ANN ARBOR—A study by a University of Michigan School of Dentistry researcher shows that some patients with periodontal disease may not need corrective surgery.

U-M Prof. Emeritus Walter Loesche says a five-year study he and several colleagues conducted shows patients may be able to avoid or minimize the need for periodontal surgery and possible tooth extractions by being treated with antibiotics. In the process, patients most likely will be able to lower the cost of their treatment.

“This is the first time a long-term study was conducted that measured the long-term effect of anti-microbial therapy in patients with both aggressive and chronic forms of periodontal disease,” Loesche said. “The results demonstrate that the initial benefits are sustained for periods of at least five years.”

For five years, Loesche and colleagues conducted research on 90 patients at a Detroit hospital who, under normal circumstances, needed periodontal surgery or tooth extractions to correct their periodontal problem. These patients, after initial treatments that included scaling and rooting planning, were given metronidazole or doxycycline to reduce levels of anaerobic bacteria in the mouth.

This treatment resulted in a 93 percent reduction in the need for periodontal surgery for teeth initially recommended for surgery and a 67 percent reduction in the need for extractions in teeth initially recommended for extraction. However, this reduction in surgical needs would be of little value to most patients if the antimicrobial treatment merely postponed the surgical needs to the following year or some point thereafter. The present report followed these patients for five years to determine how long the initial surgery-sparing effect on antimicrobial treatment would last.

About 10 percent of the patients each year failed to return for examinations. After five years, the 44 patients remaining in the study had, on average, only 2.5 teeth needing periodontal surgery or extraction compared to 9.6 teeth per patient that were recommended for surgery or extraction at the beginning of the study, a reduction of nearly 74 percent. The antimicrobial treatment spared about seven teeth per patient from surgery.

Some patients received a one-week supply of metronidazole to take after the one- and two-year check-up examinations. Those who received metronidazole were significantly less likely to need surgery compared to those who received no medication. All patients were offered a schedule of regular follow-up care.

“The benefit of using antibiotics, in combination with regular follow-ups, shows this a win-win benefit for the patient,” Loesche said. “The first is that the patient needs fewer teeth extracted or surgical intervention. The other benefit is the financial savings that result since the patient won’t need labor-intensive surgical treatments. But this treatment is not for everyone with periodontal disease,” he added, “as it was used only in patients where periodontal surgery was recommended.”

Assisting Loesche in the study were Dr. James Giordano at the University of Detroit Mercy School of Dentistry, Dr. Stephen Soehren, clinical associate professor at the U-M School of Dentistry, and Niko Kaciroti, research associate at the U-M School of Public Health. The results of the study appeared in the March issue of the Journal of the American Dental Association.

The U-M School of Dentistry is one of the nation’s leading dental schools engaged in oral health care education, research, patient care, and community service. General dental care clinics and specialty clinics providing advanced treatment enable the School to offer dental services and programs to patients throughout Michigan. Classroom and clinic instruction prepare future dentists, dental specialists, and dental hygienists for practice in private offices, hospitals, academia, and public agencies. Research seeks to discover and apply new knowledge that can help patients worldwide. For more information about the School of Dentistry, visit the Web at http://www.dent.umich.edu.

E-mail: cnewvine@umich.edu

School of DentistryWalter LoeschemetronidazoleDr. James Giordanohttp://www.dent.umich.educnewvine@umich.edu