Chemotherapy: A Viable Periodontal Treatment Modality?

Abstract

Because bacterial plaque is composed chiefly of micro-organisms, use of chemotherapeutic agents directed against a susceptible flora would seem a conceptually valid therapeutic modality, in terms of inhibition of plaque, for the prevention and treatment of periodontal disease. The objective of treatment largely dictates the modality used. If, for example, the philosophy of treatment is elimination or reduction of pocket depth, chemotherapy against supragingival plaque may complement mechanical oral hygiene in the absence of a plaque-free environment. On the other hand, access to the subgingival flora can only be achieved through systemic administration of drugs or the use of controlled delivery systems. Notwithstanding their potential benefit as adjunctive therapy, in cases of refractory periodontitis and juvenile periodontitis in which elimination of Actinobacillus actinomy-cetemcomitans by mechanical debridement alone is extremely difficult, the potential for adverse reactions from the administration of antibiotics must be weighed and their use, in general, considered unwarranted. The dynamics of the inter-relationship between supragingival and subgingival plaque necessitates control of both for the successful treatment of periodontal disease. Although there are chemical agents that have been shown to be effective in the treatment of gingivitis, the evidence pertaining to their effectiveness in the treatment of periodontitis, either alone or in conjunction with conventional therapy, is inconclusive. If specific microbial floras are associated with different forms of periodontal disease, chemotherapeutic agents to which such micro-organisms are susceptible would have to be employed for their elimination. Until accurate predictors of disease activity---including definitive indicators of which particular sites are, at any one time, actively undergoing attachment loss---are available, the use of chemotherapeutic agents directed at the subgingival flora appears extremely limited and impractical. However, with the development of predictors of disease activity, including sophisticated methods of determining even small increments of attachment loss, new drugs, and a better understanding of subgingival ecologic systems, chemotherapy may yet play a significant role in the treatment of periodontal disease.