The purpose of this study was to identify the patient populations at risk of medication-related osteonecrosis of the jaw (MRONJ) and determine which medical and dental comorbidities are significant risk factors for this disease. An electronic search of Embase, MEDLINE, Cochrane Central Register of Controlled Trials, WHO International Clinical Trials Registry Platform and ProQuest Dissertations and Theses Global was conducted to identify all human studies that reported risk factors for MRONJ. Only a qualitative analysis was performed due to significant heterogeneity in the collected data. The search strategy identified 2872 records, of which 219 studies were eligible for inclusion. A total of 4106 patients with MRONJ were identified, 39 different systemic diseases were implicated, and 14 medical and 11 dental risk factors were reported, although no statistical analysis of the significance of each of these factors was possible. The clinical reach of MRONJ may be wider than anticipated, and more data on the significance of each potential risk factor are needed to guide the identification and management of at-risk patients.

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Aim: This systematic review aimed to determine the optimum dose and duration of amoxicillin-plus-metronidazole prescribed as an adjunct to non-surgical treatment of periodontitis.Methods: Electronic searching identified 376 records, of which 18 were eligible blinded, randomized placebo-controlled trials. The primary outcomes assessed were periodontal pocket depth and clinical attachment level at 3 months, and secondary outcomes were adverse events and compliance. Subgroup analyses were conducted to compare lower and higher doses, and 7-and 14-day courses.Results: Meta-analysis showed a small beneficial effect of adjunctive amoxicillin-plusmetronidazole for each primary outcome, but there was <0.1 mm variation with antibiotic dose or duration. Risk differences for adverse events in the higher dose and longer duration groups were minimally greater (0.04 and 0.05, respectively), and there was one report of anaphylaxis; 1.3% of patients were not fully compliant. Conclusion:There was no clinically meaningful difference between different doses or duration of amoxicillin-plus-metronidazole at 3 months post-treatment. Without compelling evidence to suggest that any one regimen performed superiorly, principles of responsible antibiotic use generally recommend the highest dose for the shortest duration of time to reduce the risk of antibiotic resistance. Therefore, a 7-day regimen of 500/500 mg or 500/400 mg of amoxicillin and metronidazole would be most appropriate. K E Y W O R D Samoxicillin, metronidazole, periodontitis | INTRODUCTIONThe discovery of antibiotics in the 1940s was a fundamental turning point in medicine, but their subsequent misuse and overuse have resulted in critical levels of antibiotic resistance (Levy & Marshall, 2004). As the grim reality of a post-antibiotic era looms, all healthcare professionals have a responsibility to improve their prescribing practices (Spellberg et al., 2008). While dentists are only responsible for a small fraction of all antibiotic prescriptions (Marra, George, Chong, Sutherland, & Patrick, 2016), this still translates into millions of prescriptions each year (Fluent, Jacobsen, & Hicks, 2016), many of which are given unnecessarily for inflammatory conditions that The Council for Appropriate and Rational Antibiotic Therapy (CARAT) have developed five criteria to guide the selection of an appropriate antibiotic regimen: evidence-based results, therapeutic benefits, safety, optimal drug for optimal duration and cost-effectiveness (Slama et al., 2005). When applying these criteria to systemic antimicrobial use in periodontitis, there is reasonable evidence to suggest that the use of antibiotics as an adjunct to non-surgical therapy (NST) may provide modest improvements in clinical attachment gain (Haffajee, Socransky, & Gunsolley, 2003;Herrera, Sanz, Jepsen, Needleman, & Roldán, 2002; and that this benefit is greater in deeper pockets and in patients suffering from aggressive forms of periodontitis (Herrera et al., 2002;Zandbergen, Slot, Cobb, & Van Der Weijden, 2013)...

The use of the ICU in the management of odontogenic infection has increased significantly at the Royal Brisbane and Women's Hospital over 1 decade. The demographic data and clinical presentation of the patients admitted to the ICU did not change significantly. However, the length of ICU stay and the total length of stay have both increased. A significant increase in CT usage for odontogenic infections also occurred. Third molar infections, dysphagia, and elevated CRP might be relevant clinical predictors of a more complicated course of care requiring ICU admission. More judicious use of CT scanning, combined with prompt surgical consultation and intervention, might reduce the rate of ICU admissions for odontogenic infections.