Title	Antibiotics Help Improve The Clinical Outcome of Non-Surgical Therapy (Scaling and Root Planing [SRP]) in The Treatment of Periodontitis in Smokers
Clinical Question	Do adjunctive locally delivered antibiotics improve the clinical outcome of non-surgical therapy (scaling and root planing [SRP]) in the treatment of periodontitis in smokers?
Clinical Bottom Line	Antibiotics help improve the clinical outcome of non-surgical therapy (scaling and root planing [SRP]) in the treatment of periodontitis in smokers. Smokers tend to harbor anaerobic bacteria in periodontal pockets that are resistant to mechanical instrumentation. This systematic review of several randomized controlled clinical trials supports that doxycycline is beneficial as an adjunct to the non-surgical treatment plan of chronic periodontitis in current smokers. The local delivery of antibiotics to the periodontal pocket is within the capability of the average general dental practice and likely to be accepted by the average patient.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 16584341 Machion/2006 48 patients (48 smokers with chronic periodontitis) Randomized Control Trial Key results The patients in this study were current smokers, individuals who smoked more than 10 cigarettes per day for at least 5 years. The subjects were chronic periodontitis patients who had a minimum of four periodontal pockets with probing depths of > 5 mm and bleeding on probing of the anterior teeth. Group 1’s patients received SRP plus local drug delivery of 10% doxycycline. They showed improved clinical outcome over a period of 24 months compared with Group 2’s patients who received SRP alone. Probing depth reductions for group 1 at 45 days were 1.63 + 1.16 mm and at 24 months were 2.29 + 1.14 mm; whereas probing depth reduction for group 2 at 45 days were 1.50 + 0.55 mm and at 24 months were 2.19 + 0.76 mm. Relative attachment gain for group 1 at 45 days were 0.99 + 0.84 mm and at 24 months were 1.58 + 0.73 mm; whereas relative attachment gain for group 2 at 45 days were 0.99 + 0.88 mm and at 24 months were 0.70 + 0.94 mm. SRP + doxycycline showed greater probing depth reduction than SRP alone at 6 and 18 months (P <0.05) and greater relative attachment gain in all time periods after 3 months (P <0.05). However, at 24 months, there was no significant difference between the two groups. As for relative attachment gain, P <0.05 at all time points up to 24 months. 10522780 Ryder/1999 358 patients (100 never smokers, 137 former smokers, 121 current smokers) Randomized control trial Key results Current smokers are individuals who smoked more than 10 cigarettes per day for at least 5 years. The subjects treated with locally delivered doxycycline had the antibiotic applied to two quadrants of the mouth that had teeth with probing depths > 5 mm and > 7 mm. Group 1’s patients received SRP plus local drug delivery of doxycycline gel. They showed improved clinical outcome over a period of 9 months compared with Group 2’s patients who received SRP alone. Attachment level gain for group 1 at 4 months were 0.68 + 0.06 mm and at 9 months were 0.80 + 0.07 mm; whereas attachment level gain for group 2 at 4 months were 0.63 + 0.06 mm and at 9 months were 0.79 + 0.06 mm. Probing depth reduction for group 1 at 4 months were 1.01 + 0.05 mm and at 9 months were 1.22 + 0.06 mm; whereas probing depth reduction for group 2 at 4 months were 1.00 + 0.05 mm and at 9 months were 1.17 + 0.06 mm.
Evidence Search	(“Smokers”[Mesh]) AND (“Smoking”[Mesh]) AND (“Periodontitis”[Mesh]) AND (“Locally Delivered Antibiotics”[Mesh])
Comments on The Evidence	Validity: This is a review of two randomized controlled trials. A comprehensive detailed search was performed for relevant trials, and the individual studies were assessed for validity. Among the two randomized controlled trials, there were a total of 406 patients. Machion’s study continued for 24 months, which is very adequate follow-up, while Ryder’s study continued for 9 months, which is sufficient as well. The groups were similar at the start of the trials, and the completion rate was greater than 80%. The groups were treated the same, with adequate follow-up as well. Patient compliance was adequate. The data was not based on recall bias of patients and there were no competing interests. The evidence in these studies is of good quality.
Applicability	The subjects in these three studies are representative of dental practice patients, and these treatments are feasible in a dental practice setting. Locally delivered doxycycline can be conveniently applied to the periodontal pocket by the general dentist and can have favorable outcomes for smokers with PD > 5 mm. It is likely that SRP in combination with locally delivered antibiotics is well accepted by smokers with periodontal disease.
Specialty	(Periodontics) (Dental Hygiene)
Keywords	Smokers, smoking, periodontitis, locally delivered antibiotics
ID#	2458
Date of submission	03/07/2013
E-mail	phamv@livemail.uthscsa.edu
Author	Vy Pham
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Yong-Hee Patricia Chun, DDS, MS, PhD
Faculty mentor e-mail	chuny@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available