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Adding antibiotics to scaling and root planing
Adding antibiotics to scaling and root planing Background.—Patients with diabetes mellitus (DM) have a higher prevalence and severity of periodontal destruction compared to persons without DM. Even after scaling and root planing (SRP), many patients with DM have a high number of residual pockets and periodontal pathogens present. As a result, clinicians are considering the use of adjunctive therapies to improve SRP outcomes in these patients. Metronidazole (MTZ) and amoxicillin (AMX) are often considered the most promising treatment for chronic and aggressive periodontitis. The clinical benefits include changes in the composition of the subgingival biofilm. These changes were investigated in subjects with periodontitis and DM who received either SRP alone or SRP plus systemic MTZ and AMX. In addition, the clinical efficacy of these treatment protocols was evaluated up to 2 years after the intervention to assess its longevity of effect. Methods.—Twenty-nine patients were randomly assigned to receive SRP only (control group) and another 29 were randomly assigned to receive SRP þ MTZ (400 mg three times a day) þ AMX (500 mg three times a day) for 14 days. Six subgingival plaque samples from each subject were analyzed to detect 40 bacterial species at baseline and after 3 months, 1 year, and 2 years. The microbial agents were divided into five (red, orange, and green complexes: Actinomyces species; and ‘‘others’’) and three (red and orange complexes and Actinomyces species) microbial complexes. Results.—Both treatments significantly reduced the proportion of the red complex agents after 3 months, with the SRP group dropping from 16.3% to 7.6% and the SRP þ MTZ þ AMX group dropping from 17.8% to 5.3%. The proportion of red complex agents was maintained for up to 2 years in the antibiotic group but increased in the control group. The difference between the two groups at 2 years was statistically significant. Individuals considered at low risk for future progression of their disease were also separately analyzed at the 2-year mark. SRP-only treatment significantly changed the mean proportions of the Actinomyces species, but the antibiotic plus SRP treatment altered the purple, orange, and red complexes. The SRP þ MTZ þ AMX group had a lower proportion of the red complex than the control group after 2 years (5.2% versus 10.6%, respectively). The proportions of the Actinomyces species in the entire sample was reduced in the control group between the 1- and 2-year
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Dental Abstracts
evaluations but remained stable in the antibiotic group. For subjects in the low risk category, the reduction from 32.3% to 24.7% was statistically significant. The SRP þ MTZ þ AMX group had significantly lower percentages of sites with bleeding on probing, suppuration, and full-mouth mean pocket depth (PD) than the control group. After 1 year the antibiotic group had significantly fewer sites with a PD of 5 mm or greater than the control group, a condition maintained through the 2-year evaluation. Mean PD was reduced and mean clinical attachment increased more in the initially moderate and deep sites in the antibiotic group than in the control group after 1 and 2 years. Statistical analysis indicated that only the antibiotic use was associated with a significant increase in the probability that a patient would reach the low-risk level for future progression of disease and would not have any sites with a PD or 6 mm or greater. Discussion.—SRP þ MTZ þ AMX was more effective than SRP only for altering the composition of the subgingival biofilm in patients with type 2 DM and producing a profile more compatible with good periodontal health. The effect of using these antibiotics along with SRP was sustained for up to 2 years after the intervention.
Clinical Significance.—The clinical parameters we look for in patients were positively altered in this population of patients with periodontitis and DM by adding antibiotics to SRP. The number of residual pockets was reduced, PD was reduced, and patients were at lower risk for future disease progression for up to 2 years. These are the types of results that clinicians hope for when they treat periodontal disease.
Tamashiro NS, Duarte PM, Miranda TS, et al: Amoxicillin plus metronidazole therapy for patients with periodontitis and type 2 diabetes: A 2-year randomized controlled trial. J Dent Res 95:829836, 2016 s-Graduac¸~ao e Reprints available from M Feres, Centro de Po Pesquisa-CEPPE, Universidade Guarulhos, Prac¸a Tereza Cristina, 229 Centro, 07023-070 Guarulhos, SP, Brazil; e-mail: [email protected]
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Dental Abstracts
evaluations but remained stable in the antibiotic group. For subjects in the low risk category, the reduction from 32.3% to 24.7% was statistically significant. The SRP þ MTZ þ AMX group had significantly lower percentages of sites with bleeding on probing, suppuration, and full-mouth mean pocket depth (PD) than the control group. After 1 year the antibiotic group had significantly fewer sites with a PD of 5 mm or greater than the control group, a condition maintained through the 2-year evaluation. Mean PD was reduced and mean clinical attachment increased more in the initially moderate and deep sites in the antibiotic group than in the control group after 1 and 2 years. Statistical analysis indicated that only the antibiotic use was associated with a significant increase in the probability that a patient would reach the low-risk level for future progression of disease and would not have any sites with a PD or 6 mm or greater. Discussion.—SRP þ MTZ þ AMX was more effective than SRP only for altering the composition of the subgingival biofilm in patients with type 2 DM and producing a profile more compatible with good periodontal health. The effect of using these antibiotics along with SRP was sustained for up to 2 years after the intervention.
Clinical Significance.—The clinical parameters we look for in patients were positively altered in this population of patients with periodontitis and DM by adding antibiotics to SRP. The number of residual pockets was reduced, PD was reduced, and patients were at lower risk for future disease progression for up to 2 years. These are the types of results that clinicians hope for when they treat periodontal disease.
Tamashiro NS, Duarte PM, Miranda TS, et al: Amoxicillin plus metronidazole therapy for patients with periodontitis and type 2 diabetes: A 2-year randomized controlled trial. J Dent Res 95:829836, 2016 s-Graduac¸~ao e Reprints available from M Feres, Centro de Po Pesquisa-CEPPE, Universidade Guarulhos, Prac¸a Tereza Cristina, 229 Centro, 07023-070 Guarulhos, SP, Brazil; e-mail: [email protected]