Non-surgical periodontal treatment with and without adjunctive metronidazole in smokers and non-smokers.
OBJECTIVE
To determine whether adjunctive metronidazole therapy would compensate for the poorer treatment response to scaling and root planing reported in smokers.


METHODS
A single-blind, randomised clinical trial of 28 smokers and 56 non-smokers, stratified for periodontitis disease severity and randomly allocated to 3 treatment groups: (1) Scaling and root planing using an ultrasonic scaler with local anaesthesia (SRP), (2) SRP+ metronidazole tabs 200 mg tds for 7 days, (3) SRP + 2 subgingival applications of 25% metronidazole gel. Probing depths (PD) and attachment levels (AL) were recorded with a Florida probe at baseline, 2 months and 6 months post treatment by a single examiner who was unaware of the treatment modality. Results were analysed for all sites with baseline probing depths equal to or greater than Florida probe recordings of 4.6 mm using analysis of variance.


RESULTS
Reductions in probing depth at 6 months were significantly less (p < 0.001) in the smokers (mean 1.23 mm, 95% confidence intervals = 1.05 to 1.40 mm) than in the non-smokers (1.92, 1.75 to 2.09 mm). Attachment level gains were approximately 0.55 mm and there was no statistically significant difference between smokers and non-smokers. There were no differences in any clinical measure in response to the three treatment regimens at 2 or 6 months for either smokers or non-smokers. A reduction in the proportion of spirochaetes was observed at 6 months which was less in smokers than in non-smokers (p = 0.034). Multiple linear regression analysis on probing depth at 6 months demonstrated that smoking was a significant explanatory factor (p < 0.001) for poor treatment outcome, whilst the presence or absence of adjunctive metronidazole was not (p = 0.620).


CONCLUSIONS
This study confirms that smokers have a poorer treatment response to SRP, regardless of the application of either systemic or locally applied adjunctive metronidazole.
Palmer
R M
RM
Department of Periodontology and Preventive Dentistry, United Medical and Dental School of Guy's Hospital, London, UK. richard.palmer@umds.ac.uk
Matthews
J P
JP
Wilson
R F
RF
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D016001:Confidence Intervals; D012534:Dental Scaling; D005260:Female; D005500:Follow-Up Studies; D005782:Gels; D006801:Humans; D016014:Linear Models; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000188:drug therapy / Q000628:therapy; D010514:Periodontal Pocket / Q000188:drug therapy / Q000628:therapy; D010518:Periodontitis / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy*; D016745:Root Planing; D016037:Single-Blind Method; D012907:Smoking / Q000503:physiopathology*; D013144:Spirochaetales / Q000187:drug effects / Q000254:growth & development; D013607:Tablets; D014464:Ultrasonic Therapy
D000900:Anti-Bacterial Agents; D005782:Gels; D013607:Tablets; D008795:Metronidazole