Chronic Periodontitis

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. 

Chronic inflammatory periodontitis occurs frequently in the adult population. The exact prevalence of the disease in the US and worldwide has been estimated to be... 

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. 

Therefore, T-cells participate in bone loss during inflammation or when T-cells are chronically activated (rheumatoid arthritis, periodontitis, infections, bone prothesis) and recently have been implicated in postmenopausal bone loss (Cenci et al. 2000,2003 Roggia et al. 2001). 

Periodontitis is a dental condition caused by bacteria where plaque-induced inflammatory changes affect the periodontal ligament and the alveolar bone leading to loss of the periodontal structure and resorption of the alveolar bone. Periodontitis that, unlike gingivitis, is not reversible, tends to be chronic and requires referral. 

Periodontal disease is characterized by a sequence of chronic oral inflammation and excessive alveolar bone resorption (i.e., receding alveolar bone) that results in root surface exposure of teeth, increased sensitivity, eventual detachment of the periodontal ligament, and subsequent tooth loss. Alveolar ridge bone exhibits intrinsic porosity, a structural fragility, and a proximity to vasculature that in effect virtually ensures it has the potential to be a vulnerable site in times of rapid bone resorption, much like the trabecular-rich regions in the hip and spine. Subsequent retention of the quantity and quality of bone in edentulous jaws also becomes critically important in terms of being able to provide surface support for dental implants and dentures that are desirable for both functional and cosmetic purposes (Bodic et al., 2005) (Figure 6.4). 

Urinary tract infection, menopause syndrome, hyperthyroidism and chronic periodontitis. 

Since the recognition of the biological role of lycopene in the prevention of chronic diseases, the emphasis of the scientific community has been in the area of cancer, with special focus on prostate cancer. However, based on the hypothesis that oxidative stress may be an important etiological factor in the causation of most of the degenerative diseases and that lycopene is a potent antioxidant, the scientific community has started to study its role in diseases other than the ones reviewed in this chapter. These health disorders include skin and ocular diseases, rheumatoid arthritis, periodontal diseases, and inflammatory disorders. The scientific information pertaining to the role of lycopene in these diseases is still in its infancy. However, the rationale for undertaking these studies is scientifically valid and it is hoped that in the next 3-5 years several studies will be reported in the literature. 

Ferrando R, Szponar B, Sanchez A, Larsson L, Valero-Guillen PL. 3-Hydroxy fatty acids in saliva as diagnostic markers in chronic periodontitis. J. Microbiol. Methods. 2005 62 285-291. 

In the presence of specific stimuh, exemplified by cytokines and growth factors, MMPs can be up-regulated. Chronic activation of MMPs, due to an imbalance between the activity of MMPs and TIMPs, can result in excessive degradation of the extracellular matrix and is believed to contribute to the pathogenesis of several diseases, such as rheumatoid arthritis, osteoarthritis, periodontal disease, emphysema, atherosclerosis, skin ulceration, and cancer. 

Resistance to tetracyclines shows marked inter-regional variations and changes rapidly with time. The selection of resistant bacterial strains may be favored by widespread, often prophylactic, use in veterinary medicine and by long-term therapy for acne, periodontal disease, or symptomatic Borrelia infections. Many of the documented cases of resistance are of limited practical significance, since the tetracyclines are merely one of a number of therapeutic alternatives. The problem may be different when these drugs are the chemotherapeutic agents of first choice, that is in chronic Borrelia infections, especially arthritis due to Lyme disease and pulmonary or bubonic plague due to Yersinia pestis (154). 

Periodontal disease describes a mixture of diseases in which the periodontal attachment is destroyed, resulting in loose teeth that may exfoliate. Periodontitis is divided into chronic and aggressive forms that are localized or generahzed (affect few or many teeth). Chronic periodontitis is very common (Sects. 13.1.2-13.4.3), whereas aggressive periodontitis is rare (Chap. 14). The collagen fibers of the gingiva and periodontium are described in Chap. 3 (Sect. 3.1.5), and its epithelial cover in Chap. 5 (Sect. 5.2.3). 

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