Periodontal disease appears to arise from the interaction of pathogenic bacteria with a susceptible host. The main aims of disease management have been to establish a high standard of
oral hygiene and to professionally and thoroughly debride the root surface Chemical agents could be considered for both aspects of management.
Chemoprevention using supragingivally delivered agents such as
chlorhexidine may be questioned for value in the pre-treatment hygiene phase but have well-established efficacy immediately preoperatively and during the post-operative weeks. Long-term maintenance use of
chlorhexidine is problematic due to local side effects. Antiplaque
toothpastes show modest benefits to
gingivitis but are not proven to prevent recurrence of
periodontitis.
Chemotherapy may be directed at subgingival plaque, using antimicrobials, or at the host response using
anti-inflammatory agents. Antimicrobials can be locally or systemically delivered. In most cases antimicrobial
chemotherapy should be considered adjunctive to mechanical
debridement. The advantages of local and systemic
chemotherapy must be balanced against the disadvantages and potential side effects of agents. Antimicrobial
chemotherapy offers little or no benefit to the treatment of most chronic
adult periodontitis patients and should be reserved for the more rapid or refractory types of disease, and after the
debridement phase. Despite the large number of studies there are insufficient comparative data to support any one local delivery system or systemic regimen as superior to another. Systemic versus local antimicrobials have not been compared to date. Host response modifying drugs such as non-steriodal anti-inflammatory drugs (
NSAIDS) offer the potential to reduce breakdown and promote healing, including bone regeneration. However until more data are available,
NSAIDs should not be used in the management of chronic
periodontal diseases, there being no specific agent(s) or regimen established for use.
Chemotherapy has an important place in the management of chronic
periodontal diseases but routine use must be considered as an over prescription of these valuable agents.