Periodontal disease is one of the most common dentists witness in daily practice. With the large number of people that suffer from periodontitis (an estimated 47% of U.S. adults, and 70% aged 65 and older),1 a comprehensive approach to treatment Is necessary in order to manage the etiological factors and restore the patient to state of oral wellness. While a practitioner can remove plaque biofilm through mechanical therapy (e.g., periodontal debridement), many patients require supplemental measures as well.
One of those methods involves chemotherapeutic agents that are used to eliminate, reduce, or alter the effect of microorganisms in the oral cavity and elevate levels of pro-inflammatory mediators. Many of these chemotherapeutic agents can be used by the patient as an at-home treatment in the form of mouthwashes; other cases require antibiotics. Here are some essentials to know about periodontal disease and chemotherapeutic agents:
- Periodontal diseases are serious chronic infections that involve destruction of the tooth-supporting apparatus, including the gingiva, the periodontal ligament, and alveolar bone.2
- Although plaque is essential for the initiation of periodontal diseases, the majority of the destructive processes associated with these diseases are due to an excessive host response to the bacterial challenge.2
- Research shows that in the right patient, some periodontal diseases can be effectively treated with periodontal debridement (i.e., scaling and root planing or “SRP”) plus systemic antibiotics.3
- The best way to gauge an antibiotic/antimicrobial treatment’s efficacy is to look at the tangible benefits it provides to the patient. Today, periodontists are using systemic antibiotics and locally delivered antimicrobials and observing success. At the same time, the incidence of periodontal surgery is decreasing.3
- Many dental professionals are opposed to using antibiotics and antimicrobials because they believe they can achieve the best results by SRP followed, if necessary, by surgical procedures alone.3
- The use of chemotherapeutic agents is specifically designed to improve the clinical outcomes of mechanical treatments for periodontal diseases and may be particularly useful in the management of individuals with single or multiple risk factors.2
- The need for the development of chemotherapeutic agents is necessary as adjuncts to mechanical debridement since surgical and nonsurgical procedures cannot alone reduce the bacterial effects of periodontal disease completely.2
- Chemotherapeutic agents typically take the form of mouth rinses or dentifrices. Other agents available for the control and treatment of chronic periodontitis, such as locally applied antimicrobials/antibiotics and systemically administered antimicrobials, are reserved for more aggressive cases.4
- Currently, three resorbable, site-specific locally administered antimicrobial/antibiotics products are approved by the FDA for the treatment of chronic periodontitis—minocycline microspheres, doxycycline gel, and chlorhexidine chips)4
- The use of antiseptics, antibiotics, and host modulatory therapy as adjuncts to brushing, ultrasonics, and SRP have made non-surgical therapies more predictable, resulting in improvements in plaque control, pocket depth reductions, clinical attachment levels and bleeding.4
Strategies for the prevention and management of periodontal disease continue to evolve, and those involving mechanical debridement and the adjunct use of chemotherapeutics allow dental professionals to more effectively manage gingivitis and periodontitis. This combination approach can improve plaque control, reduce pocket depth, and improve clinical attachment levels. Re-evaluation of affected patients is key to ensure long-term health and to planning treatment that address the needs of each on an individual, personalized basis.
 Eke PI, Dye BA, Wei L, et al. Relevance of periodontitis in adults in the United States: 2009 and 2010. J Dent Res 2012;91(10):914-920.
 Genco RJ, Williams RC, eds. Periodontal Disease and Overall Health:A Clinician's Guide. Yardley, PA: Professional Audience Communications; 2010.
 Loesche WJ. Treating periodontal diseases as infections. Dimensions of Dental Hygiene. http://www.dimensionsofdentalhygiene.com/2008/06_june/features/treating_periodontal_diseases_as_infections.aspx. Published June 2008. Accessed September 29, 2016. Wilder RS, Ryan ME. Chemotherapeutics in the treatment of periodontal diseases. Dimensions of Dental Hygiene. http://www.dimensionsofdentalhygiene.com/2010/06_june/features/chemotherapeutics_in_the_treatment_of_periodontal_diseases.aspx. Published June 2010. Accessed September 29, 2016.