What do systematic reviews say?

Periodontal treatment (scaling and root planing, alone or with antimicrobials) vs Alternative (less intensive) periodontal treatment, alone or with placebo

Periodontal treatment (scaling and root planing, alone or with… led to lower bleeding on probing compared with alternative (less intensive) periodontal treatment, alone or with…; GRADE not reported.

• Treating periodontal disease for preventing adverse birth outcomes in pregnant women 2017 · Cochrane All outcomes
  MD -28.00 [-38.54, -17.46]
  1 study · 53 participants
  GRADE not reported

Adjunctive antimicrobial photodynamic therapy (aPDT) applied after submucosal instrumentation (SI) vs Submucosal instrumentation (SI) alone, or SI plus placebo/sham aPDT

Adjunctive antimicrobial photodynamic therapy (aPDT) applied after… led to higher change in bleeding on probing (BOP) compared with submucosal instrumentation (SI) alone, or SI plus placebo/sham aPDT; GRADE not reported.

• Adjunctive antimicrobial photodynamic therapy for treating periodontal and peri‐implant diseases 2024 · Cochrane All outcomes

  3 months (change from baseline)
  MD 1.60 [0.27, 2.93]
  1 study · 38 participants
  GRADE not reported

Adjunctive antimicrobial photodynamic therapy (aPDT) applied after subgingival instrumentation (SI) vs Subgingival instrumentation (SI) alone (hand or power-driven, or both), or SI plus placebo/sham aPDT

Adjunctive antimicrobial photodynamic therapy (aPDT) applied after… showed no clear difference in change in bleeding on probing (BOP) compared with subgingival instrumentation (SI) alone (hand or power-driven, or…; GRADE not reported.

• Adjunctive antimicrobial photodynamic therapy for treating periodontal and peri‐implant diseases 2024 · Cochrane All outcomes

  3 months (change from baseline)
  MD 2.38 [-1.34, 6.10]
  5 studies · 231 participants
  GRADE not reported
• Adjunctive antimicrobial photodynamic therapy for treating periodontal and peri‐implant diseases 2024 · Cochrane All outcomes

  6 months (change from baseline)
  MD 4.98 [-2.51, 12.46]
  3 studies · 127 participants
  Very low

Adjunctive antimicrobial photodynamic therapy (aPDT) applied after subgingival instrumentation (SI) vs Subgingival instrumentation (SI) alone (hand or power-driven, or both), or SI plus placebo/sham aPDT

It is very uncertain whether adjunctive antimicrobial photodynamic therapy (aPDT) applied after… changes change in bleeding on probing (BOP) compared with subgingival instrumentation (SI) alone (hand or power-driven, or… (very low certainty).

• Adjunctive antimicrobial photodynamic therapy for treating periodontal and peri‐implant diseases 2024 · Cochrane All outcomes

  6 months (change from baseline)
  MD 5.72 [1.62, 9.81]
  5 studies · 171 participants
  Very low
• Adjunctive antimicrobial photodynamic therapy for treating periodontal and peri‐implant diseases 2024 · Cochrane All outcomes

  3 months (change from baseline)
  MD 2.19 [1.00, 3.38]
  11 studies · 282 participants
  GRADE not reported

Periodontal treatment (scaling and root planing, polishing, or surgery), alone or with oral hygiene counselling, antiseptics, or antimicrobials vs no treatment

• Treating periodontal disease for preventing adverse birth outcomes in pregnant women 2017 · Cochrane All outcomes
  Reported as a secondary periodontal outcome (Analysis 1.9); results not meta-analysed due to considerable heterogeneity (I2 91% to 100%); reduction in favour of periodontal treatment.
  6 studies
  GRADE not reported

Periodontal treatment (subgingival instrumentation, with or without antimicrobials/surgery) vs usual care or no treatment

Periodontal treatment (subgingival instrumentation, with or without… led to lower bleeding on probing (BOP) compared with no active intervention/usual care; GRADE not reported.

• Treatment of periodontitis for glycaemic control in people with diabetes mellitus 2022 · Cochrane All outcomes

  3-4 months
  MD -15.56 [-21.77, -9.36]
  14 studies
  GRADE not reported

Mechanical debridement plus local antimicrobial (minocycline microspheres or doxycycline gel) vs Mechanical debridement alone

It is very uncertain whether mechanical debridement plus local antimicrobial (minocycline… changes bleeding on probing (ratios) compared with mechanical debridement alone (very low certainty).

• Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis 2018 · Cochrane All outcomes

  12 months
  OR 0.45 [0.14, 1.52]
  1 study · 50 participants
  Very low

Azithromycin + SRP vs SRP

Azithromycin + SRP led to lower percentage of bleeding on probing (BOP) compared with SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -3.32 [-6.23, -0.42]
  6 studies · 228 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  MD -1.28 [-4.32, 1.76]
  2 studies · 110 participants
  Very low
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -3.18 [-7.01, 0.65]
  6 studies · 216 participants
  GRADE not reported

Amoxicillin + clavulanate + SRP vs SRP

It is very uncertain whether amoxicillin + clavulanate + SRP changes percentage of bleeding on probing (BOP) compared with SRP (very low certainty).

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  MD 0.00 [-0.09, 0.09]
  1 study · 21 participants
  Very low
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -0.10 [-0.19, -0.01]
  1 study · 21 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -0.10 [-0.19, -0.01]
  1 study · 21 participants
  GRADE not reported

Doxycycline + SRP vs Metronidazole + SRP

Doxycycline + SRP showed no clear difference in percentage of bleeding on probing (BOP) compared with metronidazole + SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -0.05 [-0.22, 0.12]
  1 study · 22 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  Included studies have not reported this outcome
  Studies not reported
  No studies found
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -0.07 [-0.29, 0.15]
  1 study · 22 participants
  GRADE not reported

Metronidazole + SRP vs SRP

It is very uncertain whether metronidazole + SRP changes percentage of bleeding on probing (BOP) compared with SRP (very low certainty).

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  MD -6.90 [-22.10, 8.30]
  1 study · 22 participants
  Very low
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -9.00 [-16.59, -1.40]
  4 studies · 108 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -4.62 [-18.83, 9.58]
  2 studies · 45 participants
  GRADE not reported

Amoxicillin + metronidazole + SRP vs SRP

Amoxicillin + metronidazole + SRP led to lower percentage of bleeding on probing (BOP) compared with SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -2.05 [-2.98, -1.11]
  13 studies · 460 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -5.32 [-12.02, 1.37]
  5 studies · 172 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  MD -8.06 [-14.26, -1.85]
  2 studies · 389 participants
  Very low

Clindamycin + SRP vs SRP

The review found no eligible studies for this question.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  Included studies have not reported this outcome
  Studies not reported
  No studies found

Levofloxacin + SRP vs SRP

Levofloxacin + SRP showed no clear difference in percentage of bleeding on probing (BOP) compared with SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -1.38 [-3.30, 0.54]
  2 studies · 131 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -0.93 [-2.88, 1.02]
  2 studies · 131 participants
  GRADE not reported

Clarithromycin + SRP vs SRP

Clarithromycin + SRP led to lower percentage of bleeding on probing (BOP) compared with SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -4.70 [-8.42, -0.98]
  1 study · 40 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -3.00 [-6.69, 0.69]
  1 study · 40 participants
  GRADE not reported

Cefixime + SRP vs SRP

Cefixime + SRP led to lower percentage of bleeding on probing (BOP) compared with SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -0.48 [-0.60, -0.37]
  1 study · 60 participants
  GRADE not reported

Doxycycline + SRP vs SRP

Doxycycline + SRP showed no clear difference in percentage of bleeding on probing (BOP) compared with SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -0.01 [-0.21, 0.19]
  1 study · 21 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Long-term (≥ 1 year)
  Included studies have not reported this outcome
  Studies not reported
  No studies found
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD -0.09 [-0.29, 0.11]
  1 study · 21 participants
  GRADE not reported

Amoxicillin + metronidazole + SRP vs Clarithromycin + SRP

Amoxicillin + metronidazole + SRP showed no clear difference in percentage of bleeding on probing (BOP) compared with clarithromycin + SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD 4.00 [-1.09, 9.09]
  1 study · 46 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD 5.40 [-0.12, 10.92]
  1 study · 46 participants
  GRADE not reported

Amoxicillin + clavulanate + SRP vs Tetracycline + SRP

Amoxicillin + clavulanate + SRP showed no clear difference in percentage of bleeding on probing (BOP) compared with tetracycline + SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD -1.60 [-14.03, 10.83]
  1 study · 8 participants
  GRADE not reported

Metronidazole + SRP vs Amoxicillin + metronidazole + SRP

Metronidazole + SRP showed no clear difference in percentage of bleeding on probing (BOP) compared with amoxicillin + metronidazole + SRP; GRADE not reported.

• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Short-term (≤ 3 months)
  MD 4.46 [-23.48, 32.40]
  3 studies · 84 participants
  GRADE not reported
• Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis 2020 · Cochrane All outcomes

  Intermediate-term (> 3 months to < 1 year)
  MD 20.85 [3.31, 38.39]
  1 study · 22 participants
  GRADE not reported