EFFICACY OF SYSTEMICALLY ADMINISTERED ACETYLSALICYLIC-ACID PLUS SCALING ON PERIODONTAL HEALTH AND ELASTASE-ALPHA(1)-PROTEINASE INHIBITOR INGINGIVAL CREVICULAR FLUID

The purpose of this proof of principle trial was to assess whether con ventional periodontal therapy and systemically administrated acetylsal icylic acid (ASA)are functionally synergistic when combined in the tre atment of periodontitis. A total of 30 patients with untreated moderat e to severe adult periodontitis were enrolled into the study and were given placebo q.i.d. between the baseline and 6-week examination, and acetylsalicylic acid (ASA) 500 mg q.i.d. between the 6-week and 12-wee k examinations. In addition, they received supra-and subgingival scali ng in 1 quadrant after baseline examination and in 2 further randomly selected quadrants after the 6-week examination. The study design resu lted in the following 4 therapies: (1) scaling plus ASA 500 mg q.i.d.; (2) scaling plus placebo q.i.d.; (3) ASA 500 mg q.i.d. alone; (4) pla cebo q.i.d. alone. Two-way analysis of variance showed functional syne rgism of ASA and scaling, resulting in a therapeutic efficacy approxim ately equivalent to the sum of each individual therapeutic efficacy (i .e., ASA alone and scaling alone) in reducing gingival inflammation an d pocket probing depth over the 6-week observation period (interaction : p>0.05). Only the effect of ASA was significant in reducing the conc entration of elastase-alpha(1)-proteinase inhibitor in gingival crevic ular fluid (GCF E-alpha(1)-PI) (p<0.001), reduction in GCF E-alpha(1)- PI concentrations by ASA may indicate a decreased risk in periodontal disease progression. The results suggest that the combination of thera pies and their different mechanisms of action, i.e., reduction of bact erial plaque and inhibition of destructive components of the immune re sponses, may result in functionally synergistic therapeutic efficacies in patients with untreated adult periodontitis. (C) Munksgaard, 1996.