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A Closer Look at Treating Chronic Periodontitis

Numerous studies have suggested that the best way to fight chronic periodontitis is with a one-two therapeutic punch. First, a periodontist must scale and plane the roots (SRP) of the affected teeth to clear away noxious bacteria. Second, patients should take an antibiotic pill over several days to control the infection and thus allow the gingival tissues to heal. Still largely undetermined is whether some commonly prescribed antibiotics are more effective than others in returning the gingiva back to good health. In the March issue of the Journal of Clinical Periodontology, NIDCR grantees take a closer look at this issue.

They randomly assigned 92 people with chronic periodontitis to receive SRP alone or SPR in combination with one of three antibiotics. The antibiotics, which were chosen because of their different dosage regimes and mechanisms of action, were: azithromycin, metronidazole, or a sub-antimicrobial dose of doxycycline. After one year of followup, they found that patients in all four treatment groups had clinical improvement, particularly in reducing the depth of periodontal pockets and improving tooth attachment. The researchers also found that all three antibiotic and SRP regimens provided a slightly better clinical outcome than SRP alone, particularly when treating periodontal pockets greater than 6 mm at baseline. Although patients randomized to the SRP/metronidazole group had greater improvement on average in attachment loss, no antibiotic was clearly superior.

In fact, a number of patients in all treatment groups had attachment loss at the one-year mark. These numbers ranged from 15 to 32 percent in SRP/antibiotic groups to 39 percent in those who received SRP only. As the authors noted, this indicates that more work is needed to learn how to tailor treatment and match it to a patient’s specific needs. To read more about this paper by Haffajee, Torresyap, and Socransky,