Effect of adjunctive systemic azithromycin with periodontal surgery in the treatment of chronic periodontitis in smokers: a pilot study.

BACKGROUND: Along with conventional surgical therapy, systemic antibiotics may provide more effective treatment in smokers by targeting tissue-invasive bacteria. The aim of this randomized, placebo-controlled, double-masked clinical trial was to evaluate the adjunctive effects of systemic azithromycin (AZM) in combination with periodontal pocket reduction surgery in the treatment of chronic periodontitis in smokers. METHODS: Thirty patients with a greater than one pack/day smoking habit and generalized moderate to severe chronic periodontitis were randomized to the test (surgery plus 3 days of AZM, 500 mg) or control group (surgery plus 3 days of placebo). Full-mouth probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI), plaque index, and wound healing indices (WHI) were assessed at baseline and at 2 weeks and 1, 3, and 6 months following surgical intervention. Plaque and gingival crevicular fluid were collected for trypsin-like enzyme activity (benzoyl-dl-arginine naphthylamine) and bone biomarker (crosslinked telopeptide of type I collagen [ICTP]) analyses, respectively, at baseline, 2 weeks, and 1, 3, and 6 months. RESULTS: Surgical treatment of moderate (PD = 4 to 6 mm) and deep (PD > 6 mm) pockets significantly improved clinical parameters of treated and untreated teeth (CAL gain, PD reduction, and reduction of BOP). The additional use of AZM did not enhance this improvement nor did it promote reduction of ICTP levels. Compared to the control group, the test group had significantly better WHI scores at 1 month, significantly less GI at 2 weeks, and sustained reductions of red-complex bacteria with trypsin-like enzyme activity at 3 months. For non-surgery teeth, only the test group showed significant gains in overall CAL compared to baseline. CONCLUSIONS: The findings of this pilot study demonstrated that in heavy smokers, adjunctive systemic AZM in combination with pocket reduction surgery did not significantly enhance PD reduction or CAL gain. However, the clinical value of adjunctive AZM may be appreciated by more rapid wound healing, less short-term gingival inflammation, and sustained reductions of periopathogenic bacteria. More expanded studies are recommended to better determine the clinical effects of adjunctive AZM in patients who smoke.

A review of the current literature on aetiology and measurement methods of halitosis.

OBJECTIVES: This work reviews the current knowledge of aetiology and measurement methods of halitosis. DATA: Halitosis is an unpleasant or offensive odour emanating from the breath. The condition is multifactorial and may involve both oral and non-oral conditions. SOURCES: A private, monthly with keywords halitosis, malodo(u)r, (a)etiology, measurement, and management from Medline and Pubmed updated database of literature was reviewed. CONCLUSIONS: In approximately 80-90% of all cases, halitosis is caused by oral conditions, defined as oral malodour. Oral malodour results from tongue coating, periodontal disease, peri-implant disease, deep carious lesions, exposed necrotic tooth pulps, pericoronitis, mucosal ulcerations, healing (mucosal) wounds, impacted food or debris, imperfect dental restorations, unclean dentures, and factors causing decreased salivary flow rate. The basic process is microbial degradation of organic substrates. Non-oral aetiologies of halitosis include disturbances of the upper and lower respiratory tract, disorders of the gastrointestinal tract, some systemic diseases, metabolic disorders, medications, and carcinomas. Stressful situations are predisposing factors. There are three primary measurement methods of halitosis. Organoleptic measurement and gas chromatography are very reliable, but not very easily clinically implemented methods. The use of organoleptic measurement is suggested as the 'gold standard'. Gas chromatography is the preferable method if precise measurements of specific gases are required. Sulphide monitoring is an easily used method, but has the limitation that important odours are not detected. The scientific and practical value of additional or alternative measurement methods, such as BANA test, chemical sensors, salivary incubation test, quantifying beta-galactosidase activity, ammonia monitoring, ninhydrin method, and polymerase chain reaction, has to be established.