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