The clinical, microbiological and systemic characteristics of periodontitis and their changes after periodontal therapy

The aim of this thesis was to study 1. the relationship between periodontitis and systemic conditions and 2. the effect of 4 periodontal treatment modalities on clinical and microbiological periodontal parameters as well as systemic conditions. Our results showed that periodontitis is associated with a prothrombotic state, a condition involved in the development of cardiovascular diseases. In particular alveolar bone loss and the host immune response to two established periodontal pathogenic bacteria were associated with markers of prothrombotic state. In the randomized clinical trial the four treatment modalities included basic periodontal therapy (scaling, root planing and oral hygiene measures) with or without support of a local sodium hypochlorite (NaOCl) as well as with or without using systemic antibiotics (amoxicillin and metronidazole). Analysis of the results showed that basic periodontal therapy alone remains the first choice for the treatment of periodontitis. The baseline microbial composition may have predictive value for the clinical outcome. Adjunctive use of local disinfection with NaOCl to basic periodontal therapy does not contribute to an improvement in the clinical and microbiological parameters of periodontitis. Adjunctive use of antibiotics could be used to improve the periodontal clinical outcome of basic periodontal therapy. Patients participating in this trial were selected on the basis of absence of known comorbidities. However, results showed that at baseline 27% fulfilled the criteria of metabolic syndrome. Periodontal treatment resulted in a decrease of the systolic blood pressure and of triglycerides. This implies that improving periodontal health can lead to an improvement of metabolic status.