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Treatment of Periodontitis

Treatment of Periodontitis. Periodontal therapy - Type1 reduced insulin requirements SRP & systemic tetracyclines - Type2 improved glycemic control reductions in glycated hemoglobin pronounced in poorly controlled diabetics with severe periodontitis Mechanism of action of tetracyclines

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Treatment of Periodontitis

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  1. Treatment of Periodontitis • Periodontal therapy - Type1 • reduced insulin requirements • SRP & systemic tetracyclines - Type2 • improved glycemic control • reductions in glycated hemoglobin • pronounced in poorly controlled diabetics with severe periodontitis • Mechanism of action of tetracyclines • inhibition of MMPs • inhibition of glycation

  2. Studies • Grossi, Genco • Pima and Pueblo Indians • Very high HbA1c >12% • Repeat debridement + CHX, Iodine • no effect • Repeat debridement + 100mg doxy 3 weeks every 6 months or • Repeat debridement + repeat Atridox every 6 months • Modest reduction in HbA1c (~1%)

  3. Therapy with Subantimicrobial-Dose Doxycycline After one year of Periostat therapy Glycated hemoglobin of 7.5 has been achieved

  4. Phase IV Studies Medical - DiabetesDr. Engerbretsen, Columbia University • Does Periostat have an effect on measures of diabetic control? • 3 groups, 10pts / group • Typical hypoglycemic drug regimen • Mean baseline HbA1c 7.9% - 8.3% • SRP alone • SRP + 3 weeks 100mg/day doxy • SRP + 3 months Periostat • Follow up at 1 months and 3 months

  5. Phase IV Studies Medical - DiabetesDr. Engerbretsen, Columbia University • Data analysis suggests: • SRP alone or with 3 weeks of “high dose” doxy had no effect on diabetic control • No change to slight increase in HbA1c • SRP + 3 months Periostat significantly reduced HbA1c • Mean reduction from 7.9% to 6.3% • p < 0.005 vs placebo / p < 0.05 vs “high dose” doxy • Status: • Paper presented at AADR (San Antonio, March 2003)

  6. Phase IV Studies Medical - DiabetesDr. Ciancio, SUNY @ Buffalo Does Periostat have an effect on periodontal outcomes and measures of diabetic control in patients with type 1 and type 2 diabetes? • 2 groups, 10pts / group • SRP alone • SRP + 3 months Periostat • Follow up at 6 weeks and 12 weeks • Clinical measurements • ROS, TNF, IL-2, HbA1c

  7. Phase IV Studies Medical - DiabetesDr. Ciancio, SUNY @ Buffalo • Preliminary data analysis suggests: • SRP + Periostat • Significantly improved clinical parameters (1.7mm and 1.6mm incremental reduction in PD and CAL respectively vs. placebo) • Significantly reduced ROS at 6 weeks and 12 weeks • Significantly reduced IL-2 at 6 weeks • Significantly reduced HbA1c at 12 weeks • 8.5% down to 6.5% • Status: • Paper presented at AADR (San Antonio, March 2003) • Study expanded to include 150 patients and is currently being submitted to J Periodontology for publication.

  8. Summary • Diabetes mellitus has a significant impact on tissues throughout the body, including the oral cavity • Poorly controlled diabetes increases the risk of periodontitis • Periodontal infection/inflammation and treatment can alter glycemic control • Optimal oral health is necessary for improved management of people with diabetes

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