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Article: Longitudinal effect of non-surgical treatment and systemic metronidazole for 1 week in smokers and non-smokers with refractory periodontitis: A 5-year study

TitleLongitudinal effect of non-surgical treatment and systemic metronidazole for 1 week in smokers and non-smokers with refractory periodontitis: A 5-year study
Authors
Issue Date1999
PublisherAmerican Academy of Periodontology. The Journal's web site is located at http://www.perio.org
Citation
Journal Of Periodontology, 1999, v. 70 n. 7, p. 761-771 How to Cite?
AbstractBackground: Periodontitis consists of a mixture of diseases, most of which respond favorably to traditional mechanical therapy. It is now recognized that advanced periodontitis does not always respond to conventional management with scaling, periodontal surgery, and oral hygiene measures. However, various types of antibiotics given systemically or locally improve the success rate of periodontal therapy. In short-term studies, it has been shown that metronidazole, when systemically administered after debridement, resulted in treatment benefits including less need for surgical intervention. Methods: In this double-blind study, we evaluated periodontal treatment involving initial non-surgical treatment, systemic administration of metronidazole for 1 week, and then follow-ups for scaling and root planing every 6 months, for 5 years. The study population consisted of 64 subjects (37 smokers and 27 non-smokers), mean age 36.3 (±3.0 SD) years, with severe periodontal disease. After initial scaling and root planing, patients were randomly assigned to the intervention or placebo groups: 400 mg metronidazole or a placebo administered at 8-hour intervals for 1 week. The participants underwent an extensive clinical periodontal examination. Gingival crevicular fluid (GCF) was analyzed for spirochetes and granulocytes. Samples were cultured for Actinobacillus actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), and Prevotella intermedia (P.i.). Results: The number of patients infected with A.a., P.g., P.i., and spirochetes decreased during the study. Most patients who harbored spirochetes at the end of the study had these microorganisms at the beginning. Smokers responded less favorably to periodontal therapy than non-smokers. Non-smoking patients who required only non-surgical therapy in the intervention group showed statistically significant improvement in the clinical parameters after 5 years. Patients with complete healing, defined as the absence of inflamed sites ≥5 mm, after 5 years were found only in the intervention group. The patients considered healthy after 5 years were the same patients found to be healthy after 6 months. Conclusions: Decisive factors in the sustained long-term improvement of patients who respond satisfactorily to treatment are probably initial scaling and root planing; a brief course of metronidazole; and regular follow-up examinations at 6-month intervals for oral hygiene and scaling and root planing.
Persistent Identifierhttp://hdl.handle.net/10722/154054
ISSN
2015 Impact Factor: 2.844
2015 SCImago Journal Rankings: 1.070
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorSöder, Ben_US
dc.contributor.authorNedlich, Uen_US
dc.contributor.authorJin, LJen_US
dc.date.accessioned2012-08-08T08:23:01Z-
dc.date.available2012-08-08T08:23:01Z-
dc.date.issued1999en_US
dc.identifier.citationJournal Of Periodontology, 1999, v. 70 n. 7, p. 761-771en_US
dc.identifier.issn0022-3492en_US
dc.identifier.urihttp://hdl.handle.net/10722/154054-
dc.description.abstractBackground: Periodontitis consists of a mixture of diseases, most of which respond favorably to traditional mechanical therapy. It is now recognized that advanced periodontitis does not always respond to conventional management with scaling, periodontal surgery, and oral hygiene measures. However, various types of antibiotics given systemically or locally improve the success rate of periodontal therapy. In short-term studies, it has been shown that metronidazole, when systemically administered after debridement, resulted in treatment benefits including less need for surgical intervention. Methods: In this double-blind study, we evaluated periodontal treatment involving initial non-surgical treatment, systemic administration of metronidazole for 1 week, and then follow-ups for scaling and root planing every 6 months, for 5 years. The study population consisted of 64 subjects (37 smokers and 27 non-smokers), mean age 36.3 (±3.0 SD) years, with severe periodontal disease. After initial scaling and root planing, patients were randomly assigned to the intervention or placebo groups: 400 mg metronidazole or a placebo administered at 8-hour intervals for 1 week. The participants underwent an extensive clinical periodontal examination. Gingival crevicular fluid (GCF) was analyzed for spirochetes and granulocytes. Samples were cultured for Actinobacillus actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), and Prevotella intermedia (P.i.). Results: The number of patients infected with A.a., P.g., P.i., and spirochetes decreased during the study. Most patients who harbored spirochetes at the end of the study had these microorganisms at the beginning. Smokers responded less favorably to periodontal therapy than non-smokers. Non-smoking patients who required only non-surgical therapy in the intervention group showed statistically significant improvement in the clinical parameters after 5 years. Patients with complete healing, defined as the absence of inflamed sites ≥5 mm, after 5 years were found only in the intervention group. The patients considered healthy after 5 years were the same patients found to be healthy after 6 months. Conclusions: Decisive factors in the sustained long-term improvement of patients who respond satisfactorily to treatment are probably initial scaling and root planing; a brief course of metronidazole; and regular follow-up examinations at 6-month intervals for oral hygiene and scaling and root planing.en_US
dc.languageengen_US
dc.publisherAmerican Academy of Periodontology. The Journal's web site is located at http://www.perio.orgen_US
dc.relation.ispartofJournal of Periodontologyen_US
dc.subject.meshActinobacillus Actinomycetemcomitans - Isolation & Purificationen_US
dc.subject.meshAdulten_US
dc.subject.meshAnti-Bacterial Agents - Administration & Dosage - Therapeutic Useen_US
dc.subject.meshDental Scalingen_US
dc.subject.meshDouble-Blind Methoden_US
dc.subject.meshFemaleen_US
dc.subject.meshFollow-Up Studiesen_US
dc.subject.meshGingival Crevicular Fluid - Cytology - Microbiologyen_US
dc.subject.meshGranulocytes - Pathologyen_US
dc.subject.meshHumansen_US
dc.subject.meshIntervention Studiesen_US
dc.subject.meshLongitudinal Studiesen_US
dc.subject.meshMaleen_US
dc.subject.meshMetronidazole - Administration & Dosage - Therapeutic Useen_US
dc.subject.meshOral Hygieneen_US
dc.subject.meshPeriodontitis - Drug Therapy - Therapyen_US
dc.subject.meshPlacebosen_US
dc.subject.meshPorphyromonas Gingivalis - Isolation & Purificationen_US
dc.subject.meshPrevotella Intermedia - Isolation & Purificationen_US
dc.subject.meshRoot Planingen_US
dc.subject.meshSmoking - Adverse Effectsen_US
dc.subject.meshSpirochaetales - Isolation & Purificationen_US
dc.subject.meshWound Healingen_US
dc.titleLongitudinal effect of non-surgical treatment and systemic metronidazole for 1 week in smokers and non-smokers with refractory periodontitis: A 5-year studyen_US
dc.typeArticleen_US
dc.identifier.emailJin, LJ:ljjin@hkucc.hku.hken_US
dc.identifier.authorityJin, LJ=rp00028en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1902/jop.1999.70.7.761en_US
dc.identifier.pmid10440638-
dc.identifier.scopuseid_2-s2.0-0032779652en_US
dc.identifier.hkuros42146-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0032779652&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume70en_US
dc.identifier.issue7en_US
dc.identifier.spage761en_US
dc.identifier.epage771en_US
dc.identifier.isiWOS:000081601000008-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridSöder, B=6701795462en_US
dc.identifier.scopusauthoridNedlich, U=6506848917en_US
dc.identifier.scopusauthoridJin, LJ=7403328850en_US

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