Letter from a reader: Bill Landers writes in response to Dr. Robert Schoor's article

Dec. 8, 2011
Bill Landers, president of OraTec and columnist for RDH magazine, writes in response to Dr. Robert Schoor’s article on “The role of antibiotics in periodontal disease” from the November issue of Surgical-Restorative Resource.

Editor’s note: If you would like to send a letter to the editors, please email Dr. Scott Froum at [email protected] and Dr. Chris Salierno at [email protected]. We welcome responses from our readers.

Dear Editor,

Regarding “The role of antibiotics in periodontal disease” by Dr. Robert Schoor (DentistryIQ, Nov. 9, 2011) that ran in the November issue of Surgical-Restorative Resource ...

1. While I would agree that systemic antibiotics are often prescribed inappropriately and without proper instruction in their use, the remainder of the article is highly misleading. The statement that the use of systemic antibiotics for periodontal therapy is “... promiscuous, anecdotal, and contrary to the scientific literature” is unsupported, even by the author’s own references.

2. The author implies that the WHO and ADA discourage the use of antibiotics because of increasing bacterial resistance. Their concern relates to the inappropriate use and dosage of antibiotics, not their therapeutic use. The reference to the ADA advisory conflates the lessened need of prophylactic antibiotics for pre-existing medical conditions with their therapeutic usage.

3. The author provides a partial reference (Powell and Mealey) as evidence that periodontal surgery with and without antibiotics have comparable outcomes. The citation in question is probably, “Post-surgical infections: prevalence associated with various periodontal surgical procedures,” J Periodontol. 2005 Mar; 76(3):329-33. That study examined the incidence of morbidity and healing postsurgical procedures, not therapeutic outcomes. It used a single, nontherapeutic (PD, attachment loss, etc.) metric, namely postsurgical “swelling with suppuration.” Those are complications, not outcomes.

4. The author claims that the very concept of an antibiotic affecting outcomes is “naïve.” Two (uncited) studies are offered: a retrospective review of the periodontal literature, and a V.A. study that finds comparable outcomes for surgery both with and without systemic antibiotics. That contradicts the current AAP position paper (Systemic Antibiotics in Periodontics, J Periodontol. 2004; 75:1553-1565), which reports 17 studies using appropriate antibiotics, 16 of which resulted in improved outcomes.

5. The statement that a patient’s ASA status alone obviates any need for further testing is completely baffling. ASA is a classification system developed in 1941 by the American Society of Anesthesiologists to roughly assess a patient’s fitness for (general) surgery prior to selecting an anesthetic. It uses no metrics and measures nothing.

6. The author implies that bacterial testing is on the decline and difficult to perform, and that labs are hard to find, all of which are untrue. Bacterial testing is both commonplace and simple. As for hard to find, one need only Google periodontal tests. Lastly, the author implies that testing labs have so little business that many have “ceased operations,” and he names Temple University and the University of Pennsylvania as examples. Temple’s certified culture lab (OMTL) has never ceased operations. The University of Pennsylvania’s lab director, Dr. Jorgen Slots, now heads up a similar lab (OMTS) at USC. In addition to the cultural labs, clinicians can choose from a number of other microbiological tests, including DNA, BANA enzyme, and microscopy, all of which are supported by numerous published studies.

Bill Landers
President, OraTec
RDH columnist
[email protected]