Periodontal treatment

Although the mechanical periodontal treatment alone is adequate to ameliorate or resolve the clinical condition in most cases, adjunctive antimicrobial agents, delivered either systemically or locally, can enhance the effect of therapy. In this connection, two recent meta-analyses [60, 61] have shown that systemic antimicrobials in conjunction with SRP can offer an additional benefit over SPR alone in the treatment of periodontitis both in terms of change in the clinical attachment level and probing pocket depth. When examining the effect of individual antibiotics, it was found that there were statistically significant improvements in clinical attachment level with tetracy-... 

Wilson J and Low S (1992) Bioactive ceramics for periodontal treatment comparative studies in the patus monkey. J Appl Biomater 3 123-129. 

Monsarrat P, et al. Effect of periodontal treatment on the clinical parameters of patients with rheumatoid arthritis study protocol of the randomized, controlled ESPERA triaL Trials. 2013 14 253. 

No.22, Nov.2002, p.4397-404 DEVELOPMENT AND APPLICATIONS OF INJECTABLE POLYORTHO ESTERS FOR PAIN CONTROL AND PERIODONTAL TREATMENT Heller J Barr J Ng S Y Shen H-R Schwach-Abdellaoui K Gumy R Vivien-Castioni N Loup P J Baehni P Mombelli A AP Pharma Geneva,University... 

S5 BG -500 40-60 30-50 0.5-1.0 5.75 Middle ear device, tooth root replacement, periodontal treatment, maxUla-facial reconstruction, bone defect filler [13,50,68]... 

Disinfectant Formulations and Sterilization. Hundreds of appHcations covering disinfectant compositions using sodium chlorite have been described in U.S. and foreign patents. Some examples of these are as antimicrobial additives for latexes (166), marine antifouling agents (see Coatings, marine) (167,168), antimildew detergent compositions (169), toothpaste and solution compositions for prevention and treatment of periodontal oral disease (see Dentifrices) (170—172), and compositions for the disinfection of contact lenses (qv) (173). 

Ghlorhexidine Gluconate. Chlorhexidine gluconate [18472-51 -0] (l,l -hexamethylene bis[5-(p-chlorophenyl) biguanide] di-D-gluconate) is used as an antimicrobial against both aerobic and anaerobic bacteria ia the oral cavity. It is used as a therapeutic supplement ia the treatment of gingivitis, periodontal disease, and dental caries. A mouth riase form is available as a 0.12 wt% aqueous solution (288). 

Mechanical removal of plaque is the most effective measure against plaque-caused diseases, dental caries, and periodontal diseases. Even before the advent of fluoride treatments, it was assumed that a clean tooth does not decay. A toothbmsh is effective in removing dental plaque and, for those individuals who optimize its use, it usually can adequately control plaque. Despite the proven efficacy of mechanical plaque removal, the amount of patient involvement is such that only about 30% of the population in developed countries and considerably less in undeveloped countries can be expected to adequately remove plaque (1). Hence, supplementary measures such as dentifrices and dental rinses are necessary. 

Concurrent with these investigations, polyphosphazene matrices, functionalized with aminoacid esters or with imidazole groups, became of importance because of their tissue engineering aspects in bone regeneration [655,656,679], treatment of periodontal diseases [657], and nerve reconstruction problems [680-682] in which the remarkable bio compatibility of POP matrices was coupled with their tuneable bio degradability. 

FIGURE 8 Scanning electron micrographs of tetracycline-loaded microspheres for treatment of periodontal disease. 

Controlled and sustained drug delivery has recently begun to make an impression in the area of treatment of dental diseases. Many researchers have demonstrated that controlled delivery of antimicrobial agents, such as chlorhexidine [128-130], ofloxacin [131-133], and metronidazole [134], can effectively treat and prevent periodontitis. The incidence of dental caries and formation of plaque can also be reduced by controlled delivery of fluoride [135,136]. Delivery systems used are film-forming solutions [129,130], polymeric inserts [132], implants, and patches. Since dental disease is usually chronic, sustained release of therapeutic agents in the oral cavity would obviously be desirable. 

Tabata, M., Shimoda, T., Sugihara, K., Ogomi, D., Ohgushi, H. and Akashi, M. (2005) Apatite formed on/in agarose gel as a bone-grafting material in the treatment of periodontal infrabony defect. Journal of Biomedical Materials Research Part B Applied Biomaterials, 75B, 378-386. 

Kelly, H., Deasy, P., Ziaka, E. and Claffey, N. (2004) Formulation and preliminary in vivo dog studies of a novel drug delivery system for the treatment of periodontitis. Internal Journal of Pharmaceutics, 274, 167—183. 

The broad antibacterial activity of rifaximin as well as its topical action make this antibiotic suitable for intrapocket administration in periodontal disease. As a matter of fact, local application of rifaximin compares well with tetracyclines and metronidazole in other extra-GI diseases, i.e. skin infections and BY, respectively (see above). On the other hand, rifampicin (rifampin), another rifamy-cin derivative, has been successfully used in the treatment... 

Mailhot JM, Fried SL Oral health and wellness Understanding periodontal health, recognizing disease states and choices in treatment strategies. J Contemp Dent Pract 2003 4 110-121. 

Pavia M, Nobile CG, Bianco A, Angelillo IF Meta-analysis of local metronidazole in the treatment of chronic periodontitis. J Periodontol 2004 75 830-838. 

Knoll-Kohler E Metronidazole dental gel as an alternative to scaling and root planing in the treatment of localized adult periodontitis. Is its efficacy proved Eur J Oral Sci 1999 107 415— 421. 

Shaw 0 has described the topical use of such a compound, neomycin hexakispentachlorophenate, in the treatment of dental root infection and periodontic cavities. 

Trench mouth (necrotizing ulcerative gingivitis), also called Vincent s infection, usually affects young adults and is considered a form of periodontal disease. If untreated, it can lead to the loss of gum tissue and eventually loss of teeth. Today, there are more effective treatments for trench mouth than KMnO,. 

Leukocyte Adhesion Deficiency Type 2. Patients with this condition have a defect in the transport or production of the carrier molecule for the carbohydrate L-fucose (guanosine disphosphate L-fucose). The lack of fucose affects the ability of neutrophils to interact with ligands on endothelial cells such as P-selectins and E-selectins (81). Patients are susceptible to recurrent infections similar to those afflicting patients with type 1 leukocyte adhesion deficiency, have periodontal problems, and, in addition, may exhibit growth retardation and neurologic defects. Treatment with oral fucose has been known to be effective in reducing the frequency of infections (80). 

A host of bioadhesive controlled release systems have been proposed in recent years. Among the most commonly studied applications of bioadhesive materials is the area of buccal controlled delivery [408], The buccal delivery of small peptides from bioadhesive polymers was studied by Bodde and coworkers [409], and a wide range of compositions based on poly(butyl acrylate) and/or poly(acrylic acid) gave satisfactory performance. Bioadhesive poly(acrylic add)-based formulations have also been used for oral applications [402,410] for the sustained delivery of chlorothiazide [410] and for a thin bioadhesive patch for treatment of gingivitis and periodontal disease [411]. Other bioadhesive applications of polyelectrolytes include materials for ophthalmic vehicles [412,413], and systems for oral [410,414,415-419], rectal [420,421] vaginal [422] and nasal [423] drug delivery. 

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