Nonsurgical Approaches for the Treatment of Periodontal Diseases
Section snippets
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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The author is a consultant, serves on a number of advisory boards, and is named on patents as an inventor of therapeutic applications of tetracyclines discussed in this article. These patents have been fully assigned to the research foundation of Stony Brook University, State University of New York, Stony Brook, New York, and have been licensed exclusively to CollaGenex Pharmaceuticals, Newtown, Pennsylvania.