Xu Xinran, He Lu, Huo Pengcheng, Jin Dongsiqi, Zhu Yunxuan, Lu Hongye, Meng Huanxin
Department of Periodontology, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China.
Third Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China.
J Dent Sci. 2025 Jul;20(3):1470-1479. doi: 10.1016/j.jds.2025.01.014. Epub 2025 Jan 28.
BACKGROUND/PURPOSE: Adjunctive use of systemic antibiotics has more clinical improvement than scaling and root planing alone in stage III-IV periodontitis patients with type 2 diabetes mellitus (T2DM). There is still no study that concentrate on dynamic changes in oral microbiota by high throughput sequencing technique with the treatment regimen including adjunctive antibiotics.
Thirty-two periodontitis patients with T2DM who received non-surgical periodontal treatment (NSPT) in the previously published randomized trial were selected for microbiological analysis. Seventeen subjects in the test group received scaling and root planing (SRP) and antibiotics (500 mg of amoxicillin [AMX], and 200 mg of metronidazole [MTZ], three times daily for seven days). Fifteen subjects in the control group received SRP only. Examination of periodontal and hematological parameters, cytokines in serum and gingival crevicular fluid, and collection of subgingival plaque was taken at baseline and three months after treatment. The V3-V4 region of 16S DNA was sequenced, and taxonomic assignment was based on the Human Oral Microbiome database.
Both the test and the control group showed lower richness and diversity for subgingival microbiota after treatment. The distribution of subgingival microbial composition was different between the baseline and 3 months in both groups. The subgingival microbial dysbiosis index decreased significantly in both groups at 3 months, and 8 out of 12 dysbiotic discriminatory genera decreased significantly in the test group. The relative abundance of the red complex, and decreased more in the test group than that in the control group. The decrease of clinical periodontal parameters was positively correlated with the decline of and , and negatively correlated with the increase of and HbA1c level decrease was positively related to the changes of and .
NSPT could significantly change the oral microbiome towards healthy status in patients with stage III-IV periodontitis and diabetes. AMX + MTZ had more advantages in the decrease of periodontal pathogens. Periodontists should cautiously use the antibiotics to treat such patients.
背景/目的：在患有2型糖尿病（T2DM）的III-IV期牙周炎患者中，全身应用抗生素辅助治疗比单纯进行龈下刮治和根面平整术能带来更多临床改善。目前尚无研究通过高通量测序技术关注包含抗生素辅助治疗方案下口腔微生物群的动态变化。
选取先前发表的随机试验中接受非手术牙周治疗（NSPT）的32例T2DM牙周炎患者进行微生物学分析。试验组17例受试者接受龈下刮治和根面平整术（SRP）及抗生素治疗（500mg阿莫西林[AMX]和200mg甲硝唑[MTZ]，每日3次，共7天）。对照组15例受试者仅接受SRP治疗。在基线和治疗后3个月检查牙周和血液学参数、血清及龈沟液中的细胞因子，并收集龈下菌斑。对16S DNA的V3-V4区域进行测序，基于人类口腔微生物组数据库进行分类。
治疗后试验组和对照组龈下微生物群的丰富度和多样性均降低。两组基线和3个月时龈下微生物组成分布不同。两组在3个月时龈下微生物失调指数均显著降低，试验组12个失调鉴别属中的8个显著降低。试验组中红色复合体的相对丰度降低幅度大于对照组。临床牙周参数的降低与和的下降呈正相关，与和的增加呈负相关。糖化血红蛋白（HbA1c）水平降低与和的变化呈正相关。
NSPT可使III-IV期牙周炎合并糖尿病患者的口腔微生物群显著向健康状态转变。AMX+MTZ在减少牙周病原体方面更具优势。牙周病医生应谨慎使用抗生素治疗此类患者。
