ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Photodynamic Therapy (PDT) Does Not Decrease Bacterial Load More Than Conventional Therapy in Systemically Healthy Patients with Chronic Periodontitis with No Evidence Currently Available for Diabetic Patients with Chronic Periodontitis
Clinical Question In an adult patient with diabetes and periodontitis, does photodynamic therapy (PDT) decrease bacterial load as compared to conventional non-surgical therapy?
Clinical Bottom Line In systemically healthy patients with chronic periodontitis, photodynamic therapy is no more effective clinically than scaling and root planing in decreasing bacterial loads. This is found in several randomized controlled clinical trials where PDT was compared to scaling and root planing. There is currently no published evidence available on how PDT affects bacterial load in diabetic patients with chronic periodontitis.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19554711Polansky/200958 patients with chronic periodontitisRandomized Controlled Trial
Key resultsPorphyromonas gingivalis was significantly decreased in both the group receiving PDT (p=0.016) and the group not receiving PDT (p=0.041). However, there was no stastical difference between the two groups (p=0.694). There was no significant decrease in levels of Tannerella forsythia (p=0.100/ p=0.094) and Treponema denticola (p=0.895/p=0.194) in the PDT group or control group. There was also no significant difference across the two groups for T. forsythia (p=0.944) or T. denticola (p=0.259).
#2) 23731242Luchesi/201337 patients with class II furcationsRandomized Controlled Trial
Key resultsThere was no significant difference between the groups in levels of P. gingivalis, T. forsythia, A. actinomycetemcomitans. At 3 and 6 months there was no intra-group differences in the level of A. actinomycetemcomitans when compared to the initial measurment (P>0.05). However, there was intra-group differences at 3 months in levels of P gingivalis for both groups (p<0.05). For the PDT group the P. gingivalis remained significantly reduced at 6 months (P<0.05). T. forsythis was also reduced in the PDT group at 6 months (p<0.05).
#3) 24352342Mannucci/201362 adult patients with type 1 or 2 diabetes and an infected foot ulcerRandomized Controlled Trial
Key resultsThe higher concentration of photoactivated RLP068 (in photoactivated gel) used, the more the bacterial load was decreased one day post treatment (-1.92 ± 1.21, -2.94 ± 1.60, and -3.00 ± 1.82 Log- CFU/ml for 0.10, 0.30, and 0.50% RPL068). There was significant difference between the groups receiving PDT and the control group (-1.00 ± 1.02 LogCFU/ml with placebo) in only the two highest concentrations. However, during follow up the bacterial load increased and effects were only temporary. Also, no significant change in ulcer dimensions was observed.
Evidence Search ("Photochemotherapy"[Mesh] AND "Bacteria"[Mesh]) AND "Periodontitis"[Mesh] AND "humans"[MeSH Terms] and (("Photochemotherapy"[Mesh]) AND "Diabetes Mellitus, Type 2"[Mesh]) AND "Bacteria"[Mesh]
Comments on
The Evidence
Validity: Polansky’s study involved a single person providing treatment and gathering results; however, an outside lab ran the PCR test. None of the authors had competing interest, and all of the studies had adequate follow up, over 80% completion rate, adequate compliance, and contained similar groups at the beginning that were treated the same (except for the intervention) throughout the studies. Perspective: There are no studies published regarding how PDT affects bacterial levels in diabetic patients, only studies in otherwise healthy patients. None of these studies reported sustained, reliable decreases in bacterial levels in the groups receiving photodynamic therapy. In Polansky’s and Luchesi’s studies there are some significant changes in P. gingivalis; however, the changes were seen in both the control group and in the group receiving PDT suggesting the study effect was unique from PDT. As bacterial load is highly variable, none of these studies address the clinical significance of therapy. However, a medical study addressing PDT therapy in diabetics with foot ulcers found that increasing levels of concentration of photoactivated RLP068 in the photoactivated gel did decrease bacterial loads one day post treatment. Although, the effect was only temporary, with bacterial loads rising in 15 days. The concentrations that were found to produce a positive effect were higher than the concentrations used in the studies concerinng periodontitis. Systematic review of the literature needs to be done on the topic of how PDT affects bacterial loads in healthy patients for a more thorough collection of the available evidence, and randomized controlled clinical trials need to be completed for diabetic patients with chronic periodontitis receiving PDT, possibly with varying concentrations of RLP068 as reflected in the medical study. Clinical outcomes should also be addressed in future studies.
Applicability No harmful side effects have been documented for PDT. Some possible short term benefits in clinical outcomes such as bleeding on probing, pocket depth and clinical attachment level (see CAT # 613) are documented; however PDT has not been shown to be effective at decreasing bacterial levels at a clinically significant level.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords Photodynamic therapy, chronic periodontitis, bacteria
ID# 2879
Date of submission: 03/25/2015spacer
E-mail cowant@livemail.uthscsa.edu
Author Traci Cowan
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Thomas Oates, DMD, PhD & Devjit Tripathy, MD, PhD
Faculty mentor/Co-author e-mail OATES@uthscsa.edu, tripathy@uthscsa.edu
Basic Science Rationale
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Comments on the CAT
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