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MEDLIB-L  July 1996, Week 3

MEDLIB-L July 1996, Week 3

Subject:

Re: ref:?gum sx / Barbara Bishop, Part II

From:

Paul Blobaum <[log in to unmask]>

Reply-To:

Medical Libraries Discussion List <[log in to unmask]>

Date:

Sun, 14 Jul 1996 17:44:30 -0500

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (136 lines)

Here is a more detailed news account of the antibiotic treatment for gum
disease.  I didn't write down the web site where this came from,
unfortunately.
 
paul
 
Paul Blobaum   [log in to unmask]
Medical Librarian,  Lloyd W. Jessen Medical Library
Silver Cross Hospital
1200 Maple Road
Joliet, IL  60432     815-740-1234 x7477
 
 
 
Study Offers Nonsurgical Option for Treating Gum Disease
 
   (05/10/96)
     _________________________________________________________________
 
 
 
   Persons with severe periodontal disease may be able to avoid surgery
   by taking antibiotics, a new study shows. Dental scientists report
   that scaling and root planing (deep cleaning of teeth above and below
   the gum) combined with short-term use of oral and locally applied
   antibiotics dramatically reduced the need for gum surgery and tooth
   extractions by 88 percent. The regimen spared 690 of 783 teeth
   initially recommended for surgery or extraction.
 
   Periodontal disease is a progressive infection that, when untreated,
   can destroy the gums and other supporting structures of the teeth and
   can lead to tooth loss. The condition is typically treated by scaling
   and root planing (also called debridement) to clear away pockets of
   harmful bacteria that cause periodontal disease. When this is not
   successful, surgery is usually recommended. Surgery involves lifting
   back the gums, removing the hardened plaque buildup, then stitching
   the gums back in place.
 
   In a study supported by the National Institute of Dental Research, Dr.
   Walter J. Loesche of the University of Michigan School of Dentistry,
   Dr. James Giordano at the University of Detroit/Mercy School of
   Dentistry, and their colleagues used debridement plus antibiotics to
   significantly decrease levels of these damaging bacteria and reverse
   the majority of what were inevitable surgical cases. Dr. Loesche
   commented about the findings, "This antimicrobial regimen not only
   provides a treatment option for severe periodontal disease, but also
   brings such treatment into the realm of greater accessibility for many
   individuals."
 
   Ninety patients with advanced gum disease that required surgery were
   recruited from the dental clinic of an inner city hospital. Two
   periodontists, who were not involved with the treatment part of the
   study, examined each patient independently before the study to
   determine the number of teeth in need of surgery or extraction, then
   again after each round of treatment. At the outset of the study, the
   number of teeth per person requiring surgery or extraction ranged from
   four to 23, with eight patients having surgical need in 18 or more
   teeth.
 
   The researchers tested the effectiveness of metronidazole and
   doxycycline, two antibiotics known to combat specific types of
   bacteria that cause most gum disease, and the antimicrobial agent
   chlorhexidine in saving teeth from surgery or extraction. Depending on
   the severity and extent of their gum disease, patients could receive
   up to five rounds of treatment, two oral and three local, each lasting
   2 weeks. When there were no more surgical needs, patients moved into a
   maintenance phase of routine cleanings every 3 months.
 
   All study participants underwent thorough debridement, then were
   randomly assigned to a course of either oral placebo, metronidazole or
   doxycycline. Patients with seven or more teeth still in need of
   surgery after the first round were treated again with oral
   antibiotics. Patients with six or fewer teeth still needing surgery
   received up to three local treatments in which slow-release films
   containing either placebo, metronidazole or chlorhexidine were placed
   directly into the infected areas around the teeth. After each round,
   individuals with no more surgical needs moved to the maintenance
   phase.
 
   All but two participants showed improvement after the first round of
   treatment. Thirty-nine percent of the patients (10 in the placebo
   group, 25 in the antibiotic group) moved from round one directly to
   the maintenance phase. Retreatment with oral and/or local antibiotics
   eliminated the surgical needs of another 38 patients (42 percent). The
   investigators noted in particular the response of the eight
   participants with 18 or more affected teeth: after debridement plus
   two rounds of oral antibiotic treatment, 78 percent of the teeth
   recommended for surgery or extraction no longer needed it.
 
   When the five treatment rounds were completed, 17 patients (19
   percent) still required some gum surgery or extractions before
   entering the maintenance program. The two patients who did not respond
   to treatment had extreme periodontal conditions -- virtually all
   remaining teeth had been recommended for extraction -- and could not
   be helped by this regimen.
 
   A the outset of the study, 783 teeth had been identified as needing
   extraction or surgery around the tooth. At its conclusion, only 93
   teeth (12 percent) actually needed such treatment. Debridement plus
   the antimicrobial regimens reduced the need for periodontal surgery by
   93 percent, sparing 595 teeth from surgery and decreased by 67 percent
   the need for tooth extraction, saving 95 teeth. Significantly, 81
   percent of the study participants moved to the maintenance phase
   without needing any gum surgery or extractions.
 
   The study also showed that doxycycline and metronidazole were
   comparably effective in reducing the need for gum surgery. The
   investigators preferred metronizadole, however, because of the lower
   risk of developing antibiotic resistance.
 
   Follow-up examinations one year later indicated that the benefits of
   the antimicrobial treatment continued. The research team will follow
   these patients for 5 to 8 years to determine the long-term benefit of
   this nonsurgical approach.
 
   The investigators concluded that debridement plus antimicrobial
   treatment is likely to be successful for most people with advanced gum
   disease for whom surgery is initially recommended. The regimen offers
   a cost-effective alternative to traditional surgical treatment for
   periodontal disease.
 
   These findings were reported in the May issue of the journal Oral
   Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and
   Endodontics. The research was supported by a grant from the National
   Institute of Dental Research, one of the federal National Institutes
   of Health.
 
   Dr. Walter Loesche can be reached through the University of Michigan
   News and Information Service at 313-764-7260.
 
 
     _________________________________________________________________
 
   [LINK] [ Return to News & Publications Page ] [ Return to News &
   Announcements Page ]

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February 2004, Week 1
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January 2004, Week 1
December 2003, Week 5
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December 2003, Week 3
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December 2003, Week 1
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October 2003, Week 5
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March 2003, Week 5
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March 2003, Week 1
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February 2003, Week 1
January 2003, Week 5
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January 2003, Week 1
December 2002, Week 5
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December 2002, Week 3
December 2002, Week 2
December 2002, Week 1
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April 2001, Week 3
April 2001, Week 2
April 2001, Week 1
March 2001, Week 5
March 2001, Week 4
March 2001, Week 3
March 2001, Week 2
March 2001, Week 1
February 2001, Week 4
February 2001, Week 3
February 2001, Week 2
February 2001, Week 1
January 2001, Week 5
January 2001, Week 4
January 2001, Week 3
January 2001, Week 2
January 2001, Week 1
December 2000, Week 5
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December 2000, Week 3
December 2000, Week 2
December 2000, Week 1
November 2000, Week 5
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November 2000, Week 1
October 2000, Week 5
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October 2000, Week 3
October 2000, Week 2
October 2000, Week 1
September 2000, Week 5
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June 2000, Week 5
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February 2000, Week 1
January 2000, Week 5
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January 2000, Week 3
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January 2000, Week 1
December 1999, Week 5
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December 1999, Week 3
December 1999, Week 2
December 1999, Week 1
November 1999, Week 5
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November 1999, Week 3
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November 1999, Week 1
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April 1998, Week 1
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March 1998, Week 3
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March 1998, Week 1
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February 1998, Week 1
January 1998, Week 5
January 1998, Week 4
January 1998, Week 3
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January 1998, Week 1
December 1997, Week 5
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December 1997, Week 3
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December 1995, Week 5
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