CLINICAL AND MICROBIOLOGICAL CHANGES ASSOCIATED WITH THE USE OF 4 ADJUNCTIVE SYSTEMICALLY ADMINISTERED AGENTS IN THE TREATMENT OF PERIODONTAL INFECTIONS

The purpose of the present investigation was to assess the effects of periodontal surgery and 4 systemically administered agents, Augmentin, tetracycline, ibuprofen or a placebo on clinical and microbiological parameters of periodontal disease, 98 subjects were monitored at 2-mon th intervals at 6 sites per tooth for clinical parameters. Subgingival plaque samples were taken from the mesial surface of each tooth at ea ch visit and evaluated for their content of 14 subgingival species usi ng DNA probes and a colony lift method, 40 subjects who exhibited loss of attachment >2.5 mm at I or more sites during longitudinal monitori ng were treated using modified Widman flap surgery at sites with probi ng pocket depth >4 mm, subgingival scaling at all other sites and were randomly assigned I of the 4 agents. Treatment was completed within 3 0 days during which time the subject took the assigned agent, Overall, subjects exhibited a mean attachment level ''gain'' of 0.34 +/- 0.10 mm (SEM) and a mean pocket depth reduction of 0.62 +/- 0.09 mm 10 +/- 4 months post-therapy. However, certain subjects in each treatment gro up showed a poor response. Subjects receiving antibiotics exhibited si gnificantly more attachment level ''gain'' (0.57 +/- 0.15 mm, SEM) tha n subjects receiving either ibuprofen or a placebo (0.02 +/- 0.10). Th e differences between Augmentin and tetracycline groups were not signi ficant, nor were the differences between ibuprofen and placebo. 10 mon ths post-therapy, there was a reduction in the number of sites coloniz ed in any subject group by detectable levels (10(3)) of P. gingivalis. Species showing similar reductions were B. forsythus; P. inter media and P. micros. Subjects receiving systemically administered antibiotic s had a significant increase in the proportion of sites colonized by C . ochracea coupled with a greater decrease in the number of sites colo nized by P. gingivalis, B. forsythus, P. intermedia and P. micros post -therapy than subjects not receiving antibiotics. The results of this investigation indicate that adjunctive systemic antibiotics increase p eriodontal attachment ''gain'' and decrease the levels of some suspect ed periodontal pathogens in subjects with evidence of current disease progression.