This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. This double blind, placebo controlled, randomized study will compare three treatment strategies for periodontal infections in smokers and non-smokers. A conventional periodontal therapy, scaling and root planing (SRP), will be compared with two more aggressive antibacterial therapies: 1. SRP plus systemically administered metronidazole, and 2. SRP plus systemically administered metronidazole, amoxicillin, and locally administered doxycycline. Changes in clinical and microbiological parameters will be evaluated, together with serum antibody levels to specific subgingival species, and levels of cytokines in gingival crevicular fluid (GCF). Three groups of adult periodontitis subjects, divided equally into smokers and non-smokers, will be evaluated. All patients will have a detailed clinical dental examination and a series of subgingival plaque samples taken. Subjects will provide samples of GCF, blood, and saliva at baseline, and a separate saliva sample at 14 days. All subjects will receive SRP and will be assigned to one of the three treatment groups described above. Subjects will be clinically and microbiologically monitored periodically for 2 years after initial SRP. Maintenance SRP will be given every 3 months. The primary outcome variables are changes in pocket depth and attachment level for each subject and prevalence of the 'red complex' species (T. forsythensis, P. gingivalis, T. denticola) as measured by the percent of sites colonized by these species in each subject before and at different time points post-therapy. The primary outcomes will be long and short term treatment results for current cigarette smokers.
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