Subset Analysis by Smoking Status with Arestin® in Periodontitis Therapy
Howard E. Strassler, DMD
Grossi S, Goodson JM, Bland P, et al. J Dent Res. 2006;85(special issue A). Abstract 1145.
Abstract
OBJECTIVE: To analyze the antimicrobial and clinical effects of Arestin® (minocycline hydrochloride) microspheres, 1 mg, as an adjunct to scaling and root planing (SRP) in relation to smoking status. METHODS: This was a phase IV, multi-center, randomized clinical trial of patients (N = 127) with moderate to advanced periodontitis, defined as 5 sites with pocket depth (PD) 5 mm. Patients were stratified as current (N = 37), former (N = 44), and never smoking (N = 46) and randomly assigned to either SRP alone (N = 65) or minocycline HCl microspheres + SRP (A + SRP) (N = 62). Primary end points were change in numbers of red complex bacteria ([RCB], Porphyromonas gingivalis, Tannerella forsythensis, and Treponema denticola) from baseline to day 30. Secondary end points included changes in PD and bleeding on probing (BOP). RESULTS: Numbers of RCB were reduced in all groups except in current smokers treated with SRP. A + SRP reduced RCB numbers in all smoker groups to a greater degree than SRP alone. This reduction was significantly greater in current smokers (P < .02). PD reduction for A + SRP and SRP alone in current smokers was 1.28 ± 0.13 and 0.86 ± 0.15, respectively (P < .05) and in never smokers was 1.40 ± 0.09 and 1.06 ± 0.14, respectively. Factorial analysis indicates that A + SRP significantly increases PD reduction relative to SRP alone (P < .05). BOP reduction for A + SRP and SRP alone in current smokers was 36.49 ± 8.99 and 11.23 ± 4.25, respectively (P < .05). CONCLUSIONS: SRP was ineffective at reducing RCB numbers in current smokers. A + SRP significantly improved the reduction of RCB numbers in current smokers. In addition, A + SRP resulted in greater PD reduction and decreased BOP in current smokers compared with SRP alone.
COMMENTARY
Smoking is an addictive behavior that is difficult to change. Drug companies have developed nicotine-based aids to help people quit smoking, but the success rate for stopping is still very low. Smoking has been shown to be a significant contributory factor to the inflammatory processes of periodontitis and gingivitis.
This study (the examiner was blinded to the study group and all treatments were administered by a separate clinician) investigated the antimicrobial and clinical efficacy of minocycline HCl microspheres (Arestin®, OraPharma, Inc, Warminster, PA) as an adjunct to scaling and root planing (SRP) for patients with moderate to advanced periodontitis. The patients were between 30 to 65 years old and the exclusionary criteria included no serious systemic illness, no periodontal therapy within the previous 3 months (excluding maintenance therapy), and no past history of local or systemic antibiotic therapy. This is a well-conceived and executed study that provides important information. SRP was ineffective in reducing the bacteria tested, whereas Arestin reduced the bacterial counts for the patients that smoked. Also, using the minocycline HCl microspheres + SRP was more effective than SRP alone regardless of smoking status. Smoking reduced the antimicrobial and clinical effects of SRP.
For patients who are smokers with significant periodontal disease, the use of SRP combined with localized antibiotic therapy using minocycline HCl microspheres is the preferred therapy. Patients should be informed of this improved benefit of combined therapy so that they can value the treatment being provided to them. Lastly, consider implementing a smoking cessation program within your dental practice as part of your overall approach to good dental health.
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Howard E. Strassler, DMD |
