Influence of Antibiotics and Non-steroidal Anti-inflammatory Drugs on Matrix Metalloproteinase-8 Levels in Smokers with Chronic Periodontitis Thesis

Abstract

Introduction Periodontal diseases are the most common reason for losing teeth. Some factors as diabetes, smoking, old age and other genetic factors affects the etiology and progression of the disease. Aim of the study: To investigate the efficiency of NSAIDs and Amoxicillin, Metronidazole combination as an adjunct to scaling and root planing on matrix metalloprotinease 8 MMP-8 levels in GCF samples from smokers with chronic periodontitis. Patients and methods: Patients were selected having no diabetes or any other diseases causing periodontitis Patients were divided into 4 groups, each group contain 15 patients, smokers and having chronic periodontitis.

Group 1: (Smokers with chronic periodontitis) GCF sample were taken from deepest pocket, patients were instructed to take systemic Amoxicillin 500mg every 8 hours (Amoxil (R) [1]) and 250mg metronidazole every 8 hours for 7 days (flagyl)(R) [2]. Full mouth scaling and root planing using ultrasonic scaler and hand instruments under local aneathesia to minimize patient discomfort were performed, oral hygiene instructions was reinforced after therapy. Group 2:(Smokers with chronic periodontitis) GCF sample were taken from deepest pocket, patients were instructed to take systemic NSAIDS (ibuprofen) (Brufen)(R)[3]. 400 g every 8 hours for 10 days. Full mouth scaling and root planing using ultrasonic scaler and hand instruments under local aneathesia to minimize patient discomfort scaling and root planing were performed, oral hygiene instructions was reinforced after therapy.

Group 3: (Smokers with chronic periodontitis) GCF sample were taken from deepest pocket, patients were instructed to take systemic NSAID (ibuprofen) 400 g every 8 hours for 10 days (brufen) + systemic Amoxicillin 500mg every 8 hours and 250mg metronidazole every 8 hours for 7 days. Full mouth scaling and root planing using ultrasonic scaler and hand instruments under local aneathesia to minimize patient discomfort scaling and root planing were performed, oral hygiene instructions was reinforced after therapy. Group 4: smokers with chronic periodontitis GCF sample were taken from deepest pocket, Full mouth scaling and root planing using ultrasonic scaler and hand instruments under local aneathesia to minimize patient discomfort scaling and root planing were performed, oral hygiene instructions were reinforced after therapy Duration of study 6 months: After 3 months, clinical measurments and GCF samples were obtained again from the study sites in all groups. And then after another 3 months at the end of the study. In order to determine the periodontal condition, a full periodontal evaluation was made for each patient in all groups including the following clinical parameters: - Plaque index (Sillness and Loe, 1964). - Probing depth using william graduated periodontal probe (Martin) (Caton, 2011). - Clinical attachment level. Gingival Crevicular Fluid samples were collected from the deepest pocket using periopaper strips. The levels of MMP-8 in GCF samples was assayed using ELISA kit. All results will be subjected to stastical analysis and comparison. All tha data will be kept confidential. Conclusion: We concluded that: 1- The mean MMP 8 level in GCF was found to be lowest in group3 (treated with AMOXYCILLIN+METRONIDAZOLE combination and Ibuprofen) after 6 months treatment. 2- The mean MMP 8 level in GCF was found to be highest in group 4 (treated only with scaling and root planing) after 6 months treatment. 3- Regarding MMP 8 levels in GCF, all groups showed decrease in value through the follow up period. 4- Finally, MMP8 is positively related to clinical indicators and levels of gingival inflammation and therefore can be used as an inflammatory marker for periodontal disease. 5- The frequency and potential consequences of the unwanted systemic effects of antibiotics have to be balanced against the potential benefit of antibiotics. To limit the development of microbial antibiotic resistence, in general, and to avoid gastrointestinal intolerance and antibiotic hypersenstivity a preacationary restrictive attitude toward using antibiotics has been recommended. 6- The use of antimicrobials adjunctive to SRP should be carefully considered and limited to patients with a hgh risk for disease progression as smokers.