced in Rabbit Skin. J. Amer. Dent. Ass., 69:118, 1964. 14. Stanley: H. R., Graykowski, E. A. and Barile, M. F.: The Occurrence of Microorganisms in Microscopic Sections of Aphthous and Non-aphthous Lesions and Other Oral Tissues. Oral Surg., 18:335, 1964. 15. Guggenheimer, J., Brightman, V. J. and Ship? I. I.: Effect of Chlortetracycline Mouthrinses on the Healing of Recurrent Aphthous Ulcers: A Double-Blind Controlled Trial. J. Oral Ther., 4:406, 1968. 16. Committee on Prevention of Rheumatic Fever and Bacterial Endocarditis, Council on Rheumatic Fever and Congenital Heart Disease: Prevention of Bacterial Endocarditis (EM 113A rev.). New York, American Heart Association, 1965. 17. Archard, H. 0 . and Roberts, W. C.: Bacterial Endocarditis after Dental Procedures in Patients with Aortic Valve Prosthesis. J. Amer. Dent. Ass., 72:648, 1966. 18. Karl, R. C., Mertz, J. J., Veith, F. J. and Dineen, P.: Drugs in Surgery. New Eng. J. Prophylactic Antin~icrobial Med., 275:305, 1966. 19. Johnstone, F. R. C.: An Asssessment of Prophylactic Antibiotics in General Surgery. Surg. Gynec. and Obstet., 116:1, 1963. 20. King, G. C.: The Case Against Antibiotic Prophylaxis in Major Head and Neck Surgery. Laryngoscope, 71:647, 1961. Infections Complicat21. Hognian, C. F. and Sahlin, 0.: ing Gastric Surgery. Acta. Chir. Scand. 112271, 1957. 22. Pulaski, E. J.: Antibiotics in Surgical Cases. Arch. Surg., 82:545, 1961. 23. McKittrick, L. S. and Wheelock, F. C.: The Routine Use of Antibio'tics in Elective Abdominal Surgery. Surg. Gynec. Obstet., 99:376, 1954. 24. Marshall, A.: Prophylactic Antimicrobial Therapy in Retropubic Prostatectomy. Brit. J. Urol., 3 1:43 1, 1959. 25. Editorial, New Eng. J. Med., 275:335, 1966. 26. Petersdorf, R. G., Curtin, J. A. Hoeprick, P. D., Peeler, R. N. and Bennett, I. L.: Study of Antibiotic Prophylaxis in Unconscious Patients. New Eng. J. Med., 257: 1001, 1957. 27. Petersdorf, R. G. and Merchant, R. K.: A Study of Antibiotic Prophylaxis in Patients with Acute Heart Failure. New Eng. J. Med., 265565, 1959.

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43. Baer, P. N., Sumner, C. F. I11 and Scigliano, J.: Stud28. Lachdjiam, M. 0 . and Compere, E. C.: Postoperaies on a Hydrogenated Fat-Zinc Bacitracin Periodontal tive Wound Infections in Orthopedic Surgery. J. Int. Coll. Dressing. Oral Surg., 13:494, 1960. Surg. (Now Int. Surg.), 28:797, 1957. 44. Romanow, I.: The Relationship of Moniliasis to the 29. Laylor, G. W.: Preventive Use of Antibiotics in SurPresence of Antibiotics in Periodontal Packs. Periodontics, gery. Brit. Med. Bull., 16:51, 1960. 2:298, 1964. 30. Weinstein, L.: Chemoprophylaxis of Infection. Ann. 45. Mitchell, D. F. and Johnson, M.: The Nature of the Intern. Med., 43287, 1955. Gingival Plaque in the Hamster-Production, Prevention, 31. Cole, W. R. and Bernard, H. R.: A Reappraisal of and Removal. J. Dent. Res., 35:651, 1956. the Effects of Antimicrobial Therapy During the Course of 46. Keyes, P. H., Fitzgerald, R. J., Jordan: H. V. and Appendicitis in Children. Amer. Surg., 27:29, 1961. White, C. L.: The Effect of Various Drugs on Caries and 32. Stahl: S. S.: The Influence of Antibiotics on the HealPeriodontal Disease in Albino Hamsters. ORCA (Proc. of ing of Gingival Wounds in Rats. I. Alveolar Bone and Soft the Congress of the European Organization for Research Tissue. J. Periodont., 33261, 1962. on Fluorine and Dental Caries Prevention), 1962. pp. 15933. Stahl, S. S.: The Influence of Antibiotics on the Heal177. ing of Gingival Wounds in Rats. 11. Reattachment Potential 47. Rushton, M. A.: Dental Effects of Dietary Aureomyof Soft and Calcified Tissues. J. Periodont., 34:166, 1963. cin. Brit. Dent. J., 98:313, 1955. 34. Stahl, S. S.: The Influence of Antibiotics on the Heal48. Gressly, F. and Leung, S. W.: Preliminary Study of ing of Gingival Wounds in Rats. 111. The Influence of Pulpal Calculus Formation in Rodents. I.A.D.R., 40:1S, 1962 (AbNecrosis on Gingival Reattachment Potential. J. Periodont., 34:371, 1963. stract). 49. Gupta, 0 . P., Auskaps, A. M. and Shaw, J. H.: Perio35. Stahl, S. S.: The Healing of a Gingival Wound in protein-~eprived, ~ ~ i b i ~ ~ ~ ~ d~ ~ ~ ~ l t, ~~ dontal Disease in ~ ~ t Rat. d The Effects of Antibiotics ~ i Oral ~ ,l ~ ~ ~ the Rice ~ IV. on the Incidence of Periodontal Lesions. Oral Surg., 10: Surg., 17:443, 1964. 1169, 1957. 36. Schafer, T. J., Collings, C. K., Bishop, J. G. and Dor50. Shaw, J. H., Griffiths, D. and Auskaps, A. M.: The man, H . L.: The Effect of Antibiotics on Healing Following Influence of Antibiotics on the Periodontal Syndrome in the Osseous Contouring in Dogs. Periodontics, 2243, 1964. Rice Rat. J. Dent. Res., 40:511, 1961. 37. Stahl, S. S., Soberman, A. and De Cesare, A,: Gingi51. Mitchell, D. F. and Holmes, L. A.: Topical Antival Healing. V. The Effect of Antibiotics Administered Durbiotic Control of Dentogingival Plaque, J. Periodont,, 36: ing the Early Stages of Repair. J. Periodont., 40:521, 1969. 202,1965. 38. Stahl, S. S., Witkin, G. J., Cantor, M. and Brown, R.: 52. Scopp, I. W., Gillette, W., Kumar, V. and Larato, D.: Gingival Healing. 11. Clinical and Histologic Repair SeTreatment of Oral Lesions with Topically Applied Vancoquences Following Gingivectomy. J. Periodont. 39:109, nlycin Hydrochloride. Oral Surg,, 24:703, 1967. 1968. 53. Littleton, N. W. and White, C. L.: Dental Findings , 39. ~ t a h lS. S., Witkin, G. J., Heller, A. and Brown, R.: from a Preliminary Study of Children Receiving Extended Gingival Healing. 1V. The Effects of Homecare on Gingivec~ ~ ~ iT b , i ~ ~~ A ~i ~ ~ . ~~ A ~ ~68:520, 1964. J. ~ ~D ~ ~, . .. tomy Repair. J. Periodont., 40:264, 1969. 54. Winer, R. A., Cohen, M. M. and Chauncey, H. H.: 40. Ariaudo, A. A.: The Efficacy of Antibiotics in PerioAntibiotic Therapy in Periodontal Disease. J. Oral Ther., dontal Surgery: A Controlled Study with Lincomyin and 2:403, 1966. Placebo in 68 Patients. J. Periodont., 40:150, 1969. 55. Lobene, R. R., Brion, M. and Socransky, S. S.: Effect 41. Fraleigh, C. M.: An Evaluation of Topical Terramyof Erythromycin on Dental Plaque and Plaque Forming cin in Postgingivectomy Pack. J. Periodont., 27:201, 1956. Microorganisms of Man. J. Periodont., 40:287, 1969. 56. Bowers, G. M., Hardin, J. F. and Moffitt, W. C.: 42. Baer, P. N., Goldman, H. M. and Scigliano, J.: Studies on a Bacitracin Periodontal Dressing. Oral Surg., Chemotherapy of Dental Plaque Infections. Dent. Clin. N. 11:712, 1958. Amer., 14:855, 1970.

Abstracts
MESIAL DRIFT TEETH ADULT OF IN MONKEYS (MACACA IRUS) WHEN FORCES FROM THE CHEEKS AND TONGUE HAD BEENELIMINATED Moss. J. P. and Picton, D. C. A. Arch. Oral Biol. 15:979, October, 1970 Cheek teeth on one side of the mouth were covered by an acrylic dome to eliminate the effect of muscles and direct occlusal forces. The same teeth on the opposite side of the mouth were used as controls. The opposing teeth on both sides were extracted to eliminate the influence of occlusal forces. Tooth contacts were removed with a diamond disc allowing for movement of the teeth. From 6 to 17 weeks it was observed that the controls and the experimental sides both drifted mesially at about the same rate, which led to a conclusion that the cheeks and tongue did not play a significant part in mesial drift in these animals. University College Hospital Dental Sclzool, Londorz, W.C. I , England. Armstrong, W. G. Arch. Oral Biol. 15: 1001, October, 1970 Samples of whole human saliva were stirred with synthetic hydroxyapatite preparations, and then submitted for disc electrophoresis. It was found that high proline, high glutamic acid and high glycine levels made up about one-half of the total amino acid residues. Significant (0.5 percent) quantities of hexosamine were present, implying a glycoprotein nature for the components. Parotid saliva samples that were taken showed basically the same results. I n addition there was significantly less aspartic acid, threonine and isoleucine. Departnzent of Biochemist,-)., Tlze Royul Derztal Hospital, School of Dental Surgery, 32 Leicestrr Square, LolZdon, W.C. 2, England.