Subantimicrobial dose doxycycline as adjunctive treatment for periodontitis. A review.
BACKGROUND
Subantimicrobial dose doxycycline (SDD--20 mg doxycycline twice daily) is indicated as an adjunctive treatment for periodontitis. Doxycycline downregulates the activity of matrix metalloproteinases (MMPs), key destructive enzymes in periodontal disease. Current understanding of periodontal pathogenesis suggests that MMPs play a major role in the destruction of periodontal tissues, leading to the clinical signs of periodontitis. Research supports that downregulation of MMPs by SDD confers benefit to patients with periodontitis.


METHODS
We review the clinical, microbiological and safety data relating to the use of SDD in patients with periodontitis, and consider the historical events that led to the development of adjunctive SDD as a treatment for periodontitis.


RESULTS
Studies have shown that SDD, when prescribed as an adjunct to scaling and root planing (SRP), results in statistically and clinically significant gains in clinical attachment levels and reductions in probing depths over and above those that are achieved by SRP alone. SRP must be thorough and performed to the highest standard to maximise the benefits of adjunctive SDD. SDD does not result in antibacterial effects, or lead to the development of resistant strains or the acquisition of multiantibiotic resistance. The frequency of adverse events is low, and does not differ significantly from placebo.


CONCLUSIONS
Adjunctive SDD confers clinical benefit to patients with periodontitis. A comprehensive treatment strategy is suggested, involving patient education and motivation, reduction of the bacterial burden by SRP, host response modulation with SDD, and periodontal risk factor modification.
Preshaw
Philip M
PM
School of Dental Sciences, University of Newcastle upon Tyne, UK. p.m.preshaw@ncl.ac.uk
Hefti
Arthur F
AF
Jepsen
Søren
S
Etienne
Daniel
D
Walker
Clay
C
Bradshaw
Mark H
MH
D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic; D012534:Dental Scaling; D004318:Doxycycline / Q000008:administration & dosage*; D006801:Humans; D007155:Immunologic Factors; D061965:Matrix Metalloproteinase Inhibitors; D010518:Periodontitis / Q000188:drug therapy*; D011480:Protease Inhibitors / Q000008:administration & dosage*; D013753:Tetracycline Resistance
D007155:Immunologic Factors; D061965:Matrix Metalloproteinase Inhibitors; D011480:Protease Inhibitors; D004318:Doxycycline