Nonsurgical Approaches for the Treatment of Periodontal Diseases

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Risk factors

It has been recognized that the severity of periodontal disease, its rate of progression, and its response to therapy vary from patient to patient. Bacteria are essential for the initiation of the disease but insufficient by themselves to cause the disease. The host must be susceptible, and it is the patient's risk factors that determine susceptibility to the disease. Risk factors are patient characteristics associated with the development of a disease.

The antimicrobial approach

The antimicrobial approach to periodontal therapy has been used for many years, recognizing that the prevalence and severity of these diseases can be reduced by mechanical plaque removal or by the use of a variety of systemic or topically applied antimicrobial agents aimed at inhibiting pathogenic bacteria.

The host modulatory approach

Host modulation is a new term that has been incorporated into dental jargon and has not been well defined. The definition of host from a medical dictionary reads “the organism from which a parasite obtains its nourishment or in the transplantation of tissue, the individual who receives the graft” [55]. The definition for the term modulation is “the alteration of function or status of something in response to a stimulus or an altered chemical or physical environment” [55]. In diseases of the

Clinical application

The author has implemented a three-pronged approach to periodontal therapy in her clinical practice (Fig. 3). The initial visit by a patient includes a medical and dental history, a risk assessment profile, periodontal charting, and radiographic analysis. The patient must be made aware of the fact that periodontal disease is not curable but that it can be treated and well controlled with constant monitoring by the dentist/hygienist and good patient compliance. The patient must also be informed

Summary

Periodontal pathogens and destructive host responses are involved in the initiation and progression of periodontitis in the individual at risk for disease. Therefore, the successful long-term management of this disease may require a treatment strategy that integrates therapies that address all of these components. There is now overwhelming evidence for the role of bacterial pathogens and host-derived MMPs, cytokines, and other mediators in the destructive processes of periodontal disease,

Acknowledgments

The author would like to acknowledge Laura Bertolotti for her assistance in the organization of this manuscript.

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References (87)

  • H.I. Bader

    Floss or die: implications for dental professionals

    Dent Today

    (1998)
  • R.C. Oliver et al.

    Periodontal diseases in the United States population

    J Periodontol

    (1998)
  • M. Heanue et al.

    Manual versus powered toothbrushing for oral health

    Cochrane Database Syst Rev

    (2003)
  • C.M. Cobb

    Non-surgical pocket therapy: mechanical

    Ann Periodontol

    (1996)
  • G. Koshy et al.

    A full-mouth disinfection approach to nonsurgical periodontal therapy—prevention of reinfection from bacterial reservoirs

    Periodontol 2000

    (2004)
  • A. Aoki et al.

    Lasers in nonsurgical periodontal therapy

    Periodontol 2000

    (2004)
  • G. Greenstein

    Periodontal response to mechanical non-surgical therapy: a review

    J Periodontol

    (1992)
  • C.D. Overholser et al.

    Comparative effects of 2 chemotherapeutic mouthrinses on the development of supragingival dental plaque and gingivitis

    J Clin Periodontol

    (1990)
  • Mankodi S, Mostler K, Charles CH, et al. Comparative antiplaque/antigingivitis efficacies of two antiseptic...
  • G. Pitts et al.

    Mechanism of action of an antiseptic, anti-order mouthwash

    J Dent Res

    (1983)
  • S.G. Ciancio et al.

    Effect of a chemotherapeutic agent delivered by an oral irrigation device on plaque, gingivitis, and subgingival microflora

    J Periodontol

    (1989)
  • T.F. Flemmig et al.

    Chlorhexidine and irrigation in gingivitis: 6 months correlative clinical and microbiological findings

    J Dent Res

    (1989)
  • S.G. Ciancio et al.

    The effect of an antiseptic mouthrinse on implant maintenance: plaque and peri-implant gingival tissues

    J Periodontol

    (1995)
  • J.J. Zambon et al.

    The effect of an antimicrobial mouthrinse on early healing of gingival flap surgery wounds

    J Periodontol

    (1989)
  • M. Sanz et al.

    Clinical enhancement of post-periodontal surgical therapy by a 0.12% chlorhexidine gluconate mouthrinse

    J Periodontol

    (1989)
  • D.H. Fine

    Mouthrinses as adjuncts for plaque and gingivitis management. A status report for the American Journal of Dentistry

    Am J Dent

    (1988)
  • S.G. Ciancio

    Antiseptics and antibiotics as chemotherapeutic agents for periodontitis management

    Compend Contin Educ Dent

    (2000)
  • N.C. Sharma et al.

    Comparative effectiveness of an essential oil mouthrinse and dental floss in controlling interproximal gingivitis and plaque

    Am J Dent

    (2002)
  • V. Kerdvongbundit et al.

    Effect of triclosan on healing following non-surgical periodontal therapy in smokers

    J Clin Periodontol

    (2003)
  • Y. Furuichi et al.

    The effect of a triclosan/copolymer dentifrice on healing after non-surgical treatment of recurrent periodontitis

    J Clin Periodontol

    (1999)
  • T. Xu et al.

    Effectiveness of a triclosan/copolymer dentifrice on microbiological and inflammatory parameters

    Compend Contin Educ Dent

    (2004)
  • A. Stabholz et al.

    Clinical and microbiological effects of sustained release chlorhexidine in periodontal pockets

    J Clin Periodontol

    (1986)
  • M.K. Jeffcoat et al.

    Adjunctive use of a subgingival controlled-release chlorhexidine chip reduces probing depth and improves attachment level compared with scaling and root planing alone

    J Periodontol

    (1998)
  • M.K. Jeffcoat et al.

    Use of a biodegradable chlorhexidine chip in the treatment of adult periodontitis: clinical and radiographic findings

    J Periodontol

    (2000)
  • J.M. Gordon et al.

    Tetracycline: levels achievable in gingival crevice fluid and in vitro effect on subgingival organisms. Part I. Concentrations in crevicular fluid after repeated doses

    J Periodontol

    (1981)
  • D. Pascale et al.

    Concentration of doxycycline in human gingival fluid

    J Clin Periodontol

    (1986)
  • D. Sakellari et al.

    Concentration of 3 tetracyclines in plasma, gingival crevice fluid and saliva

    J Clin Periodontol

    (2000)
  • W.J. Killoy et al.

    Controlled local delivery of tetracycline in the treatment of periodontitis

    Compendium

    (1992)
  • J.M. Goodson et al.

    Monolithic tetracycline-containing fibers for controlled delivery to periodontal pockets

    J Periodontol

    (1983)
  • J.M. Goodson et al.

    Multicenter evaluation of tetracycline fiber therapy: II. Clinical response

    J Periodontal Res

    (1991)
  • I. Fourmousis et al.

    Evaluation of tetracycline fiber therapy with digital image analysis

    J Clin Periodontol

    (1998)
  • C.B. Walker et al.

    The effects of sustained release doxycycline on the anaerobic flora and antibiotic-resistant patterns in subgingival plaque and saliva

    J Periodontol

    (2000)
  • S. Garrett et al.

    Two multi-center studies evaluating locally delivered doxycycline hyclate, placebo control, oral hygiene, and scaling and root planing in the treatment of periodontitis

    J Periodontol

    (1999)
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