Systemic Doxycycline as an Adjunct to Scaling and Root Planing in Diabetic Patients With Periodontitis

A Systematic Review and Meta-analysis

Kenneth Chou Hung Yap; Shaju Jacob Pulikkotil

Disclosures

BMC Oral Health. 2019;19(209) 

In This Article

Background

Periodontitis is a chronic inflammatory disease which leads to progressive destruction of the periodontium and tooth loss.[1] Removal and control of the accumulation of the plaque biofilm is the mainstay of periodontal treatment.[2] Scaling and root planing (SRP) is the mechanical removal of plaque, calculus and diseased cementum. Some patients might still encounter constant loss of attachment because of the failure of scaling and root planing to reduce or eliminate periodontal microorganisms to achieve health even after thorough SRP.[3] Some bacteria are likely to get away from host defenses after non-surgical periodontal therapy due to restricted means of entry to the root surface and the tissue-invading abilities of the pathogens.[4] This raises the question of the effectiveness of SRP due to the bacteria residue in the tissues and also the inadequate plaque control of each patient.[5] To battle this phenomenon, a variety of antibiotics were used as adjunctive therapy to enhance the treatment outlook of SRP.[6] Systemic doxycycline have been long used as an adjunct to supplement the effect of scaling and root planing.[7]

A substantially larger increase in CAL in diabetic patients with periodontitis who were given systemic doxycycline were seen as compared to without doxycycline after 3 months.[8,9] These outcomes shows that there is a better resolution of periodontal lesions when patients are given systemic doxycycline as compared to just SRP. On the contrary, other studies showed results that are contradictory to the previous results stating that there is no significant increase in CAL in the group that has received SRP with systemic doxycycline as compared to the group of patients treated with SRP after 3 months.[10] In terms of HbA1c levels, some studies suggested that there is a marked reduction in HbA1c levels in group with SRP with systemic doxycycline as compared to the control group which only had SRP. On the other hand, Promsudthi et al. and O'Connell et al. was not able to show a marked reduction in HbA1c levels when test group (SRP with doxycycline) and control group (SRP only) were compared to each other after 3 months.[9,10] There is a need to identify the efficacy of the systemic doxycycline in improving the periodontal health and glycemic control in diabetic patients with periodontitis given the lack of concrete evidence to show improved metabolic control and periodontal status when systemic doxycycline is used as an adjunct to scaling and root planing. This review based on a systematic search will identify the eligible studies and analyse data to determine the efficacy of systemic doxycycline as an adjunct to scaling and root planing in diabetic patients with periodontitis.

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