title: Treatment with subantimicrobial dose doxycycline improves the efficacy of scaling and root planing in patients with adult periodontitis.
abstract: BACKGROUND
  In a previous study, subantimicrobial dose doxycycline (SDD) significantly improved clinical parameters associated with periodontal health in patients with adult periodontitis (AP) when used as an adjunct to a maintenance schedule of supragingival scaling and dental prophylaxis. In this double-blind, placebo-controlled, parallel-group, multicenter study, the efficacy and safety of SDD were evaluated in conjunction with scaling and root planing (SRP) in patients with AP.
  
  
  METHODS
  Patients (n = 190) received SRP at the baseline visit and were randomized to receive either SDD 20 mg bid or placebo bid for 9 months. Efficacy parameters included the per-patient mean changes in clinical attachment level (CAL) and probing depth (PD) from baseline, the per-patient percentages of tooth sites with attachment loss (AL) > or = 2 mm and > or = 3 mm from baseline, and the per-patient percentage of tooth sites with bleeding on probing. Prior to analysis, tooth sites were stratified by the degree of disease severity evident at baseline
  
  
  RESULTS
  In tooth sites with mild to moderate disease and severe disease (n = 183, intent-to-treat population), improvements in CAL and PD were significantly greater with adjunctive SDD than with adjunctive placebo at 3, 6, and 9 months (all P <0.05). In tooth sites with severe disease, the per-patient percentage of sites with AL > or = 2 mm from baseline to month 9 was significantly lower with adjunctive SDD than with adjunctive placebo (P<0.05). Improvements in clinical outcomes occurred without detrimental shifts in the normal periodontal flora or the acquisition of doxycycline resistance or multiantibiotic resistance. SDD was well tolerated, with a low incidence of discontinuations due to adverse events.
  
  
  CONCLUSIONS
  The adjunctive use of SDD with SRP is more effective than SRP alone and may represent a new approach in the long-term management of AP.
authors.affiliation: University of Rochester, Eastman Dental Center, NY 14620, USA.
authors.forename: J G
authors.initials: JG
authors.lastname: Caton
authors.forename: S G
authors.initials: SG
authors.lastname: Ciancio
authors.forename: T M
authors.initials: TM
authors.lastname: Blieden
authors.forename: M
authors.initials: M
authors.lastname: Bradshaw
authors.forename: R J
authors.initials: RJ
authors.lastname: Crout
authors.forename: A F
authors.initials: AF
authors.lastname: Hefti
authors.forename: J M
authors.initials: JM
authors.lastname: Massaro
authors.forename: A M
authors.initials: AM
authors.lastname: Polson
authors.forename: J
authors.initials: J
authors.lastname: Thomas
authors.forename: C
authors.initials: C
authors.lastname: Walker
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects; D003773:Dental Plaque / Q000382:microbiology; D003777:Dental Prophylaxis; D012534:Dental Scaling; D004311:Double-Blind Method; D004318:Doxycycline / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005884:Gingival Hemorrhage / Q000145:classification / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000145:classification / Q000188:drug therapy / Q000517:prevention & control; D010514:Periodontal Pocket / Q000145:classification / Q000188:drug therapy / Q000517:prevention & control; D010518:Periodontitis / Q000145:classification / Q000188:drug therapy / Q000517:prevention & control*; D010919:Placebos; D016745:Root Planing; D012449:Safety; D013223:Statistics as Topic; D013753:Tetracycline Resistance; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010919:Placebos; D004318:Doxycycline