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Volume 4 No. 2, April 2009 |
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Doxycycline in the Treatment of Periodontal Disease in Patients with Type 2 Diabetes Mellitus: Systemic Versus Local Magdy A. Hassan(1) & Alsayed M. Alsalamony(2)
Oral medicine & Periodontology Department, Cairo University(1).
Internal Medicine Department, Mansoura University
(2),
Egypt.
Background/Aim: Diabetes mellitus and periodontal diseases are
two of the most common chronic inflammatory disorders that affect
millions of people worldwide. The influence of diabetes mellitus
over periodontal disease is well established, but the effect of
periodontal disease treatment over diabetes mellitus. Control is not
so clear. On the same hand, investigators have reported reduced
glycemic control in diabetic patients suffering from chronic
periodontitis. Doxycycline is one of the most commonly used
antibiotics in the treatment of periodontal disease since they have
many beneficial functions. Beside their antimicrobial activities,
doxycycline has many non-antimicrobial activities especially in
medically compromised patients, such as those patients with poorly
controlled diabetes mellitus. This intervention clinical study was
designed to evaluate the effect of the adjunctive use of doxycycline,
either systemic or local, on the metabolic control in a group of
poorly controlled type 2 diabetic patients suffering from advanced
chronic periodontitis. Materials & methods: This study was conducted
on ninety poorly controlled (HbA1c> 8 %) diabetic patients suffering
from advanced chronic periodontitis (clinical attachment level
>5mm). The patients were randomly classified into three groups: (SRP+SD
group) scaling and root planing + systemic doxycycline 100 mg / day
for 14 days, (SRP+LD group) scaling and root planing + local
doxycycline and (control group) received no periodontal treatment.
All patients were subjected to history taking, physical examination,
periodontal examination and laboratory investigation at baseline, 3
months, and 6 months of the study. Plaque index (PLI), gingival
index (GI), probing pocket depth (PPD), and clinical attachment
level (CAL) were used for periodontal evaluation. HbA1c was used for
metabolic control evaluation. Results: Significant improvement in
both treatment groups (P>0.05) were obtained, where PPD was reduced
from 6.30±0.64 to 4.51±0.55 in (SRP+SD group), while PPD was reduced
from 6.3±0.64 to 4.71±0.48 in (SRP+LD group). In addition, CAL
showed significant gain in both treatment groups (1.05mm and 0.82mm
respectively). An 18% reduction in HbA1c percentage was obtained in
(SRP+SD group); while in (SRP+LD group) the reduction was 15%.
Comparison of both treatment regimens showed no significant
differences in periodontal parameters or metabolic control
throughout the study periods (P<0.05). Conclusions: Although both
treatment regimens resulted in a significant improvement in
periodontal parameters, as well as, metabolic control in type 2
diabetics, the use of systemic doxycycline resulted in a slightly
more improvement in both periodontal parameters and metabolic
control when good plaque control was achieved. |
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