A Randomized, Placebo‐Controlled Trial of Doxycycline: Effect on the Microflora of Recurrent Periodontitis Lesions in High Risk Patients

Abstract

Twenty-seven patients with a recent history of periodontal abscesses and/or loss of gingival attachment level (GAL) despite active periodontal therapy were enrolled in a double-blind, randomized, placebo-controlled trial. Clinical measurements and subgingival scaling were performed every 2 months. When a site exhibited greater than or equal to 2 mm loss of GAL or a periodontal abscess, patients were administered either doxycycline at a dosage of 200 mg to start and 100 mg per day for 3 weeks, or a placebo. Clinical measurements of GAL and microbial analysis of subgingival plaque at study and control sites were made at the time of active disease and at intervals of 1 week and 7 months after completion of the drug regime. Plaque samples were screened for the presence of Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Bacteroides intermedius (Bi), Eikenella corrodens (Ec) and Fusobacterium nucleatum (Fn) by indirect immunofluorescence antibody technique and for spirochetes (Sp) using Ryu's stain. Based on presence or absence analysis of the sum scores of the 6 pathogens, both the placebo (n = 10) and the doxycycline groups (n = 17) exhibited similar scores at the time of detection of active disease (mean placebo = 2.38 +/- 0.32; mean doxycycline = 2.95 +/- 0.27; P = 0.18). One week after treatment, the probability of detection was unchanged in the placebo group (mean placebo = 3.14 +/- 0.47), but was significantly reduced in the doxycycline group (mean doxycycline = 1.77 +/- 0.26; P = 0.0002). Study (active) sites exhibited scores 2 to 3 times higher than control (inactive) sites before doxycycline treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients

“…Twenty five papers were found eligible for inclusion. From these papers, three were initially excluded for the meta‐analysis since they reported results from the same sample from another included study (Listgarten et al 1978, Kulkarni et al 1991, Palmer et al 1999).…”

The Antimicrobial Treatment of Periodontal Disease: Changing the Treatment Paradigm

“…Other groups have monitored treatment efficacy by the reduction of black-pigmented species, such as P. gingivalis and P. intermedia, from plaque samples and observed in most cases a significant reduction in levels that lasted for several months (Loesche et al, 1984(Loesche et al, , 1991(Loesche et al, , 1992aWalker and Gordon, 1990;Kulkarni et al, 1991;van Winkelhoff et al, 1992;Socransky and Haffajee, 1993;Haffajee et al, 1995;Mombelli et al, 1996), Even when all the teeth were debrided within a 24-hour period and chlorhexidine preparations were applied to the pockets, tongue, oral mucosa, and tonsils, P. gingivalis was eliminated from only six of 10 patients for up to 2 months (Bollen et al, 1998).…”

Efficacy of locally‐delivered doxycycline microspheres in chronic localized periodontitis and on Porphyromonas gingivalis

“…Controlled‐release antimicrobial delivery systems have shown beneficial effects when used with mechanical debridement 23 . Doxycycline has a wide spectrum of activity against common periodontal pathogens, such as Aa , Pi , Pg , and other periodontal pathogens 24 …”