The Role of The Role of Pharmacotherapeutics Pharmacotherapeutics in Periodontal Disease in Periodontal Disease
Dec 22, 2015
The Role of The Role of Pharmacotherapeutics in Pharmacotherapeutics in
Periodontal DiseasePeriodontal Disease
Delivery methods?Delivery methods?
• LocalLocal– IrrigationIrrigation– SustainedSustained
• SystemicSystemic– AntimicrobialAntimicrobial– Anti-inflammatoriesAnti-inflammatories
Key PointsKey Points
1.1. Irrigation may help reduce gingivitisIrrigation may help reduce gingivitis
2.2. Sustained release antimicrobials may Sustained release antimicrobials may leverage SC/RPleverage SC/RP
3.3. Systemic antibiotics versus aggressive Systemic antibiotics versus aggressive periodontitisperiodontitis
4.4. NSAIDs may help limit periodontitisNSAIDs may help limit periodontitis
Key PointKey Point
1. Irrigation may help reduce gingivitis1. Irrigation may help reduce gingivitis
How far subgingivally do How far subgingivally do irrigants extend?irrigants extend?
• Supragingivally– only a few millimeters Supragingivally– only a few millimeters at bestat best
• Subgingivally– much moreSubgingivally– much more
Points for consideration:Points for consideration:
• In general, medicaments In general, medicaments > water alone> water alone
• Supragingival and marginal irrigationSupragingival and marginal irrigation
• Subgingival > SupragingivalSubgingival > Supragingival
• Subgingival + SC/RP about the same as Subgingival + SC/RP about the same as SC/RP aloneSC/RP alone
Key PointKey Point
2. Sustained release antimicrobials may 2. Sustained release antimicrobials may leverage SC/RPleverage SC/RP
• May produce marginal improvements in:May produce marginal improvements in:– Attachment levelsAttachment levels– Probing depthsProbing depths– Gingival bleedingGingival bleeding
Criteria for antibiotic use are Criteria for antibiotic use are not well developednot well developed
• Tested only in adult periodontitisTested only in adult periodontitis• Risks and benefits of routine use are uncertainRisks and benefits of routine use are uncertain• Side effects to be consideredSide effects to be considered
– disconfortdisconfort
– erythemaerythema
– recessionrecession
– allergyallergy
• Re-treatment implications uncertainRe-treatment implications uncertain
Key PointKey Point
3. Systemic antibiotics indicated for
• Acute infections
• Early onset periodontitis
• Refractory periodontitis
Typical antibiotics used against Typical antibiotics used against periodontitisperiodontitis
Tetracycline-Hcl 500mg/TID/21days
Metronidazole 500mg/TID/8days
Ciprofloxacin 500mg/BID/8days
Metronidazole & Amoxicillin
250mg/TID/8days of each drug
Metronidazole & Ciprofloxacin
500mg/BID/8days of each drug
ConsiderationsConsiderations for use: for use:
• Resistant bacterial strainsResistant bacterial strains
• Implications for re-treatmentImplications for re-treatment– intervalsintervals– dosagedosage– durationduration– drug choicedrug choice