title: Clinical and microbiological changes associated with the use of 4 adjunctive systemically administered agents in the treatment of periodontal infections.
abstract: The purpose of the present investigation was to assess the effects of periodontal surgery and 4 systemically administered agents, Augmentin, tetracycline, ibuprofen or a placebo on clinical and microbiological parameters of periodontal disease. 98 subjects were monitored at 2-month intervals at 6 sites per tooth for clinical parameters. Subgingival plaque samples were taken from the mesial surface of each tooth at each visit and evaluated for their content of 14 subgingival species using DNA probes and a colony lift method. 40 subjects who exhibited loss of attachment > 2.5 mm at 1 or more sites during longitudinal monitoring were treated using modified Widman flap surgery at sites with probing pocket depth > 4 mm, subgingival scaling at all other sites and were randomly assigned 1 of the 4 agents. Treatment was completed within 30 days during which time the subject took the assigned agent. Overall, subjects exhibited a mean attachment level "gain" of 0.34 +/- 0.10 mm (SEM) and a mean pocket depth reduction of 0.62 +/- 0.09 mm 10 +/- 4 months post-therapy. However, certain subjects in each treatment group showed a poor response. Subjects receiving antibiotics exhibited significantly more attachment level "gain" (0.57 +/- 0.15 mm, SEM) than subjects receiving either ibuprofen or a placebo (0.02 +/- 0.10). The differences between Augmentin and tetracycline groups were not significant, nor were the differences between ibuprofen and placebo. 10 months post-therapy, there was a reduction in the number of sites colonized in any subject group by detectable levels (10(3)) of P. gingivalis. Species showing similar reductions were B. forsythus, P. intermedia and P. micros. Subjects receiving systemically administered antibiotics had a significant increase in the proportion of sites colonized by C. ochracea coupled with a greater decrease in the number of sites colonized by P. gingivalis, B. forsythus, P. intermedia and P. micros post-therapy than subjects not receiving antibiotics. The results of this investigation indicate that adjunctive systemic antibiotics increase periodontal attachment "gain" and decrease the levels of some suspected periodontal pathogens in subjects with evidence of current disease progression.
authors.affiliation: Department of Periodontology, Forsyth Dental Center, Boston, MA, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Haffajee
authors.forename: S
authors.initials: S
authors.lastname: Dibart
authors.forename: R L
authors.initials: RL
authors.lastname: Kent
authors.forename: S S
authors.initials: SS
authors.lastname: Socransky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use; D019980:Amoxicillin-Potassium Clavulanate Combination; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy* / Q000601:surgery*; D001438:Bacteroidaceae / Q000302:isolation & purification; D017024:Chemotherapy, Adjuvant; D002969:Clavulanic Acids / Q000008:administration & dosage / Q000627:therapeutic use; D003773:Dental Plaque / Q000382:microbiology; D012534:Dental Scaling; D018450:Disease Progression; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D010514:Periodontal Pocket / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D010919:Placebos; D013357:Subgingival Curettage; D013524:Surgical Flaps; D013752:Tetracycline / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D002969:Clavulanic Acids; D010919:Placebos; D019980:Amoxicillin-Potassium Clavulanate Combination; D000658:Amoxicillin; D013752:Tetracycline; D007052:Ibuprofen