Superbugs in Dental Practice: A Narrative Review

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1 Anushka Gupta, Nagesh Lakshminarayan REVIEW ARTICLE 10.00/jpjournals... 1 Anushka Gupta, 2 Nagesh Lakshminarayan ABSTRACT Microbes do undergo perpetual mutations, thus they evolve swiftly. This may have chilling repercussions on the world. Overuse, underuse and misuse of antimicrobials over many sure resulting in the development of antimicrobial resistance throughout the world. The rise in antibioticresistant infections can be considered as a catastrophic threat. This threat is akin to terrorism and global warming that could cause the effectiveness of the world s health systems to slip back by 200 years. There is extensive literature in medical science, showing evolution of drug resistance resulting in emergence of superbugs. Dentistry is not an exception and superbugs like Methicillin resistant Staphylococcus aureus (MRSA) are reported on the surfaces of dental operatory including the airwater syringe and active participation from all the healthcare professionals to prevent mankind from entering a postantibiotic era. Keywords: Antibiotic resistance, Antimicrobials, Dental practice, NDM1, Superbugs. How to cite this article: Gupta A, Lakshminarayan N.. J Dent Sci Oral Rehab 201;6(1):0000. Source of support: Nil INTRODUCTION None Abuse of miracle drugs ensues resistance Alexander Fleming s warning comes true. 1 The war between bugs and drugs is continuing since the ing in niae, Acinetobacter baumannii, Pseudomonas aeruginosa and The misuse of antibiotics in medicine and agriculture due to usage of NDM1: AN EYE OPENER genes. The antibiotic emergence. Although some degree of resistance has reached a dangerous level. we may be on the brink of a medical disaster. We may be heading toward the end of antibiotic era with minor Staphylococcus aureus lactamases 1 There are Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumo MECHANISM OF DRUG RESISTANCE 34 1 Postgraduate Student, 2 Professor and Head 1,2 Department of Public Health Dentistry, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India Corresponding Author: Anushka Gupta, Postgraduate Student Department of Public Health Dentistry, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India, Phone: dranushkagupta@gmail.com when it is no longer affected by a normally effective concentration of antibiotic. Bacteria have a wide variety of rent mechanisms to resist the same antibiotic agent. There are four mechanisms for drug resistance.

2 lactamase Production destroys the antimicrobial agent based on their lactam since this drug cannot cross the external membrane of lactams inhibit lactamases are readily transmissible between bacterial Escherichia coli Enterobacter cloacae,, P. aeruginosa, Haemophilus influenzae, Neisseria gonorr hoeae 2 and Fusobacterium Nucleatum. 8 naturally resistant. It can arise following random genetic bacteria. Wang and others clearly demonstrated that two Streptococcus gordonii and Treponema denticola Change in Target changing the structure of the target so that it is no longer to increase in resistant bacterial strains in the mouth. ANTIBIOTIC RESISTANCE IN DENTISTRY misused antibiotics in treatment situations. 9 This has a 2 Act as Barrier int rinsic resistances of these organisms to many antibiotics. In P. aeruginosa 2 nonuse or minimal usage of systemic antimicrobials was urging caution in the usage of syste mic antimicro bials. wherein a drug that initially enters the cell through the from microbial cells is shown to be associated with the In the ence of antibiotic resistant and even multiresistant oral bacteria. This emergence of resistant microbes is linked of either dosage or indication. E. coli. 2 Resistance to antibiotics can be divided into two categories: intrinsic and acquired. Intrinsic resistance DRUGS USED IN DENTISTRY AND THE DEVELOPING RESISTANCE TOWARD THEM Penicillins and Cephalosporins Resistance to The Journal of Dental Sciences and Oral Rehabilitation, JanuaryMarch 201;6(1):0000 3

3 Anushka Gupta, Nagesh Lakshminarayan with the members of the genus Bacteroides and Prevotella Prevotella 11 has been correlated with bacteria. not been fully elucidated. AlmaguerFlores A et al collected subgingival F. nucleatum ss vincentii and F. periodonticum resistant to amoxicillin. 12 A. naeslundii S. constellatus A. naeslundii S. mitis S. oralis A. odontolyticus S. sanguis. al found V. parvula and several A. naeslundii strains as C. rectus F. nucleatum P. anaerobius P. intermedia F. melaninogenica T. denticola T. socranskii Clindamycin S. constellatus P. nigrescens E. saburreum A. naeslundii 1 S. oralis P. melaninogenica and P. intermedia. his colleagues found Aggregatibacter Actinomycetemcomitans B. oralis Capnocytophaga Campylobacter spp Macrolides cing strains. Low concentrations of the drug are bacterecently been considered for the management of odonbacterial resistance and good antibiotic levels in bone. A. actinomycetemcomitans E. corrodens and H. aphrophilus strains resistant to clindamycin. 1 Prevotella strains of P. gingivalis and Tannerella forsythia carrying the tet and erm resistance genes have commonly been isolated. A. actinomycetemcomitans B. oralis Campylobacter. Eikenelia corrodens F. nucleatum and V. parvula were found to be erythromycinresistant. A. actinomycetemcomitans B. oralis Campylobacter Eikenelia corrodens F. nucleatum H. aphrophilus V. parvula L. case S. mutans Tetracycline and F. nucleatum Porphyromonas gingivalis Metronidazole 1 Gramnegative bacilli and has moderate activity against T. denticola have already been isolated. Resistance to tetra that the Gramnegative Prevotella and Veillonella as well as Fusobacterium prausnitzii were all relatively 1 36

4 Streptococcus Veillonella parvula Peptostreptococcus micros Prevotella intermedia Gemella morbillorum and A. actinomycetemcomitans. 18 allowed an E. faecalis a solution containing an extremely high concentration of tetracycline in a root canal model. 19 found A. actinomycetemcomitans C. rectus F. nucleatum P. anaerobius P. gingivalis P. intermedia F. melaninogenica T. denticola T. socranskii chete resistant to minocycline. tion of E. faecalis E. faecalis but only as an irrigant. Topically Applied Antibiotics Although high concentrations can be obtained with of resistant bacterial strains following local delivery. effects of subgingival antibiotic slow release devices on the microbiota of gastrointestinal tract. This lack of data chance of the transfer of multidrug resistance after local Antiseptics S. aureus and E. coli strains have become resistant concen trations did not contribute to a change in the Streptococcus constellatus resistant to doxycycline. 12 occurrence of doxycyclineresistant bacteria in the Chloramphenicol Streptococcus salivarius Lactobacillus casei, E. corrodens and Bacteroides oralis resistant to Aminoglycosides and no resistance formation was detected. A similar observation has been made for essential oils when used by P. gingivalis 22 ENDODONTIC SUPERBUGS Contemporary Endodontic Medicaments 21 Of all the organisms which have been found in root E. faecalis inactivation of E. faecalis challenge. Enterococcus faecalis E. faecalis E. faecalis isolated from Journal of Dental Sciences and Oral Rehabilitation, JanuaryMarch 201;6(1):0000 3

5 Anushka Gupta, Nagesh Lakshminarayan the oral cavity are resistant to both clindamycin and in root canal medicaments. 21 which are undesirable. The antibiotics may function as an S. fecalis S. fecalis was four times as resistant as mycin. Renata Ximenes Lins et al found that all isolates of endodontic E. faecalis resistant to Tetracycline. disease in remission. 29 F. nucleatum resistant Staphylo coccus aureus in vitro dental infections. 2 abscesses were Gramnegative anaerobes and were highly Prevotella oralis and Porphyromonas gingivalis showed no resistance to any of the three antibiotics. and clindamycin and the aerobic bacteria resistant to a rising trend in the levels of resistant organisms in dentoalveolar infections and questioning the ongoing such infections. 2 resistant bacteria on teeth. Two silver resistant E. cloacae isolates were isolated from infected teeth containing were anaerobic Gramnegative rods that belonged to the Capnocytophaga lactamase one of the cases. PERIODONTIC SUPERBUGS which confers bacterial resistance is low bacterial metabolic activity within the biofilm reducing the assimilation of antibiotics. The extracellular matrix of the 28 P. intermedia isolates of A. actinomycetemcomitans and one of 11 of P. gingivalis of A. actinomycetemcomitans and two of P. intermedia nigrescens Ardila P. gingivalis F. nucleatum were amoxicillin essential for eventual antibiotic treatment. therefore be seriously questioned. When antibiotics are 38

6 A. actinomycetemcomitans were CONCLUSION The introduction of new antibiotics has always been assonew antimicrobial agents is required to circumvent this one or more antibiotics are now widely observed. All 29 Antibiotic resistance of which must be conceived from a world ecological human race at every turn. Let us avoid giving them vive. to decreased rates of resistance. limit the use of antibiotics to cases where indications for use have been fully validated. REFERENCES after root canal irrigation with high concentrations of shifts after subgingival debridement and formation of bacterial resistance when combined with local or systemic chlorhexidine. Oral abscesses and ra Journal of Dental Sciences and Oral Rehabilitation, JanuaryMarch 201;6(1):

7 Anushka Gupta, Nagesh Lakshminarayan Antimicrobial Lactamase 40