Bisphosphonates are potent inhibitors of bone resorption. Although the majority of studies have focused on the effects of bisphosphonates on osteoclasts, recent findings suggest that they may also have a direct action on osteoblasts. We studied the effects of long-term exposure to bisphosphonates, YM-529 and etidronate, on cell growth, alkaline phosphatase (ALP) activity and calcification of an osteoblastic cell line, MC3T3-E1 cells. The addition of 10^-10M or 10^-14M YM-529 increased the ALP activity in comparison with the control at 35 and 25 days after confluence respectively without marked effects on cell growth or appearance. The addition of 10^-6M etidronate also increased the activity at 15 days after confluence. The result of calcium staining of the cells and matrices suggested that calcification was promoted at 35 days after confluence by exposure to 10^-10 or 10^-14M YM-529. These results suggest that proper concentrations of bisphosphonates promote calcification of osteoblastic cells and that bisphosphonates directly act on the function of osteoblasts as well as on osteoclasts.

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We report a rare case of pathologic fracture resulting from osteomyelitis of the mandible. The patient, a 64-year-old male, came to us because of swelling of the mandible and presence of sequestrum with purulent discharge in the left molar region of the mandible. Radiograph showed a diffuse rarefaction (moth-eaten appearance) extending in the mandibular body. After sequestrectomy, pathologic fracture occurred in the left molar region. Antibiotic treatment was continued for five months, infection was controlled, osteomyelitis was healed and the fracture site was comlpletely united by bone without surgical intervention or rigid fixation.

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The efficacy of azithromycin as a chemoprophylactic agent for acute dental infection was assessed, and a questionnaire survey about the impression of azithromycin was conducted. METHODS: Eighty-three patients were given 500 mg of azithromycin for three days. Seven days after the onset of the treatment, we evaluated the clinical symptoms and collected the questionnaires. RESULTS: Clinical efficacy was observed in 89.2% of the patients, and that by questionnaire was 86.7%. Diarrhea as a side effect was seen in two patients. In the questionnaire, 79% of patients noted its effect from the second to fourth day after the medication. Although half of the patients did not care about the convenience, of taking the medication once a day, which is one of the advantages of azithromycin, most of the patients were satisfied with its efficacy.
Furthermore, 72.3% of patients considered azithromycin to be significantly more acceptable compared with other antibiotics. CONCLUSION : Azithromycin is a useful therapeutic regimen for the treatment of acute dental infections.

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Azithromycin is an azalide antibiotic, which has a strong effect on a wide variety of oral bacteria. It is taken up by phagocytes and is released over a long period in the inflamed tissue. This study investigated the clinical and microbiological effects, and measured the drug concentration in gingival of periodontal patients systemically administered azithromycin. The subjects were 26 adults diagnosed with periodontitis and given azithromycin (zithromac^®) 500 mg once daily for 3 days. Clinical parameters such as PD, GI, BOP and GCF were examined at days 0, 7, and 14, and subgingival plaque was collected by paper points at days 0, 4, 7 and 14. The total number of cultivable bacteria was counted and six of the periodontopathic bacteria —Porphyromonas gingivalis, Actinobacillus actinomysetemcomitans, Bacteroides forsythus, Prevotella intermedia, Prevotella nigresence, and Toreponema denticola—were assessed by the PCR method. The lining gingiva of periodontal pocket was collected by pocket curettage at days 4 and 7. The azithromycin concentration was measured by agar diffusion bioassay.
The total number of bacteria was significantly decreased at days 4 and 7, but was slightly increased at day 14. Continuous reduction of the six bacteria was recognized until day 14 by PCR. These bacteria were not detected at day 14 without Porphyromonas gingivalis. This result might be due to improvement of anaerobic condition caused by pocket reduction. The azithromycin concentration in the lining gingival tissues of periodontal pocket was 2.92±1.97μg/g at day 4 and 1.27±0.95μg/g at day 7. Half the drug concentration was still detected at 7 days after the first administration in inflamed gingiva.
These results indicate that azithromycin may be a useful adjunct agent for adult periodontitis. In the future, we will consider a new periodontal therapy using this behavior of azithromycin.

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Dental drugs for clinical use are listed in the Drug Price List according to the pharmacologic-therapeutic classification in the Japanese Standard Commodity Classification. In April 2000, 93 dental drugs were divided into two lists : 42 drugs stayed in the Drug Price List, whereas 51 were moved to the health and Welfare Ministry Official Bulletin.
We studied the classifications of dental drugs in both lists and also conducted research on trends in the use of dental drugs in 18 private dental college and university hospitals. The results were compared with those obtained in a similar study we conducted in 1981.
In the study, we found that drugs for endodontic therapy and for caries prevention were moved from the Price List to the Official Bulletin, where we found some classification titles that were different from those in the Price List. The titles in the Official Bulletin were never used in any textbooks or formularies in dentistry, and therefore they were thought to be unsuitable for clinical use.
Trends in the use of dental drugs in dental hospitals did not significantly change from the results in 1981. The mean number of dental drugs used per hospital was 23. There were another 23 dental drugs, mainly local anesthetics and root canal preparations, which were not used in any dental hospitals. Dental drugs prepared in the hospital pharmacies were lower both in number and in amount from the previous study. The ratio that kept package inserts of dental drugs among all hospitals was improved to 80% from 60% in the previous study.

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