Low‐cost periodontal therapy

Abstract

Periodontitis is a complex infectious disease that affects low-income individuals disproportionately. Periodontitis is associated with specific bacterial species and herpesviruses, and successful prevention and treatment of the disease is contingent upon effective control of these pathogens. This article presents an efficacious, highly safe, minimally invasive, practical and low-cost periodontal therapy that involves professional and patient-administered mechanical therapy and antimicrobial agents. The major components are scaling for calculus removal, periodontal pocket irrigation with potent antiseptics, and treatment with systemic antibiotics for advanced disease. Povidone-iodine and sodium hypochlorite have all the characteristics for becoming the first-choice antiseptics in the management of periodontal diseases. Both agents show excellent antibacterial and antiviral properties, are readily available throughout the world, have been safely used in periodontal therapy for decades, offer significant benefits for individuals with very limited financial resources, and are well accepted by most dental professionals and patients. Four per cent chlorhexidine applied with a toothbrush to the most posterior part to the tongue dorsum can markedly reduce or eliminate halitosis in most individuals. Systemic antibiotics are used to treat periodontopathic bacteria that are not readily reached by topical therapy, such as pathogens within gingival tissue, within furcation defects, at the base of periodontal pockets, and on the tongue, tonsils and buccal mucosae. Valuable antibiotic therapies are amoxicillin-metronidazole (250 mg of amoxicillin and 250 mg of metronidazole, three times daily for 8 days) for young and middle-aged patients, and ciprofloxacin-metronidazole (500 mg of each, twice daily for 8 days) for elderly patients and for patients in developing countries who frequently harbor enteric rods subgingivally. Scaling to remove dental calculus and the prudent use of inexpensive antimicrobial agents can significantly retard or arrest progressive periodontitis in the great majority of patients.

Effectiveness of a pre-procedural mouthwash in reducing bacteria in dental aerosols: randomized clinical trial

“…Only CPC has shown to be as effective as CHX in reducing the content of bacteria in dental aerosols, 3 results that corroborate those reported in the present study for 0.075% CPC+Zn+F. An additional advantage for CPC compared with CHX is its lower cost 37 and the reduced chance of patient intolerance to the product. 38 Therefore, the main strength of this study is that it is the first RCT to determine the efficacy of a new formulation containing CPC in reducing oral bacterial load in the patient's mouth and consequently, in the aerosols, as well as determining the microbial composition of these aerosols.…”

Multi-omics Analysis of Periodontal Pocket Microbial Communities Pre- and Posttreatment

“…Conventional periodontal therapy includes a stabilization phase and a maintenance phase (11). Stabilization of the disease is accomplished by periodontal biofilm disruption and removal of calculus and other biofilm-retentive factors and may involve adjunctive antimicrobial medication and/or surgery (12). Long-term goals in the maintenance stage are to have patients exercise proper plaque control and commit to professional prophylactic treatments to minimize the likelihood of a clinical relapse.…”

Evaluation of the use of systemic antimicrobial agents by professionals for the treatment of periodontal diseases

“…Some studies showed that the association of amoxicillin (a penicillin with broader spectrum) and metronidazole (a nitroimidazole compound) -especially in a regime of 400 mg of metronidazole plus 500 mg of amoxicillin, 3 times a day for 7-14 days -plays an important role in treating anaeroberelated infection in the oral cavity and may significantly improve the short-term results of non-surgical therapy in patients with aggressive periodontitis 5,6,9,10 , diminishing the need for surgical therapy. This association has shown good results by presenting a synergic effect between the drugs 9,11,35 . Azythromicin, a member of a new subclass of macrolide, the azalides, has also been shown to be effective as adjunct to the treatment of aggressive periodontitis (regime of 500 mg de azythromicin, once a day, for 3 days) 12 .…”