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The Use of Aureomycin in Oral Infections a Preliminary Report
THE USE OF A U R EO M Y C IN IN O R A L INFECTIO NS A PRELIM IN ARY REPORT
G eo rge M organ Stewart,* D.D.S., and Lester H u gh Roth.f D.D.S., Pittsburgh
is one of the most recently discovered chemotherapeutic agents and antibiotics used in the treatment of infective disease. It is derived from a soil organism, a new species of the Actinomycetes, of the genus Strep,tomyces for which the name Streptomyces aureofaciens is being proposed. T h e name, “ aureomycin,” was designated because of the faintly yellow appearance of the crystalline antibiotic produced from Streptomyces aureofaciens and the typical golden yellow growth of the colony of this fungus.1 Preliminary studies indicate successful treatment of some rickettsial and viral infections with aureomycin. It is also effective against both gram-positive and gram-negative types of organisms in vitro. These reports, together with the low tox icity and few side reactions among dogs and mice, suggested clinical trials of aureomycin in the treatment of oral in fections.2 T h e forms of the drug supplied were: 25 mg. cones; 15 mg. troches; and 250 mg. capsules for use in systemic treatment. This preliminary report represents over 100 cases with a variety of oral infections treated with aureomycin.
A
u r e o m y c in
Plan of Investigation
Prior to this investigation, aureomycin had been used in the treatment of some human diseases such as primary atypical pneumonia, Rocky M ountain spotted fever, Q fever, brucellosis, infections caused by the coli-aerogenes group of
bacteria, Streptococcus faecalis infections of the urinary tract and virus-like infec tions o f the eye.3 These conditions were treated principally with oral doses of 250 mg. capsules of strain A-377. In these investigations, which began on M arch 12, 1949, patients were observed every 24 hours while undergoing treat ment and given varying dosages. As these are, to our knowledge, the first dental investigations conducted on man, there was no prescribed dosage for the test m a terial to be used in the given cases. Each case history included height, weight, age, sex, color, chief complaint, past illnesses, present history, and the treatment plan in order to evaluate a dosage for our investigation. Treatm ent began with low concentra tions of aureomycin hydrochloride, which were gradually increased in successive cases until considerable amounts were tol erated. These cases received no other chemotherapy during aureomycin treat ment, although some had been treated unsuccessfully with other agents before
Received for publicatiqn October 3, 1949. *Professor of Periodontia and Physiology, School of Dentistry, University of Pittsburgh. flnstructor in Prosthesis and Periodontia, School of Dentistry, University of Pittsburgh. 1. Duggar, B. M ., Aureomycin: A Product of the Continuing Search for New Antibiotics. Ann. New York Acad. Sc. 5 1 :1 7 7 (Nov. 30) 1948. 2. Harned, B. K .; Cunningham, R. W .; Clark, M . C .; Cosgrove, R .j Hine, C . H .; McCauley, W. J.; Stokey, E . ; Vessey, R . E.; Yuda, N. N., and Subba Row, Y . The Pharmacology of Duomycin. Ann. New York Acad. Sc. 5 1 :182 (Nov. 30) 1948. 3. Collins, H . S.; Paine, T . F ., Jr., and Finland, M . Clinical Studies With Aureomycin. Ann. New York Acad. Sc. 51:232 (Nov. 30) 1948.
The Journal of the A m erica n Dental Association
564
aureomycin therapy was started. Diagno sis of oral infection was supported by oral smears, using Gram ’s stain wherever in dicated. T h e cases selected were mostly of the advanced or acute type of infec tion. In some cases, color photographs were taken in various stages of treatment and they clearly show the results of the therapy. No local treatment other than aureomycin was used in these cases. No scaling, curettage, or any other mechan ical or therapeutic procedure was at tempted. T h e patients were instructed to abstain from the use of any mouthwash or dentifrice, but, if so desired, to cleanse the teeth lightly with tapwater and tooth brush. A certain number of the patients treated were selected at random and placed upon restricted diets; that is, they abstained from alcoholic beverages, smok ing, foods highly seasoned with condi ments, nuts, pastries, chocolate, candy, chewing gum and carbonated beverages. A ll of the remaining patients were en tirely unrestricted in diet and drinking habits, but were merely encouraged to force water intake. Necrotic Gingivitis
Case 1 .— O n M arch 12, 1949, a white, 22 year old housewife, 5' 3 " tall, weighing 138 pounds, complained o f pain around the teeth, fetid breath, gingival bleeding, tender mouth, headache, and tempera ture of 100.4° F. O ral examination re vealed necrotic areas of the labial gin givae, highly inflamed and edematous, with fetid odor of the breath and exces sive salivation. O ral smears, stained with Gram’s iodine reagent, led to the diagno sis of necrotic gingivitis. Color photo graphs were taken. A t 11 a . m . , M arch 12, 1949, the first investigation was begun, using aureomy cin hydrochloride troches (15 m g.). The patient was instructed to dissolve one troche in the mouth every four hours, day and night. T h e following morning, she reported less pain and marked signs of
improvement with reduced bleeding. The dosage was then increased to one troche every three hours for the next 24 hours. O n M arch 14 (two days after start of treatm ent), the patient was greatly im proved, there was complete healing of the necrotic areas and only slight pain per sisted. Treatm ent was continued with the same dosage, one troche every three hours, for the next two days. O n M arch 15, al most all of the original symptoms were gone. O n M arch 16, affected tissues pre sented a normal appearance and the con dition was completely healed. The pa tient was asked to return for observation for the next three days and then one week later to evaluate the effect. Meanwhile, the medication was withdrawn. T h e pa tient returned, as requested, and all mouth tissues appeared normal. A total of 22 troches were taken without any re action or untoward incident due to the drug, except for a yellow discoloration of the dorsum of the tongue. Other Cases.— Eighteen patients were treated with aureomycin hydrochloride troches (15 m g.). Six of these patients were penicillin-resistant as well as penicil lin-allergic. Patients were administered troches, in an average dose of one every three hours while awake, for a period of four days. A fter the first 24 hour period of medication with aureomycin troches, there was marked relief in all cases, and after 72 hours the clinical picture was greatly improved. A fter 120 hours, all lesions were completely healed and there was no evidence of toxic reaction or in tolerance to the drug. One case was treated solely with aureo mycin capsules (250 mg. each). For the first 24 hours the dosage was one capsulc every three hours, night and day; and for the next three days, one capsule every two hours. A t the end of five days the patient was completely recovered. There was no reaction to the drug until the fifth day, when there were increased stools and a feeling of nausea.
Stewart-Roth
Necrotic Gingivitis with Associated Vincent's Angina
Case 2 . — O n M arch 31, 1949, a white, 30 year old housewife, weighing 118 pounds, and 5' 5 " tall, complained of loss of sleep and appetite, loss of weight (5 pounds in ten days), severe pain in the cheeks, headache, gingival bleeding, phar yngitis, enlarged submaxillary and cervi cal lymph nodes, fetid breath, a temper ature of 99.8° F., and complete inability to eat in the past 24 hours. T h e patient gave a history of primary anemia two years earlier. O ral examina tion exhibited poor oral hygiene, massive deposits of calculus, extensive recession of the gingivae w ith marked hyperplasia, rampant caries, fractured crowns of sev eral posterior teeth, profuse gingival bleeding, and grey necrotizing areas on mucous membranes of cheek opposite the retromolar areas, the soft palate, the walls of the pharynx and the labial gingivae. There was Class III mobility of the teeth. O ral smears were taken and G ram ’s stain revealed great numbers of Vincent’s or ganisms in the field. O n M arch 31, 1949, at 11 a .m ., ther apy with aureomycin hydrochloride troches (15 mg.) was started. For the first 24 hours, one troche was taken every two hours day and night. O n April 1, at 11 a .m ., the patient was greatly im proved and reported that, after taking two doses of the prescribed troches, she had been able to eat comfortably for the first time in ten days. Tem perature was normal, swelling of the submaxillary and cervical lymph nodes was reduced, and the ulcerations and areas of necrosis were decreased. T he bleeding persisted. There were no ill effects from the therapy. For the next four days, one troche every hour w hile awake was prescribed. O n April 2, 1949, there was a further improvement and the ulcerations were approximately one-fifth the size that they were on M arch 31. T h e tongue became a golden yellow in color. O n April 3, all gingival bleeding
J.A.D.A., Vol. 40, M a y 1950 . . . 565
had ceased, but slight swelling of cervical and submaxillary nodes persisted. There was a further reduction of ulcerative areas, and the tone of the tissue was al most normal. O n April 5, the mouth was clear of ulcerations, hyperplasia was no longer present and the lymphatic nodes were normal. T h e tongue was a brownish yellow. T h e dosage was reduced to one troche every three hours for one day and then one every four hours for three days. O n April 6, the condition was the same as on April 5 except that the tongue was darker. T h e patient was comfortable and the condition was considered inactive. O n the following three days the patient returned for examination, photographs and further prognosis for retention of the remaining teeth. There was no recurrence of the previous condition. A total of 74 troches had been taken with no ill effect. The discoloration is indicative of the duration and quantity of the therapy used locally. Other Cases. — T w o more cases were treated with aureomycin troches (15 m g.). O ne case was completely healed on the fifth day following the beginning of therapy. Tem perature was reduced to normal within 24 hours and there was relief of pain within six hours. The second case was very severe, with elevated temperature sustained for three days. Aureomycin capsules (250 mg.) each, were first prescribed: for the first 24 hours, one capsule every three hours for three doses, then one every four hours for three doses; in the next 24 hours, one capsule every two hours, day and night. After that, aureomycin troches (15 mg.) were started and continued day and night averaging one troche every two hours for six days until healing was complete. There was no side reaction or toxicity. A total of 86 troches and 18 capsules was administered. In another case, in which treatment was with one 250 mg. aureomycin capsule every two hours on the first day and one
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The Journal of the A m erican Dental A ssociation
every four hours on the second day, the patient developed a severe headache with vomiting and nausea. Treatm ent with capsules was terminated and troches were administered for a period of four days, giving one every three hours on the first day, one every two hours on the second day, and one every hour on the third and fourth days. There was no further toxic reaction. U neventful and complete heal ing had taken place by the end of the fourth day of troche administration. Another patient was treated with one aureomycin troche ( 15 m g.) every hour for the first 48 hours. O n the third day, one troche every three hours was pre scribed and on the fourth day, one every four hours. By the fifth day the patient was completely healed and had had no toxic reaction during treatment. A total of 36 troches was administered. It was observed that in the before-men tioned cases, bleeding of the gingivae was completely eliminated in an average time of 36 hours. Ulcerations of mucous mem brane were reduced measurably at the end of each 24 hour period. Chronic Suppurative Pericementitis
Five patients with chronic suppurative pericementitis were treated with aureo mycin cones (25 m g.) which were applied subgingivally to the periodontal pocket. Inflammatory symptoms and suppuration were greatly reduced. Tw o cases were treated with aureo mycin troches. In 48 hours the suppura tion lessened, the offending taste was eli minated, and the tissue tone improved. In one case in which aureomycin was used, there was a history of marked al lergy to penicillin therapy. However, there was no evidence of idiosyncrasy to aureomycin. Gingivitis with Associated Pharyngitis
In 14 cases in which gingivitis was treated with aureomycin troches, one
every two hours, pharyngitis was present. It is interesting to note that, while the treatment was for the gingivitis primarily, there was marked improvement in the throat conditions in as little as six hours and complete relief in 24 to 36 hours. T h e average dose was 6 troches, one every two hours. N o unfavorable systemic re action took place. Acute Gingivitis
In two cases, acute gingivitis was treated with one aureomycin troche (15 mg.) every three hours. A fter 48 hours gingival bleeding had subsided and tissue tone was improved. Chronic Gingivitis
In three cases, chronic gingivitis was treated with aureomycin troches (15 m g.) in an average dose of one troche every three hours for four days. All bleeding ceased and gingival tone was restored to normal. O ne patient was treated with aureo mycin cones (25 mg.) applied subgin givally to a hypertrophied pocket. After 48 hours, the pocket was found to be re duced to normal. T h e patient was ex amined at intervals for three months but no further treatment was indicated, and healing was complete. Pericoronitis
In five cases of pericoronitis, aureomy cin cones (25 mg.) were crushed and placed subgingivally under the inflamed flap. W ithin 24 hours pain was alleviated and gingival inflammation was reduced. Acutely Infected Pulp
In three cases of acute pulp infection, extraction of the affected teeth was indi cated. A whole (25 m g.) aureomycin cone was placed in the sockets postoperatively. T h e sockets healed uneventfully.
J.A.D.A., Vol. 40, M a y 1950 . . . 567
Stew art-Roth
Acute Abscess
In 13 cases of acute abscess, extraction of the teeth was indicated. Postoperatively, whole aureomycin cones (25 mg.) were placed into the sockets, held in place with absorbable gelatin sponge (Gelfoam ) and sutured. Twenty-four hours later, healing was progressing nor mally and there was little postoperative pain. In one case of acute abscess with tissue swelling treatment was with aureomycin cones (25 m g.). The palate was incised for drainage and the aureomycin cones placed in the opening. Forty-eight hours later, the patient’s face remained slightly swollen. Penicillin therapy was instituted as the value of aureomycin was then un determined. Aureom ycin cones as used above were not absorbed, since postoperative exam i nation from six to twelve weeks later re vealed that the cones were unabsorbed and there was a typical foreign body re action. A new type of cone is now under observation. There is nothing conclusive at this time in regard to the value of the cones as applied in these cases. Isolated Periodontal Pockets
Thirteen cases of isolated periodontal pockets were treated with aureomycin cones (25 m g.), crushed and applied sub gingivally to the periodontal pocket. After 24 hours, there was evidence of a reduc tion in the depth of the pocket and relief from bleeding. These cases are currently under observation. No conclusion can be given as to the efficiency of the therapy in this preliminary report. Periodontal Abscess
In two cases of periodontal abscess, treatment was by means of incision and the application of aureomycin cones (25 m g.) within the abscessed area. There was relief from pain in 10 to 12 hours.
Inflammatory symptoms and suppura tion were greatly reduced. Postoperative Complications
In five cases in which there were post operative complications— pain or exten sive soft tissue laceration following re moval of tooth— aureomycin troches pro duced an analgesic effect. This effect may possibly be due to the reduction of inflammation in the lacerated tissues, al though this cannot be stated with cer tainty at this time. Further cases will be observed and evaluated. Healing seems to be accelerated in the presence of aureo mycin. Acute Suppurative Pulpitis
In three cases of acute suppurative pul pitis, treatment with aureomycin cones (25 mg.) was employed. Pulpotomy was performed and a cone sealed into the pulpal chamber in order to observe the effect of the therapy and to permit peri odic examination. A t the time of writing, these patients were comfortable. Malocclusion
In one case of inflamed gingivae due to traumatic occlusion, which caused pain and gingival bleeding, aureomycin troches (15 m g.) were prescribed, one every three hours. Forty-eight hours later, tissue was improved and bleeding ceased. Gingivitis Associated with Arthritis
In one case of hyperplasia and bleeding of the gingivae associated with arthritis, aureomycin troches were given, one every three hours. W ithin 48 hours, bleeding had almost ceased and the hyperplasia was reduced. Diagnosis Undetermined
In one case in which aureomycin cap sules (250 mg.) were prescribed, one
The Journal of the A m erica n Dental Association
568
every three hours, diarrhea and severe headache resulted and there was no relief of symptoms. In two cases of soft palate inflamma tion of unknown origin, aureomycin troches ( 15 mg. ) were prescribed, one every four hours. Relief was obtained within 12 to 24 hours. In one case of gingival hyperplasia a biopsy was made but the report was not conclusive. Aureomycin cones were pul verized and placed subgingivally through out the hyperplastic area. There was a slight improvement in tissue tone after three days of treatment. Gingival bleed ing ceased the second day. Summary and Conclusion
Aureomycin troches have been found effective in the treatment of acute and chronic gingivitis, necrotic gingivitis, and when these conditions are associated with V incent’s angina and pharyngitis. T h e addition of aureomycin capsules (250 mg.) is effective in the treatment of necrotic gingivitis associated w ith V in cent’s angina. However, severe headache, vomiting and nausea have resulted in some cases.
T he reduction of periodontal pockets is best obtained by the use of aureomycin cones (25 m g.). However, extreme care must be taken in the application or technic of this form of therapy. Aureomycin cones, placed postoperatively in the alveolus of an extracted tooth, result in rapid initial healing but may cause a foreign body reaction in the form used in these studies. Although no controls were used, our studies lead us to believe that aureomycin as prescribed for local and systemic use was beneficial in the treatment of oral infections. Results were superior to those formerly obtained with other antibiotics. T h e only evidence of toxicity was found in those patients treated systemically, to whom large doses of capsules were ad ministered orally. W ith local therapy in the mouth there was no stomatitis reac tion in any of the cases treated. However, there frequently occurs a yellow colora tion upon the dorsum of the tongue and, with continued treatment, the tongue may become a brownish yellow. These discol orations are not accompanied by irrita tion and disappear shortly after the drug is discontinued.
▲ It is trite to say that the reputation of a profession depends upon the of the individuals who comprise it. Usually the standards, prestige, and cultural signifi a profession are considered to be intangibles, and little worth weighing. Nevertheless, be readily appraised with reference to those professional leaders who set the goals for and establish the norms of the profession.— Chauncey D . Leake, M . D ., “ Thum bnail of Em inent Physicians,” North Carolina M edical Journal 10:3g8, A ugust ¡948.
R e p u t a t io n o f a P r o f e s s io n .—
behavior cance of they can conduct, Sketches
G eo rge M organ Stewart,* D.D.S., and Lester H u gh Roth.f D.D.S., Pittsburgh
is one of the most recently discovered chemotherapeutic agents and antibiotics used in the treatment of infective disease. It is derived from a soil organism, a new species of the Actinomycetes, of the genus Strep,tomyces for which the name Streptomyces aureofaciens is being proposed. T h e name, “ aureomycin,” was designated because of the faintly yellow appearance of the crystalline antibiotic produced from Streptomyces aureofaciens and the typical golden yellow growth of the colony of this fungus.1 Preliminary studies indicate successful treatment of some rickettsial and viral infections with aureomycin. It is also effective against both gram-positive and gram-negative types of organisms in vitro. These reports, together with the low tox icity and few side reactions among dogs and mice, suggested clinical trials of aureomycin in the treatment of oral in fections.2 T h e forms of the drug supplied were: 25 mg. cones; 15 mg. troches; and 250 mg. capsules for use in systemic treatment. This preliminary report represents over 100 cases with a variety of oral infections treated with aureomycin.
A
u r e o m y c in
Plan of Investigation
Prior to this investigation, aureomycin had been used in the treatment of some human diseases such as primary atypical pneumonia, Rocky M ountain spotted fever, Q fever, brucellosis, infections caused by the coli-aerogenes group of
bacteria, Streptococcus faecalis infections of the urinary tract and virus-like infec tions o f the eye.3 These conditions were treated principally with oral doses of 250 mg. capsules of strain A-377. In these investigations, which began on M arch 12, 1949, patients were observed every 24 hours while undergoing treat ment and given varying dosages. As these are, to our knowledge, the first dental investigations conducted on man, there was no prescribed dosage for the test m a terial to be used in the given cases. Each case history included height, weight, age, sex, color, chief complaint, past illnesses, present history, and the treatment plan in order to evaluate a dosage for our investigation. Treatm ent began with low concentra tions of aureomycin hydrochloride, which were gradually increased in successive cases until considerable amounts were tol erated. These cases received no other chemotherapy during aureomycin treat ment, although some had been treated unsuccessfully with other agents before
Received for publicatiqn October 3, 1949. *Professor of Periodontia and Physiology, School of Dentistry, University of Pittsburgh. flnstructor in Prosthesis and Periodontia, School of Dentistry, University of Pittsburgh. 1. Duggar, B. M ., Aureomycin: A Product of the Continuing Search for New Antibiotics. Ann. New York Acad. Sc. 5 1 :1 7 7 (Nov. 30) 1948. 2. Harned, B. K .; Cunningham, R. W .; Clark, M . C .; Cosgrove, R .j Hine, C . H .; McCauley, W. J.; Stokey, E . ; Vessey, R . E.; Yuda, N. N., and Subba Row, Y . The Pharmacology of Duomycin. Ann. New York Acad. Sc. 5 1 :182 (Nov. 30) 1948. 3. Collins, H . S.; Paine, T . F ., Jr., and Finland, M . Clinical Studies With Aureomycin. Ann. New York Acad. Sc. 51:232 (Nov. 30) 1948.
The Journal of the A m erica n Dental Association
564
aureomycin therapy was started. Diagno sis of oral infection was supported by oral smears, using Gram ’s stain wherever in dicated. T h e cases selected were mostly of the advanced or acute type of infec tion. In some cases, color photographs were taken in various stages of treatment and they clearly show the results of the therapy. No local treatment other than aureomycin was used in these cases. No scaling, curettage, or any other mechan ical or therapeutic procedure was at tempted. T h e patients were instructed to abstain from the use of any mouthwash or dentifrice, but, if so desired, to cleanse the teeth lightly with tapwater and tooth brush. A certain number of the patients treated were selected at random and placed upon restricted diets; that is, they abstained from alcoholic beverages, smok ing, foods highly seasoned with condi ments, nuts, pastries, chocolate, candy, chewing gum and carbonated beverages. A ll of the remaining patients were en tirely unrestricted in diet and drinking habits, but were merely encouraged to force water intake. Necrotic Gingivitis
Case 1 .— O n M arch 12, 1949, a white, 22 year old housewife, 5' 3 " tall, weighing 138 pounds, complained o f pain around the teeth, fetid breath, gingival bleeding, tender mouth, headache, and tempera ture of 100.4° F. O ral examination re vealed necrotic areas of the labial gin givae, highly inflamed and edematous, with fetid odor of the breath and exces sive salivation. O ral smears, stained with Gram’s iodine reagent, led to the diagno sis of necrotic gingivitis. Color photo graphs were taken. A t 11 a . m . , M arch 12, 1949, the first investigation was begun, using aureomy cin hydrochloride troches (15 m g.). The patient was instructed to dissolve one troche in the mouth every four hours, day and night. T h e following morning, she reported less pain and marked signs of
improvement with reduced bleeding. The dosage was then increased to one troche every three hours for the next 24 hours. O n M arch 14 (two days after start of treatm ent), the patient was greatly im proved, there was complete healing of the necrotic areas and only slight pain per sisted. Treatm ent was continued with the same dosage, one troche every three hours, for the next two days. O n M arch 15, al most all of the original symptoms were gone. O n M arch 16, affected tissues pre sented a normal appearance and the con dition was completely healed. The pa tient was asked to return for observation for the next three days and then one week later to evaluate the effect. Meanwhile, the medication was withdrawn. T h e pa tient returned, as requested, and all mouth tissues appeared normal. A total of 22 troches were taken without any re action or untoward incident due to the drug, except for a yellow discoloration of the dorsum of the tongue. Other Cases.— Eighteen patients were treated with aureomycin hydrochloride troches (15 m g.). Six of these patients were penicillin-resistant as well as penicil lin-allergic. Patients were administered troches, in an average dose of one every three hours while awake, for a period of four days. A fter the first 24 hour period of medication with aureomycin troches, there was marked relief in all cases, and after 72 hours the clinical picture was greatly improved. A fter 120 hours, all lesions were completely healed and there was no evidence of toxic reaction or in tolerance to the drug. One case was treated solely with aureo mycin capsules (250 mg. each). For the first 24 hours the dosage was one capsulc every three hours, night and day; and for the next three days, one capsule every two hours. A t the end of five days the patient was completely recovered. There was no reaction to the drug until the fifth day, when there were increased stools and a feeling of nausea.
Stewart-Roth
Necrotic Gingivitis with Associated Vincent's Angina
Case 2 . — O n M arch 31, 1949, a white, 30 year old housewife, weighing 118 pounds, and 5' 5 " tall, complained of loss of sleep and appetite, loss of weight (5 pounds in ten days), severe pain in the cheeks, headache, gingival bleeding, phar yngitis, enlarged submaxillary and cervi cal lymph nodes, fetid breath, a temper ature of 99.8° F., and complete inability to eat in the past 24 hours. T h e patient gave a history of primary anemia two years earlier. O ral examina tion exhibited poor oral hygiene, massive deposits of calculus, extensive recession of the gingivae w ith marked hyperplasia, rampant caries, fractured crowns of sev eral posterior teeth, profuse gingival bleeding, and grey necrotizing areas on mucous membranes of cheek opposite the retromolar areas, the soft palate, the walls of the pharynx and the labial gingivae. There was Class III mobility of the teeth. O ral smears were taken and G ram ’s stain revealed great numbers of Vincent’s or ganisms in the field. O n M arch 31, 1949, at 11 a .m ., ther apy with aureomycin hydrochloride troches (15 mg.) was started. For the first 24 hours, one troche was taken every two hours day and night. O n April 1, at 11 a .m ., the patient was greatly im proved and reported that, after taking two doses of the prescribed troches, she had been able to eat comfortably for the first time in ten days. Tem perature was normal, swelling of the submaxillary and cervical lymph nodes was reduced, and the ulcerations and areas of necrosis were decreased. T he bleeding persisted. There were no ill effects from the therapy. For the next four days, one troche every hour w hile awake was prescribed. O n April 2, 1949, there was a further improvement and the ulcerations were approximately one-fifth the size that they were on M arch 31. T h e tongue became a golden yellow in color. O n April 3, all gingival bleeding
J.A.D.A., Vol. 40, M a y 1950 . . . 565
had ceased, but slight swelling of cervical and submaxillary nodes persisted. There was a further reduction of ulcerative areas, and the tone of the tissue was al most normal. O n April 5, the mouth was clear of ulcerations, hyperplasia was no longer present and the lymphatic nodes were normal. T h e tongue was a brownish yellow. T h e dosage was reduced to one troche every three hours for one day and then one every four hours for three days. O n April 6, the condition was the same as on April 5 except that the tongue was darker. T h e patient was comfortable and the condition was considered inactive. O n the following three days the patient returned for examination, photographs and further prognosis for retention of the remaining teeth. There was no recurrence of the previous condition. A total of 74 troches had been taken with no ill effect. The discoloration is indicative of the duration and quantity of the therapy used locally. Other Cases. — T w o more cases were treated with aureomycin troches (15 m g.). O ne case was completely healed on the fifth day following the beginning of therapy. Tem perature was reduced to normal within 24 hours and there was relief of pain within six hours. The second case was very severe, with elevated temperature sustained for three days. Aureomycin capsules (250 mg.) each, were first prescribed: for the first 24 hours, one capsule every three hours for three doses, then one every four hours for three doses; in the next 24 hours, one capsule every two hours, day and night. After that, aureomycin troches (15 mg.) were started and continued day and night averaging one troche every two hours for six days until healing was complete. There was no side reaction or toxicity. A total of 86 troches and 18 capsules was administered. In another case, in which treatment was with one 250 mg. aureomycin capsule every two hours on the first day and one
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The Journal of the A m erican Dental A ssociation
every four hours on the second day, the patient developed a severe headache with vomiting and nausea. Treatm ent with capsules was terminated and troches were administered for a period of four days, giving one every three hours on the first day, one every two hours on the second day, and one every hour on the third and fourth days. There was no further toxic reaction. U neventful and complete heal ing had taken place by the end of the fourth day of troche administration. Another patient was treated with one aureomycin troche ( 15 m g.) every hour for the first 48 hours. O n the third day, one troche every three hours was pre scribed and on the fourth day, one every four hours. By the fifth day the patient was completely healed and had had no toxic reaction during treatment. A total of 36 troches was administered. It was observed that in the before-men tioned cases, bleeding of the gingivae was completely eliminated in an average time of 36 hours. Ulcerations of mucous mem brane were reduced measurably at the end of each 24 hour period. Chronic Suppurative Pericementitis
Five patients with chronic suppurative pericementitis were treated with aureo mycin cones (25 m g.) which were applied subgingivally to the periodontal pocket. Inflammatory symptoms and suppuration were greatly reduced. Tw o cases were treated with aureo mycin troches. In 48 hours the suppura tion lessened, the offending taste was eli minated, and the tissue tone improved. In one case in which aureomycin was used, there was a history of marked al lergy to penicillin therapy. However, there was no evidence of idiosyncrasy to aureomycin. Gingivitis with Associated Pharyngitis
In 14 cases in which gingivitis was treated with aureomycin troches, one
every two hours, pharyngitis was present. It is interesting to note that, while the treatment was for the gingivitis primarily, there was marked improvement in the throat conditions in as little as six hours and complete relief in 24 to 36 hours. T h e average dose was 6 troches, one every two hours. N o unfavorable systemic re action took place. Acute Gingivitis
In two cases, acute gingivitis was treated with one aureomycin troche (15 mg.) every three hours. A fter 48 hours gingival bleeding had subsided and tissue tone was improved. Chronic Gingivitis
In three cases, chronic gingivitis was treated with aureomycin troches (15 m g.) in an average dose of one troche every three hours for four days. All bleeding ceased and gingival tone was restored to normal. O ne patient was treated with aureo mycin cones (25 mg.) applied subgin givally to a hypertrophied pocket. After 48 hours, the pocket was found to be re duced to normal. T h e patient was ex amined at intervals for three months but no further treatment was indicated, and healing was complete. Pericoronitis
In five cases of pericoronitis, aureomy cin cones (25 mg.) were crushed and placed subgingivally under the inflamed flap. W ithin 24 hours pain was alleviated and gingival inflammation was reduced. Acutely Infected Pulp
In three cases of acute pulp infection, extraction of the affected teeth was indi cated. A whole (25 m g.) aureomycin cone was placed in the sockets postoperatively. T h e sockets healed uneventfully.
J.A.D.A., Vol. 40, M a y 1950 . . . 567
Stew art-Roth
Acute Abscess
In 13 cases of acute abscess, extraction of the teeth was indicated. Postoperatively, whole aureomycin cones (25 mg.) were placed into the sockets, held in place with absorbable gelatin sponge (Gelfoam ) and sutured. Twenty-four hours later, healing was progressing nor mally and there was little postoperative pain. In one case of acute abscess with tissue swelling treatment was with aureomycin cones (25 m g.). The palate was incised for drainage and the aureomycin cones placed in the opening. Forty-eight hours later, the patient’s face remained slightly swollen. Penicillin therapy was instituted as the value of aureomycin was then un determined. Aureom ycin cones as used above were not absorbed, since postoperative exam i nation from six to twelve weeks later re vealed that the cones were unabsorbed and there was a typical foreign body re action. A new type of cone is now under observation. There is nothing conclusive at this time in regard to the value of the cones as applied in these cases. Isolated Periodontal Pockets
Thirteen cases of isolated periodontal pockets were treated with aureomycin cones (25 m g.), crushed and applied sub gingivally to the periodontal pocket. After 24 hours, there was evidence of a reduc tion in the depth of the pocket and relief from bleeding. These cases are currently under observation. No conclusion can be given as to the efficiency of the therapy in this preliminary report. Periodontal Abscess
In two cases of periodontal abscess, treatment was by means of incision and the application of aureomycin cones (25 m g.) within the abscessed area. There was relief from pain in 10 to 12 hours.
Inflammatory symptoms and suppura tion were greatly reduced. Postoperative Complications
In five cases in which there were post operative complications— pain or exten sive soft tissue laceration following re moval of tooth— aureomycin troches pro duced an analgesic effect. This effect may possibly be due to the reduction of inflammation in the lacerated tissues, al though this cannot be stated with cer tainty at this time. Further cases will be observed and evaluated. Healing seems to be accelerated in the presence of aureo mycin. Acute Suppurative Pulpitis
In three cases of acute suppurative pul pitis, treatment with aureomycin cones (25 mg.) was employed. Pulpotomy was performed and a cone sealed into the pulpal chamber in order to observe the effect of the therapy and to permit peri odic examination. A t the time of writing, these patients were comfortable. Malocclusion
In one case of inflamed gingivae due to traumatic occlusion, which caused pain and gingival bleeding, aureomycin troches (15 m g.) were prescribed, one every three hours. Forty-eight hours later, tissue was improved and bleeding ceased. Gingivitis Associated with Arthritis
In one case of hyperplasia and bleeding of the gingivae associated with arthritis, aureomycin troches were given, one every three hours. W ithin 48 hours, bleeding had almost ceased and the hyperplasia was reduced. Diagnosis Undetermined
In one case in which aureomycin cap sules (250 mg.) were prescribed, one
The Journal of the A m erica n Dental Association
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every three hours, diarrhea and severe headache resulted and there was no relief of symptoms. In two cases of soft palate inflamma tion of unknown origin, aureomycin troches ( 15 mg. ) were prescribed, one every four hours. Relief was obtained within 12 to 24 hours. In one case of gingival hyperplasia a biopsy was made but the report was not conclusive. Aureomycin cones were pul verized and placed subgingivally through out the hyperplastic area. There was a slight improvement in tissue tone after three days of treatment. Gingival bleed ing ceased the second day. Summary and Conclusion
Aureomycin troches have been found effective in the treatment of acute and chronic gingivitis, necrotic gingivitis, and when these conditions are associated with V incent’s angina and pharyngitis. T h e addition of aureomycin capsules (250 mg.) is effective in the treatment of necrotic gingivitis associated w ith V in cent’s angina. However, severe headache, vomiting and nausea have resulted in some cases.
T he reduction of periodontal pockets is best obtained by the use of aureomycin cones (25 m g.). However, extreme care must be taken in the application or technic of this form of therapy. Aureomycin cones, placed postoperatively in the alveolus of an extracted tooth, result in rapid initial healing but may cause a foreign body reaction in the form used in these studies. Although no controls were used, our studies lead us to believe that aureomycin as prescribed for local and systemic use was beneficial in the treatment of oral infections. Results were superior to those formerly obtained with other antibiotics. T h e only evidence of toxicity was found in those patients treated systemically, to whom large doses of capsules were ad ministered orally. W ith local therapy in the mouth there was no stomatitis reac tion in any of the cases treated. However, there frequently occurs a yellow colora tion upon the dorsum of the tongue and, with continued treatment, the tongue may become a brownish yellow. These discol orations are not accompanied by irrita tion and disappear shortly after the drug is discontinued.
▲ It is trite to say that the reputation of a profession depends upon the of the individuals who comprise it. Usually the standards, prestige, and cultural signifi a profession are considered to be intangibles, and little worth weighing. Nevertheless, be readily appraised with reference to those professional leaders who set the goals for and establish the norms of the profession.— Chauncey D . Leake, M . D ., “ Thum bnail of Em inent Physicians,” North Carolina M edical Journal 10:3g8, A ugust ¡948.
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