New SRP Guideline from ADA

SRP is recommended as the initial nonsurgical treatment for people with chronic periodontitis

NEW: Evidence-based clinical practice guideline on nonsurgical treatment of chronic periodontitis

Developed by a panel of experts convened by the American Dental Association Council on Scientific Affairs

How was it done?
A systematic review of 72 research articles that provided data on clinical attachment gain and were at least 6 months in duration.

Why clinical attachment gain?
Clinical attachment is a valid metric and a more stable indicator of periodontal improvement than probing depth reduction or bleeding. Gains in clinical attachment account for about 50% of probing depth reduction.

What was the improvement?
A modest benefit of 0.49 mm net gain in clinical attachment was found. This benefit was found to outweigh any adverse effects like discomfort or sensitivity.

Why wasn't the finding greater?
There are several reasons. Baseline levels of disease were not included in the assessment of mean change. Therefore, it is possible that the value reported may underrepresent the true effect of treatment, especially in deeper pockets. Second, there was inconsistency among the studies in how sites and teeth were assessed. Some included only periodontally involved areas, others the whole mouth. Whole mouth measurements may also lead to an underestimation of the treatment effect.

What about adjunctive therapy?
The panel also reviewed the benefit of adding a variety of different systemic and locally delivered antimicrobials. Systemic subantimicrobial doxycycline provided a small net benefit to the SRP. Locally delivered antimicrobials were lacking in evidence.

What about lasers?
The panel found that there is insufficient evidence on the potential benefits of lasers. This is due to the wide variety available along with multiple protocols for use.

What does this mean for patients?
The panel recommended 'in favor' of SRP as the initial treatment of choice for patients with chronic periodontitis. In favor means that the scientific research favors this intervention. The panel was also in favor of adding systemic subantimicrobial doxycyline to the SRP. For the additional use of locally delivered antimicrobials, the panel found that evidence was lacking, and felt this was a decision left to the expert opinion of the clinician.

Where can I find this guideline?
The guideline is was published in the July issue of JADA, and is on the ADA website

The Waterpik® Water Flosser: An Effective Alternative to Subgingival Antibiotic Treatment for Periodontal Maintenance Patients

30 subjects with moderate to severe periodontal disease received scaling and root planing and were then randomized into two groups. One received minocycline into their deepest periodontal pockets. The second group used a Waterpik® Water Flosser with water once a day.

Both treatment groups experienced a significant improvement in all clinical parameters (bleeding on probing, pocket depth, clinical attachment level) at 30 days. Both procedures appeared to be able to maintain a low bacterial load inside periodontal pockets. The investigators concluded that the Waterpik® Water Flosser is an effective alternative to subgingival antibiotics for periodontal maintenance over a 30 day period.

Genovesi AM et al Minverva Stomatol 2013