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Date: Monday, May 13, 1996 FOR IMMEDIATE RELEASE Contact: Pat Sheridan (301)496-4260
Persons with severe periodontal disease may be able to avoid surgery by taking antibiotics, a new study shows. Dental scientists report that scaling and root planing (deep cleaning of teeth above and below the gum) combined with short-term use of oral and locally applied antibiotics dramatically reduced the need for gum surgery and tooth extractions by 88 percent. The regimen spared 690 of 783 teeth initially recommended for surgery or extraction.
Periodontal disease is a progressive infection that, when untreated, can destroy the gums and other supporting structures of the teeth and can lead to tooth loss. The condition is typically treated by scaling and root planing (also called debridement) to clear away pockets of harmful bacteria that cause periodontal disease. When this is not successful, surgery is usually recommended. Surgery involves lifting back the gums, removing the hardened plaque buildup, then stitching the gums back in place.
In a study supported by the National Institute of Dental Research, Dr. Walter J. Loesche of the University of Michigan School of Dentistry, Dr. James Giordano at the University of Detroit/Mercy School of Dentistry, and their colleagues used debridement plus antibiotics to significantly decrease levels of these damaging bacteria and reverse the majority of what were inevitable surgical cases. Dr. Loesche commented about the findings, "This antimicrobial regimen not only provides a treatment option for severe periodontal disease, but also brings such treatment into the realm of greater accessibility for many individuals."
Ninety patients with advanced gum disease that required surgery were recruited from the dental clinic of an inner city hospital. Two periodontists, who were not involved with the treatment part of the study, examined each patient independently before the study to determine the number of teeth in need of surgery or extraction, then again after each round of treatment. At the outset of the study, the number of teeth per person requiring surgery or extraction ranged from four to 23, with eight patients having surgical need in 18 or more teeth.
The researchers tested the effectiveness of metronidazole and doxycycline, two antibiotics known to combat specific types of bacteria that cause most gum disease, and the antimicrobial agent chlorhexidine in saving teeth from surgery or extraction. Depending on the severity and extent of their gum disease, patients could receive up to five rounds of treatment, two oral and three local, each lasting 2 weeks. When there were no more surgical needs, patients moved into a maintenance phase of routine cleanings every 3 months.
All study participants underwent thorough debridement, then were randomly assigned to a course of either oral placebo, metronidazole or doxycycline. Patients with seven or more teeth still in need of surgery after the first round were treated again with oral antibiotics. Patients with six or fewer teeth still needing surgery received up to three local treatments in which slow-release films containing either placebo, metronidazole or chlorhexidine were placed directly into the infected areas around the teeth. After each round, individuals with no more surgical needs moved to the maintenance phase.
All but two participants showed improvement after the first round of treatment. Thirty-nine percent of the patients (10 in the placebo group, 25 in the antibiotic group) moved from round one directly to the maintenance phase. Retreatment with oral and/or local antibiotics eliminated the surgical needs of another 38 patients (42 percent). The investigators noted in particular the response of the eight participants with 18 or more affected teeth: after debridement plus two rounds of oral antibiotic treatment, 78 percent of the teeth recommended for surgery or extraction no longer needed it.
When the five treatment rounds were completed, 17 patients (19 percent) still required some gum surgery or extractions before entering the maintenance program. The two patients who did not respond to treatment had extreme periodontal conditions -- virtually all remaining teeth had been recommended for extraction -- and could not be helped by this regimen.
At the outset of the study, 783 teeth had been identified as needing extraction or surgery around the tooth. At its conclusion, only 93 teeth (12 percent) actually needed such treatment. Debridement plus the antimicrobial regimens reduced the need for periodontal surgery by 93 percent, sparing 595 teeth from surgery; and decreased by 67 percent the need for tooth extraction, saving 95 teeth. Significantly, 81 percent of the study participants moved to the maintenance phase without needing any gum surgery or extractions.
The study also showed that doxycycline and metronidazole were comparably effective in reducing the need for gum surgery. The investigators preferred metronizadole, however, because of the lower risk of developing antibiotic resistance.
Follow-up examinations one year later indicated that the benefits of the antimicrobial treatment continued. The research team will follow these patients for 5 to 8 years to determine the long-term benefit of this nonsurgical approach.
The investigators concluded that debridement plus antimicrobial treatment is likely to be successful for most people with advanced gum disease for whom surgery is initially recommended. The regimen offers a cost-effective alternative to traditional surgical treatment for periodontal disease.
These findings were reported in the May issue of the Journal of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. The research was supported by a grant from the National Institute of Dental Research, one of the federal National Institutes of Health.
Dr. Walter Loesche can be reached through the University of Michigan News and Information Service at 313-764-7260.