Adjunctive treatment with subantimicrobial doses of doxycycline: effects on gingival fluid collagenase activity and attachment loss in adult periodontitis.

OBJECTIVES: The therapeutic effects of doxycycline and other tetracyclines in the treatment of periodontitis involve, at least in part, mechanisms that are unrelated to their antimicrobial activity. Previous clinical studies have shown that doxycycline administered orally, at doses below those needed for antimicrobial efficacy, to human subjects with adult periodontitis resulted in significantly reduced collagenase activity in gingival crevicular fluid (GCF) and in extracts of inflamed gingival tissues. The purpose of the present study was to identify clinically effective dosing regimens using subantimicrobial dose doxycycline (SDD) as an adjunctive therapy in patients with adult periodontitis. MATERIAL AND METHODS: A total of 75 adult men and women qualified for enrollment into the three-part, placebo-controlled, double-blind, parallel-group study. Patients were stratified based on repeatedly exhibiting pathologic levels of periodontal attachment (ALv) and GCF collagenase activity at several appointments prior to baseline. Patients were administered a scaling and prophylaxis, then 1 of 5 treatment schedules for 12 weeks (part I), followed by a 12-week period of no drug therapy (part II), a second scaling and prophylaxis, and 12 additional weeks of treatment (part III). Primary determinants of efficacy included reductions in GCF collagenase activity and changes in relative ALv. RESULTS: 66 patients completed the 1st 12 weeks (part I) of the 3-part, 36-week study; 51 patients completed the entire 36-week study. From baseline to week 12 (part I), treatment with specially formulated SDD capsules (20 mg) 2x daily (1 x every 12 h) for up to 12 weeks was shown to significantly reduce GCF collagenase activity and to improve ALv, effects not seen in patients treated with placebo. Continuous drug therapy over the 12-week treatment period was needed to maintain and maximize the reduction in GCF collagenase and the improvement in ALv. Improvements in periodontal disease parameters occurred without the emergence of doxycycline-resistant micro-organisms. In patients administered an "on-off-on" regimen of SDD over 36 weeks (parts I-III), essentially no attachment loss occurred in patients receiving the highest of these SDD regimens (20 mg 2x daily during part I and 20 mg 1 x daily in part III), whereas patients administered placebo capsules experienced a mean attachment loss of approximately 0.8 mm at the 24- and 36-week time periods. CONCLUSIONS: Doxycycline administered at subantimicrobial doses led to improvements in disease parameters, with no apparent side effects, and appears to have significant potential as an oral adjunctive therapy in the long-term management of adult periodontitis.

Comparison of a chlorhexidine rinse and a wooden interdental cleaner in reducing interdental gingivitis.

The purpose of this study was to evaluate the effectiveness of an antimicrobial rinse (chlorhexidine) compared to a positive control of mechanical oral hygiene in reducing interdental gingival inflammation. The mechanical group showed a significantly greater reduction in interdental gingivitis as determined by bleeding compared to the chemical rinse. Even though the chemical rinse has been shown to be effective in reducing inflammation on the visible buccal and lingual gingival surfaces, it is significantly less effective than the mechanical device in reducing bleeding in the interdental area.

The prevalence of interdental gingival inflammation: a report from the 1986 ADA annual health screening.

This study screened 1986 ADA annual session participants for interdental gingival inflammation by using the Eastman Interdental Bleeding Index (EIBI). The EIBI provides a sensitive and objective measure of interdental gingival inflammation, and has been shown to be reliable. At least one bleeding site was found in 81% of the 435 dentists examined. This study showed that in a dental population, the prevalence of gingival inflammation was high when the health of interdental tissues was assessed.

The relative clinical effectiveness of three anticalculus dentifrices.

A three-month double-blind clinical study was conducted to compare the effect of three commercially available antitartar dentifrices in retarding the rate of supragingival calculus formation. After a thorough dental prophylaxis, the subjects were instructed to brush their teeth twice daily with either Prevent, Crest Tartar Control Formula (TCF), or Colgate TCF. Supragingival calculus accumulation on the mandibular anterior teeth was measured after 3 months use of the assigned dentifrice. The results of this study showed that Prevent retarded calculus formation 38.0% more than Crest TCF. Colgate TCF retarded calculus accumulation by 36.0% more than Crest TCF. No significant differences in anticalculus effectiveness were noted between Prevent and Colgate TCF.