This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.We hypothesize first that the clinical and microbiological benefits resulting from scaling and root planing (SRP) will be enhanced by either systemically administered metronidazole, repeated professional plaque removal, or both, and second that the combination of the adjunctive therapies will have greater clinical and microbiological benefit than either adjunct alone, and that these changes will be sustained for a longer period of time.Complex microbial ecosystems exist on tooth surfaces both above and below the gingival margin. These biofilms (plaques) can adversely affect their habitat both locally in terms of dental caries and periodontal disease and perhaps systemically in terms of increased risk of cardiovascular disease and lung infectionMetronidazole is attractive for the treatment of adult periodontitis patients in part because of the narrow spectrum within which this agent is thought to work -- specifically on the anaerobes associated with periodontal diseases. Our data and the literature suggest that metronidazole may be the antibiotic of choice to be used in conjunction with other treatments to control specific pathogenic segments of the subgingival microbiota.Four groups of forty-four subjects (N=176) with adult periodontitis will be enrolled. The study will evaluate the effects of four periodontal treatments: 1.) Scaling and root planing (SRP) plus placebo; 2.) SRP plus metronidazole; 3.) SRP plus cleaning; 4.) SRP plus metronidazole plus cleaning. Subjects will be clinically monitored and plaque samples taken at baseline, 3, 6, 12, 18, and 24 months.
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