Effective, safe, practical and affordable periodontal antimicrobial therapy: where are we going, and are we there yet?

Abstract

Several important trends are noticeable in the management of periodontal disease. Searching for specific risk factors for periodontal disease permits therapy planning with the intention of doing less for low-risk patients and increasing the preventive and therapeutic modalities for high-risk patients. Also, significant progress in the area of chemotherapeutic development enables dentists to increase the number of periodontitis patients receiving nondisruptive antimicrobial therapy and decreases the need for surgical treatment. Use of anti-infective chemotherapeutic and antibiotic agents has become a specialized and increasingly effective means of preventing and treating destructive periodontal disease. Local care, including subgingival application of some type of antiseptics, is widely accepted. The use of systemic antibiotics is not routine and should be reserved for aggressive and refractory periodontal infections. In general, it is better to be thoroughly familiar with a limited number of drugs and treatment methods and use them properly than to try to master a plethora of antimicrobial therapies. Combating periodontal infections is best accomplished by combined mechanical and chemotherapeutic efforts of the dental professional and the patient. The trend during recent years has been to treat periodontal infections aggressively, employing short-course antimicrobial therapy using a battery of safe and affordable antimicrobial agents, each exhibiting high activity against various periodontal pathogens and administered in ways to concurrently affect pathogens residing in different oral ecological niches, followed by regular maintenance visits having a strong anti-infective emphasis. At the beginning of therapy, patients should be assigned self-help tasks having maximal antimicrobial effectiveness, with a focus on control of the subgingival periodontopathic microbiota. When patients see positive clinical results from their daily oral hygiene efforts, they are motivated to remain active participants in managing their periodontal condition. This article emphasizes anti-infective periodontal therapies that are effective and, when properly administered, are essentially nontoxic; are widely available around the world to dentists as well as to patients; and are acceptable to most patients in terms of methods of application, supporting oral hygiene efforts and financial costs. We believe that, with improved knowledge of the periodontopathic microbiota, with the availability of microbiological tests to identify periodontal pathogens and optimal therapy, with various safe and affordable yet effective antimicrobial agents and therapies and, eventually, with the development of one or more effective vaccines, the future looks very bright for patients at risk for or suffering from destructive periodontal disease.

In Vivo Killing of Porphyromonas gingivalis by Toluidine Blue-Mediated Photosensitization in an Animal Model

“…There is considerable interest in the use of locally applied antimicrobial agents in the treatment of periodontitis (39). A major advantage of this approach over the systemic administration of such agents is that it minimizes disruption of the normal microflora at other body sites, so helping to avoid opportunistic infections at these sites.…”

“…on May 11, 2018 by guest http://aac.asm.org/ that slowly release agents into the periodontal pocket has been used (28,39). The use of PDT, however, is not beset by such problems, as the photosensitizer needs to be retained in the periodontal pocket for only a short time; this may be minutes or seconds, depending on the power of the laser light delivery system used.…”

Activity of Pradofloxacin against Porphyromonas and Prevotella spp. Implicated in Periodontal Disease in Dogs: Susceptibility Test Data from a European Multicenter Study

“…It is microbial density that is considered critical for the development of gingivitis and some types of chronic periodontitis, while the types of the microorganisms may be of greater importance in the initiation of aggressive periodontitis (41). Indeed, it is now well accepted within the dental research community that periodontal disease results not just from simple accumulation of volume of dental plaque but from the growth and dominance of specific pathological organisms following the development of complex plaque.…”

“…If left untreated, periodontal bacteria may spread to other sites in the body via bacteremia (5,32) and lead to renal, coronary, or hepatic diseases (9,33,39). As virtually all cases of periodontal disease are bacterial disorders, they can be prevented or effectively treated by controlling pathogenic microbes residing in subgingival and supragingival plaque (41). For humans and dogs, the dental practitioner has relied heavily upon mechanical debridement in combating periodontal infections (18,41).…”

“…As virtually all cases of periodontal disease are bacterial disorders, they can be prevented or effectively treated by controlling pathogenic microbes residing in subgingival and supragingival plaque (41). For humans and dogs, the dental practitioner has relied heavily upon mechanical debridement in combating periodontal infections (18,41). There is evidence, however, that additional strategies, including the use of antimicrobials, are necessary to effectively combat periodontal infection, especially in the cases of sites with probing depths exceeding 5 mm (18,36,44).…”