Faculty Collaboration Database

Subantimicrobial dose doxycycline as adjunctive treatment for periodontitis. A review. J Clin Periodontol 2004 Sep;31(9):697-707

Date

08/18/2004

Pubmed ID

15312090

DOI

10.1111/j.1600-051X.2004.00558.x

Scopus ID

2-s2.0-4444301025 (requires institutional sign-in at Scopus site)   123 Citations

Abstract

BACKGROUND: Subantimicrobial dose doxycycline (SDD--20 mg doxycycline twice daily) is indicated as an adjunctive treatment for periodontitis. Doxycycline downregulates the activity of matrix metalloproteinases (MMPs), key destructive enzymes in periodontal disease. Current understanding of periodontal pathogenesis suggests that MMPs play a major role in the destruction of periodontal tissues, leading to the clinical signs of periodontitis. Research supports that downregulation of MMPs by SDD confers benefit to patients with periodontitis.

METHOD: We review the clinical, microbiological and safety data relating to the use of SDD in patients with periodontitis, and consider the historical events that led to the development of adjunctive SDD as a treatment for periodontitis.

RESULTS: Studies have shown that SDD, when prescribed as an adjunct to scaling and root planing (SRP), results in statistically and clinically significant gains in clinical attachment levels and reductions in probing depths over and above those that are achieved by SRP alone. SRP must be thorough and performed to the highest standard to maximise the benefits of adjunctive SDD. SDD does not result in antibacterial effects, or lead to the development of resistant strains or the acquisition of multiantibiotic resistance. The frequency of adverse events is low, and does not differ significantly from placebo.

CONCLUSIONS: Adjunctive SDD confers clinical benefit to patients with periodontitis. A comprehensive treatment strategy is suggested, involving patient education and motivation, reduction of the bacterial burden by SRP, host response modulation with SDD, and periodontal risk factor modification.

Author List

Preshaw PM, Hefti AF, Jepsen S, Etienne D, Walker C, Bradshaw MH

Author

Arthur Hefti DDS,PhD Associate Dean - Research & Graduate Studies in the Dentistry department at Marquette University

MESH terms used to index this publication - Major topics in bold

Chemotherapy, Adjuvant
Clinical Trials as Topic
Dental Scaling
Doxycycline
Humans
Immunologic Factors
Matrix Metalloproteinase Inhibitors
Periodontitis
Protease Inhibitors
Tetracycline Resistance