Antimicrobial properties of human dentin impregnated with tetracycline HCI or chlorhexidine

Abstract Substantivity of tetracycline HCI and chlorhexidine digluconate to human root dentin was assessed in vitro. 51 extracted single-rooted teeth, their crowns removed, were assigned to 1 of 4 treatments in groups of 12. A control groups included 3 roots. Each group was divided into 3 subgroups to allow evaluation of drug exposure for 1, 3 or 5 min. The roots were immersed in tetracycline HCI (10 or 50 mg/ml) or chlorhexidine digluconate (0.12 or 0.2%) solutions following root planing. Control roots were immersed in sterile saline (0.9%). Following drug immersion, the roots were transferred to tubes containing 2 ml tris buffered saline. The tubes were incubated at room temperature for 22 days. Desorption media were replaced at 24-h intervals. Removed media were examined for antimicrobial activity using a microtiter assay in which bacterial growth was evaluated by optical density readings. Roots immersed in tetracycline HCl 50 mg/ml released antimicrobial activity to successive desorption media for 14 days. Tetracycline HCl 10 mg/ml activity lasted 4 days. Roots subjected to chlorhexidine digluconate released antimicrobial activity for 24 h only. Within each treatment, there were no differences between the 3 exposure intervals of 1, 3 or 5 min. Our findings suggest usage of the periodontally exposed instrumented root as a depot for sustained release of tetracycline HCI, but not chlorhexidine digluconate, to the subgingival environment. The substantiveness of tetracycline HCI seems related to drug concentration rather than the exposure interval. Clinical trials are needed to confirm the clinical significance of these in vitro observations.     

Periodic subgingival antimicrobial irrigation of periodontal pockets

The present investigation was undertaken to study the clinical effect of professionally performed periodic subgingival irrigation per se and as an adjunct to scaling and root planing. 10 patients suffering from moderate-severe periodontal disease participated in the study. Following an initial 3-month period of supervised supragingival plaque control, a total of 102 periodontal sites with probing pocket depth greater than or equal to 6 mm and "bleeding on probing" were selected and subjected to a Baseline examination comprising assessments of oral hygiene and gingival conditions, probing depths and probing attachment levels. The pockets in the various jaw quadrants were randomly assigned to one of the following treatment groups: (1) periodic subgingival irrigation with hydrogen peroxide, (2) periodic subgingival irrigation with chlorhexidine, (3) periodic subgingival irrigation with saline and (4) no subgingival treatment. During the first part of the study (baseline-32 weeks), no mechanical debridement of the subgingival area was performed. The irrigation treatment was carried out by the operator 3 times per week during weeks 1 + 2 and 5 + 6 of the trial. In the 2nd part of the trial (32-52 weeks), the sites were subjected to scaling and root planing combined with professional irrigation during weeks 32-38. The previously non-irrigated control sites were not subjected to adjunctive irrigation when mechanically debrided. During the entire study, the patients were recalled for professional tooth cleaning once every 4 weeks. Re-examinations were carried out at 4, 6, 32, 40 and 52 weeks. The results revealed that repeated professional irrigation of unscaled periodontal pockets with chlorhexidine or hydrogen peroxide resulted in a temporarily reduced frequency of bleeding sites, but not in any clinically significant changes in probing assessments. A similar improvement of bleeding scores was observed in the saline-irrigated control group. Scaling and root planing, in combination with an optimal supragingival plaque control, resulted in a marked resolution of the clinical symptoms of periodontal disease. Adjunctive irrigation with chlorhexidine or hydrogen peroxide did not improve the healing result above and beyond that obtained after mechanical debridement alone or in combination with saline irrigation. Hence, the study failed to demonstrate that professionally performed periodic subgingival irrigation with chlorhexidine or hydrogen peroxide, used alone or in combination with thorough mechanical debridement, has a significant therapeutic effect.     

The antimicrobial and clinical effects of a single subgingival irrigation of chlorhexidine in advanced periodontal lesions

The antimicrobial effects of subgingival chlorhexidine (CH) irrigations on the pathogenic flora in advanced periodontal lesions were assessed. Changes in the patterns of colonization within the subgingival sites were monitored by differential dark-field microscopy, in 16 patients, over a period of 10 weeks. In addition, changes in the clinical parameters of the diseased sites were also monitored. Initial base-line evaluations were made for both the clinical and microbiological parameters. 4 sites of moderate to advanced periodontal disease were selected in each patient. These were randomly irrigated with a single dose of either 0.2% CH gel, 0.2% CH solution, or physiological saline, while 1 site was left as a control. The patients were seen weekly, until the 5th week, then at the 7th and 10th weeks. At each appointment, a microbiological sample was taken from the subgingival region of each site, together with an assessment of the clinical indices. Results indicated that a single irrigation of an 0.2% solution of CH or 0.2% CH gel had a marked effect in decreasing the % of spirochaetes and, to some extent, motile bacteria. There was a concomitant shift in colonization to cocci, fusiform and filamentous organisms in pockets that were irrigated; this coincided with a reduction in the % of bleeding sites. Various patterns of colonization were observed which have been described and may assist in differential dark field (DDF) monitoring of lesions. Bleeding on blunt probing was found to be correlated with a flora dominated by spirochaetes. No other correlations were found over the 10-week period between the other parameters.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinical and microbiological effects of sustained release chlorhexidine in periodontal pockets

Previous studies have shown that a 3-day exposure of the pocket flora to the sustained release of chlorhexidine significantly reduced the relative numbers of spirochetes and motile rods in periodontal pockets to negligible amounts. By 14 days post-treatment, their numbers had returned to pre-treatment levels. The present study extended the exposure time of the pocket flora to the sustained release of chlorhexidine in an attempt to prolong the suppression of the microbial flora for a clinically significant period of time. Clinical parameters were also studied. Sustained release devices (SRD) were inserted into 13 pockets from 8 patients. Pocket depth ranged between 5 and 8 mm. The SRD's were replaced every 3 days to give a total exposure of 9 days. Plaque index (PlI), bleeding on probing and pocket depth were measured, and bacterial samples taken for dark field microscopy and anaerobic culture. There was a marked decrease in the relative proportions of spirochetes and motile rods and the total anaerobic count post-treatment. Pocket depth was reduced in all 13 pockets. These results indicate that a prolonged exposure to chlorhexidine suppresses the pocket flora to negligible amounts and reduces pocket depth for up to 11 weeks post-treatment.     

Influence of a single application of subgingival chlorhexidine gel or tetracycline paste on the clinical parameters of adult periodontitis patients

Abstract. The clinical effects of subgingivally placed 1% chlorhexidine gel (w/w) and 40% tetracycline (w/w) paste in periodontal pockets of 22 adult periodontitis patients were studied. The 2 agents were applied following scaling and root planing in pockets exceeding 4 mm. The patients were randomly divided into 3 groups: (a) scaling and root planing (SCRP) only, the control group; (b) corsodyl gel + SCRP; (c) Tetracycline paste + SCRP. Gel or paste were gently applied using a syringe with a blunt needle until the selected pocket was overfilled. Evaluations were made of clinical parameters including the plaque index (PI), gingival index (GI), bleeding index (GI-S), probing pocket depths, probing attachment levels and position of the gingival margin. The results suggested that all the treatment modalities were effective in producing statistically significant improvements in clinical parameters. It was concluded that the conventional treatment modalities were essential in the treatment of periodontal diseases, but in view of the structure of the periodontal pocket and adjacent complex root surface, subgingival drug application in certain cases, might also provide adjunctive improvement.     

Clinical effects of simultaneous ultrasonic scaling and subgingival irrigation with chlorhexidine

The clinical and microbial effects of a single episode of simultaneous ultrasonic scaling and subgingival irrigation with chlorhexidine (CHX) were studied as a function of clinical probing depth in patients with adult periodontitis. 60 patients were randomly assigned to receive subgingival irrigation under cavitation with either sterile water or 0.12% CHX delivered through the tip of an ultrasonically activated scaler as part of initial periodontal therapy in a double-blind study design. 3 periodontal sites were randomly selected for examination from each patient on the basis of clinical probing depth, with 1 site being selected within each of the following ranges: 1-3 mm, 4-6 mm, and 7-9 mm. Pretreatment and post-treatment (days 14 and 28) clinical assessments included a plaque index (PI), gingival index (GI), and clinical probing depth (CPD). Subgingival specimens also were collected from 1-3 mm and 4-6 mm sites on a random subset of patients (15 per group). Plaque counts of spirochetes and motile organisms were made by darkfield microscopy. Significant reductions in PI, GI, and CPD were observed among all sites within both treatment groups at 14 and 28 days post-treatment. CHX irrigation resulted in a significantly greater reduction in CPD than did water among sites initially probing 4-6 mm at both 14 and 28 days post-treatment (25% versus 13% and 31% versus 18%, respectively). Spirochete counts were modestly but nonsignificantly reduced at 14 days post-treatment among sites 4-6 mm within both treatment groups. These results suggest that subgingival irrigation with CHX during ultrasonic scaling provides differential clinical benefits that are site-dependent.     

Comparison of the immediate effects on the sub-gingival microflora of acrylic strips containing 40% chlorhexidine, metronidazole or tetracycline

In the management of chronic periodontitis, there has been a renewed interest in the local delivery of antimicrobial drugs into periodontal pockets. This study assessed the effects of the acrylic strip delivery system containing chlorhexidine, metronidazole or tetracycline on subgingival microflora assessed by dark field microscopy. Strips containing 40% chlorhexidine, metronidazole or tetracycline were placed for 2 to 3 days into pockets greater than 6 mm which bled on probing. Plaque samples were obtained before and after treatment and counts of morphological and motile groups of organisms were made by dark field microscopy. Prior to treatment, the dark field microscopic counts were similar to those previously reported for diseased sites with motile bacteria, in particular spirochaetes, present in high numbers. Following treatment, all 3 antimicrobial drugs produced a significant increase in the proportion of cocci and significant decreases in all other types of organisms. Motile organisms, in particular, were markedly reduced and spirochaetes could not be recovered from some sites treated with metronidazole and tetracycline. Metronidazole was significantly more effective than tetracycline or chlorhexidine on spirochaetes. The results indicate that acrylic strips may be useful in the management of chronic periodontitis as an adjunct to routine mechanical methods.     

Studies of a periodontal tissue lesion in the rat, untreated or treated with chlorhexidine digluconate

Abstract The studies currently reported farmed part of an enquiry whose overall objective was to identify a suitable animal model upon which initial screening of compounds and formulations with prophylactic and/or therapeutic potential in periodontitis could be carried out, An earlier study (Rovin et al. 1966) reported that periodontal inflammation could be produced in the conventional laboratory rat by application of a ligature to the molar teeth. The present paper describes the pathological and histopathological changes in the periodontium following application of ligatures to the molar teeth of young rats, and the tissue responses observed after topical application of chlorhexidine digluconate. Plaque formed rapidly and an acute periodontitis was induced; application of increasing concentrations of chlorhexidine digluconate gave a progressive diminution in the severity of the lesions. The major bacterial components of the plaque were actinomycetes and streptococci.     

Changes in amount of gingival crevicular fluid after a single episode of periodontal treatment

A total of 51 periodontal sites from 6 adults with no systemic diseases or medication were selected for the study. All sites showed radiologic bone loss and pockets of 4 mm or more. Crevicular fluid (CF) was collected by inserting filter paper strips into periodontal pockets for 5 s and was measured by Periotron. Samples were collected before and 2, 5, 10, 20, and 40 days after a single episode of periodontal treatment (scaling, root planing and curettage). Plaque Index (PII), Papilla Bleeding Index (PBI) and pocket depth (PD) were measured before and 40 days after treatment. The amount of bone loss was estimated from orthopantomograms taken immediately before the trial. Two days after treatment an increase in the amount of CF was seen. After this the amount of CF decreased, reaching the pretreatment level on day 5 after treatment and a level clearly below pretreatment level on day 10 after treatment. Forty days after treatment a slight increase in the amount of CF was seen. The difference between pretreatment values and values at days 2, 10, 20, and 40 was highly significant. In pretreatment samples, positive correlations were found between the amount of CF and PD, PBI and bone loss and, in samples collected 40 days after treatment between CF and PD. CF measurements made before treatment were of no value in predicting the changes in clinical parameters after treatment.     

Effect of a controlled-release chlorhexidine chip on clinical and microbiological parameters of periodontal syndrome

AIM: The aim of this study was to evaluate the effectiveness of a controlled-released chlorhexidine chip (CHX) as adjunctive therapy to scaling and root planing (SRP) in the treatment of chronic periodontitis. MATERIAL AND METHODS: Twenty patients with at least four sites with probing depth >or= 5 mm and bleeding on probing were selected. This randomized single-blind study was carried out in parallel design. The control group received SRP alone, while the test group received SRP plus CHX chip. The clinical parameters, Plaque Index (PlI), Papillary Bleeding Score (PBS), Bleeding on Probing (BOP), Gingival Recession (GR), Probing Depth (PD) and Relative Attachment Level (RAL), and the microbiological parameter BANA test were recorded at baseline and after 3, 6 and 9 months. RESULTS: Both groups presented significant improvements in all parameters analyzed over the study period. There were no statistically significant differences between the two groups for any parameter analyzed after 9 months, except for BOP, which was significantly reduced in the control group. The mean reductions on PD and RAL were 2.4 mm and 1.0 mm for the control group and 2.2 mm and 0.6 mm for the test group, respectively. CONCLUSION: The CHX chip did not provide any clinical or microbiological benefit beyond that achieved with conventional scaling and root planning, after a 9-month period.     

The effects of a simplified mechanical oral hygiene regime plus supragingival irrigation with chlorhexidine or metronidazole on subgingival plaque

23 patients with pockets greater than or equal to 4 mm and evidence of bone loss on radiographs received thorough scaling and root planing followed by instruction in Bass brushing. They refrained from routine interdental cleaning for the first 28 days. A pulsating jet irrigator was used once daily supragingivally with 0.02% chlorhexidine (CH) 0.05% metronidazole (MD) or 0.01% quinine sulphate inactive control (PL), on a randomized double blind basis. Molar sites were not irrigated and served as control sites; they were only mechanically cleaned. For each patient, subgingival plaque samples were obtained from 2 test and 1 control sites at baseline (day 0), and on days 7, 28, 56 and 84. Plaque samples were monitored by darkfield microscopy on the basis of morphological characteristics of 4 types of bacteria: cocci, motile cells, spirochaetes and "others" (nonmotile rods, filaments and fusiforms). The simplified oral hygiene regime of scaling, root planing and Bass toothbrushing combined with interdental supragingival pulsating jet irrigation with CH, MD or PL appeared superior to a system of simplified oral hygiene alone, particularly during the first 4 weeks. However, at most time-points, the benefits were not statistically significant except for metronidazole. By day 84, the end of the experimental period, all groups approximated baseline levels. The results indicate that supragingival pulsated jet irrigation has limited effects on the composition of subgingival plaque. More marked changes occur when the irrigation fluid contains a chemical agent such as metronidazole known to be effective against important subgingival organisms, but probably not to such an extent as to change the composition of the flora from one associated with diseased sites to one associated with healthy sites.     

Non-surgical periodontal treatment with a new ultrasonic device (Vector-ultrasonic system) or hand instruments

OBJECTIVES: The aim of this prospective, randomized, controlled clinical study was to compare the effectiveness of a newly developed ultrasonic device to that of scaling and root planing for non-surgical periodontal treatment. MATERIAL AND METHODS: Thirty-eight patients with moderate to advanced chronic periodontal disease were treated according to an "one-stage procedure" with either a newly developed ultrasonic device (VUS) (Vector-ultrasonic system) or scaling and root planing (SRP) using hand instruments. Clinical assessments by plaque index (PlI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL) were made prior to and at 6 months after treatment. Differences in clinical parameters were analyzed using the Wilcoxon signed ranks test and Mann and Whitney U-test. RESULTS: No differences in any of the investigated parameters were observed at baseline between the two groups. The mean value of BOP decreased in the VUS group from 32% at baseline to 20% after 6 months (p<0.001) and in the SRP group from 30% at baseline to 18% after 6 months (p<0.001).The results have shown that at moderately deep sites (initial PD 4-5 mm) mean CAL changed in the test group from 4.6+/-1.2 to 4.2+/-1.6 mm (p< 0.001) and in the control group from 4.8+/-1.3 to 4.4+/-1.5 mm (p<0.001). At deep sites (initial PD>6 mm) mean CAL changed in the test group from 8.5+/-1.9 to 7.9+/-2.4 mm (p<0.001) and in the control group from 7.9+/-1.6 to 7.2+/-2.2 mm (p<0.001). No statistically significant differences in any of the investigated parameters were found between the two groups. CONCLUSION: Non-surgical periodontal therapy with the tested ultrasonic device may lead to clinical improvements comparable to those obtained with conventional hand instruments.     

Clinical effects on chronic periodontitis of a simplified system of oral hygiene including subgingival pulsated jet irrigation with chlorhexidine

The aim of this study was to investigate the effects of a simplified system of oral hygiene, comprising Bass brushing, scaling, root planing and subgingival irrigation using a pulsated monojet oral irrigator, in patients with chronic periodontitis. After initial assessment, patients received scaling, root planing and instruction in Bass brushing and in use of a pulsated jet oral irrigator (Water Pik + Imax attachment) to irrigate subgingivally. 11 patients with 262 approximal periodontal pockets used 0.02% chlorhexidine (CH), or a placebo as the irrigating solution once daily for 28 days. Plaque index (PlI), sulcus bleeding index (SBI), and probing pocket depth (PPD) were assessed on days 0, 28, 56 and 84. Within procedure comparisons for all groups showed that the regime was highly effective in reducing PlI, SBI and PPD, improvements being maintained at least until day 84. Between procedure comparisons showed that benefits were improved only marginally by the use of 0.02% CH as the irrigation fluid. The patients found the procedure pleasant and neither injuries nor staining were noted during the study. It was concluded that this simplified oral hygiene system was effective in reducing periodontal inflammation and pocket depth, although no significant added benefit with 0.02% CH was apparent. The technique may be useful in patients who cannot achieve high levels of routine mechanical oral hygiene, particularly interdentially. The effects of using higher concentrations of chlorhexidine should be investigated.     

Adjunctive use of tetracycline fibers with nonsurgical periodontal therapy in an adult with Down syndrome: a case report

Individuals with Down syndrome (DS) are susceptible to severe periodontal disease, due to immune alterations related to functional defects of polymorphonuclear leukocytes and monocytes. The adjunctive use of locally delivered antimicrobials has been proven to be beneficial, especially in areas where mechanical therapy might fail. This article describes the management of a patient with DS who had aggressive periodontitis. The treatment used a local drug delivery system with tetracycline fibers as an adjunct to scaling and root planing.     

Tetracyclines in the management of periodontal diseases

Abstract Periodontal diseases essentially comprise a group of oral infections whose primary aetiological factor is dental plaque. Removal of the cause (and its effects) is the primary aim of both non-surgical and surgical treatment regimens, although the infective nature of the diseases has led to the widespread use of antimicrobials as an adjunct to mechanical debridement. The tetracyclines are primarily bacteriostatic agents that are effective against many Gram-negative species including putative periodontopathogens such as Actinobacillus actinomycetemcomitans (A.a.). The proven efficacy of this group of drugs in the management of periodontal diseases may be related not only to their antibacterial actions, but to a number of additional properties that have been recently identified. These include collagenase inhibition, anti-inflammatory actions, inhibition of bone resorption and their ability to promote the attachment of fibroblasts to root surfaces. Consequently, tetracyclines have also been used as an adjunct to bone grafting in periodontal defects, and as agents for “conditioning” root surfaces to enhance the regeneration of periodontal tissues. When tetracyclines are taken orally, consideration must be given both to the potential unwanted effects and to interactions with other drugs that are taken concurrently. Such problems are minimised however, when the drugs are incorporated into controlled, slow-release formulations which are currently being researched and marketed for intra-oral use.     

Microbial succession in recolonizing deep periodontal pockets after a single course of supra- and subgingival debridement

In the present study, the effect of supra and subgingival plaque debridement on the dynamics of the subgingival microflora in deep pockets was investigated. 8 adult periodontitis patients participated in the study. In each patient, 4 clinically diseased sites were investigated microbiologically by phase contrast microscopy for the determination of both the %s as well as the total numbers of spirochetes and motile rods and by anaerobic cultivation for the determination of the different black-pigmented Bacteroides species. After base-line examination, patients were treated by mechanical removal of supra- and subgingival plaque deposits. 2 and 8 weeks after treatment, clinical and microbiological parameters were re-evaluated. During the experimental period, no oral hygiene procedures were performed in order to achieve fast recolonization of the pockets. Treatment resulted in a significant reduction in probing pocket depth and gain of probing attachment. 2 weeks after treatment, no further improvements could be observed. A positive correlation was found between the reduction in probing pocket depth and decrease in Bacteroides gingivalis (P less than 0.009) and between gain in probing attachment and reduction in the % of B. gingivalis (P less than 0.009). No correlation between these clinical parameters and B. intermedius, spirochetes or motile rods was apparent. An inverse relationship between B. gingivalis and B. intermedius was observed. We found that changes in %s of spirochetes and motile rods are not correlated with changes in total numbers of these bacterial groups. It was concluded that monitoring of %s of micro-organisms may not supply rational information on the microbiological conditions of the subgingival area.     

Clinical and bacteriologic response to irrigation with a chlorhexidine solution in the treatment of periodontal pockets]

Most of parodontal diseases have a bacterial aetiology. Their episodic and asynchronic evolution differs from site to site. The "in situs" antimicrobian used in the parodontal bags reduces the systemic administration. Various antibiotics or antiseptics slow liberation systems were experimented. Two patients suffering from advanced parodontitis were treated after radicular scraping by subgingival irrigation with a syringe filled with chlorhexidine. Each patient presented at last four parodontal bags more or less six millimetres (6 mm) deep. The following clinical parameters were noted: Patch index, bleeding index, bag depth. A bacteriological analysis was realized at the beginning and of the treatment. Controls were made at D60. Results showed a significant improvement of clinical parameters. It seems that the chlorhexidine irrigation improves the parodontal treatment efficiency.     

Clinical and microbiological effects of subgingival restorations with overhanging or clinically perfect margins

The close association between restorations with overhanging margins and chronic destructive periodontitis has been known for many years. However, the mechanisms by which overhanging restorations will interact in the pathogenesis of periodontal disease are still unknown. Generally it is accepted that overhanging restorations contribute to the promotion of the disease process by virtue of their capacity to retain bacterial plaque. The purpose of the present study was to determine if the placement of subgingival restorations with overhanging margins results in changes in the subgingival microflora. 9 dental students with clean teeth and clinically healthy gingivae (GI less than 0.1) gave their consent to participate in the study. 5 MOD cast gold onlays with 1 mm proximal overhanging margins were placed in mandibular molars for 19-27 weeks. They were replaced in a cross-over design by 5 similar onlays with clinically perfect margins which served as controls. Another 5 onlays were placed in reverse order in the remaining patients. Prior to and every 2-3 weeks after insertion, subgingival microbiological samples were obtained by inserting a fine sterile paper point for 30 sec into the gingival sulcus subjacent to the restoration. The predominant cultivable flora was determined using continuous anaerobic culturing techniques. Following the placement of restorations with overhanging margins, a subgingival flora was detected which closely resembled that of chronic periodontitis. Increased proportions of Gram-negative anaerobic bacteria, black-pigmented Bacteroides and an increased anaerobe: facultative ratio were noted. Following the placement of the restorations with clinically perfect margins, a microflora characteristic for gingival health or initial gingivitis was observed. Black-pigmented Bacteroides were detected in very low proportions (1.6-3.8%). These changes in the subgingival microflora were obvious irrespective of whether the restorations with the overhanging margins were placed in the first period of the experiment or following the cross-over. Clinically, increasing gingival indices were detected at the sites where overhanging margins were placed. Bleeding on gentle probing always preceded the peak level of black-pigmented Bacteroides. Loss of attachment was not detected in any site. Changes in the subgingival microflora after the placement of restorations with overhanging margins document a potential mechanism for the initiation of periodontal disease associated with iatrogenic factors.     

The effect of periodontal therapy on uncontrolled type 2 diabetes mellitus in older subjects

OBJECTIVE: The purpose of this study was to examine the effect of periodontal therapy on glycemic control in older type 2 diabetic patients. METHODS: Fifty-two diabetic patients, age 55-80 years (mean age = 61 years), with glycated hemoglobin (HbA1c) 7.5-11.0% (mean +/- s.d. = 8.98 +/- 0.88) and severe periodontitis were included in the present study. The treatment group received mechanical periodontal treatment combined with systemic doxycycline, 100 mg day(-1) for 14 days. The control group received neither periodontal treatment nor systemic doxycycline. Clinical periodontal parameters, fasting plasma glucose (FPG), and HbA1c levels were measures at baseline and 3 months. RESULTS: Periodontal treatment significantly improved periodontal status of the treatment group (P < 0.05), however the reduction in the level of FPG and HbA1c did not reach significance. In the control group, no significant changes in clinical periodontal parameters, FPG and HbA1c levels were observed, except for significant increase in attachment loss (P < 0.05). Comparing the two groups, although the 3-month level of HbA1c of the treatment group was lower than that of the control group, the difference did not reach significance. CONCLUSIONS: The results of the present study indicate that the periodontal condition of older Thais with uncontrolled diabetes is: (a) significantly improved 3 months after mechanical periodontal therapy with adjunctive systemic antimicrobial treatment, and (b) rapidly deteriorating without periodontal treatment. The effect of periodontal therapy on the glycemic control of older uncontrolled diabetics will require further studies that will have to include much larger sample sizes.     

The effects of a simplified oral hygiene regime plus supragingival irrigation with chlorhexidine or metronidazole on chronic inflammatory periodontal disease

This study compared a simplified oral hygiene regime (scaling, root planing and Bass brushing) with this same regime plus 0.02% chlorhexidine (CH), 0.05% metronidazole (MD) and inactive control (PL) solutions delivered supragingivally by a pulsating water jet irrigator. 22 patients were distributed randomly into 3 groups, 0.02% chlorhexidine (CH), 0.05% metronidazole (MD), and inactive control (PL). Approximal surfaces with associated pockets greater than or equal to 4 mm were monitored at day 0, for plaque index (PII), gingival index (GI), sulcus bleeding index (SBI), baseline measurement for gingival shrinkage and probable pocket depth. All monitored surfaces were then immediately scaled and root planed. All patients received identical oral hygiene instruction (Bass brushing), with a sodium fluoride toothpaste and a multituft toothbrush, and were shown how to use the oral irrigator. Proficiency in use of the oral irrigator was checked again at day 7. No interdental cleaning was taught. The active treatment period was 28 days. Patients were seen at days 7, 28, 56 and 84, and all parameters were recorded at each visit, but no further oral hygiene instruction was given. Within procedure comparisons of the findings at days 28 (end of active treatment) 56 and 84 with those at day 0, showed statistically highly significant improvements in all parameters for all groups. Regarding between procedure comparisons, CH was better in reducing PII at all times except at day 84, and on several occasions in reducing GI and SBI. Irrigated groups were always better than nonirrigated groups. Although the differences were statistically highly significant, clinically the differences between groups were relatively small, except for CH effect on PII.(ABSTRACT TRUNCATED AT 250 WORDS)