Refractory periodontal diseases are characterized by continued degeneration of the periodontium despite adequate sanative, surgical, and/or pharmacological therapy. Pilot data suggest that such patients might have elevated CD4 counts and are ‘hyperimmune'. We used a combination of subantimicrobial dose doxycycline (20 mg/BID; Periostat®) and low-dose flurbiprofen (50 mg/day) in this population. Objectives of this pilot study were to confirm earlier CD4 data and to evaluate the effectiveness of Periostat®/flurbiprofen treatment.
Methods:
Patients were recruited from the Severe/Refractory Periodontal Disease Research Unit at the Faculty of Dentistry, University of Toronto. Patients had radiographic evidence of progressive bone loss and at least 30% of sites demonstrated attachment loss of > 5mm with two sites being > 6mm. Attachment levels were calculated. Gingival crevicular fluid (GCF) and microbial samples were taken from 4 sites depths > 6mm to identify putative periodontal pathogens and to assay with IL-1B levels. Whole blood samples were taken to identify CD4+ and CD8+ levels. All tests were done before and then after patients were treated with the Periostat®/flurbiprofen regimen, with samples being taken every 4 months.
Results:
18 patients (56 observations) had refractory disease. Mean CD4 levels in patients were: CD4+ = 52.7% and CD8+=20.0%. Thirteen of 18 subjects presented with CD4+ levels > 52.0% (upper range of normal); the measurements spanning 32.6% to 64.5%. CD8+ counts generally fell within a normal range. Very low levels of putative periodontal pathogens were identified. For patients treated with Periostat®/flurbiprofen, a clinically significant reduction in probing depth and increases attachment levels were noted.
Conclusions:
T-cell counts, particularly CD4+ levels, are elevated albeit within normal range in patients suffering from refractory periodontitis as compared to normals. These values weren't changed during treatment. Marked clinical improvements were noted in patients with refractory periodontitis who were placed on Periostat®/flurbiprofen.