Professionally Delivered Local Antimicrobials in the Treatment of Patients with Periodontitis—A Narrative Review

Abstract

This review sheds light on the recent published scientific evidence relating to the use of professionally delivered local antimicrobial agents (LA’s). The review also analyses drug delivery systems available to date and provides an update on the latest scientific evidence about the benefits, limitations, and clinical results obtained by use of local drugs in the treatment of periodontal disease. The search strategy revealed randomized controlled trials (RCTs) that compared the efficacy of adjunctive LA’s to mechanical therapy alone. Based on the available evidence gathered from this review, we can infer that the use of local antimicrobial agents in conjunction to scaling and root debridement (SRD) delivers significant benefits in periodontal therapy and it is a useful aid, avoiding many of the side effects that systemic antibiotic therapy may involve. Local drug delivery (LDD) is an efficient and effective means of delivering drugs based on the evidence presented in the review. The authors of this review would suggest the use of local antimicrobials in cases of localized periodontitis or individual areas that do not respond to the usual mechanical therapy alone. This review summarizes the current use of local drug delivery in periodontal management ensuring that the general practitioners are able to choose an appropriate local antimicrobial.

Antibacterial effect of coconut water and coconut oil on Aggregatibacter actinomycetemcomitans

“…Therefore, topical antimicrobial agents have been studied as an alternative approach for treatment of periodontitis. (13) To our knowledge, there are no in vitro studies on the effect of coconut products on oral pathogens other than Candida albicans and Streptococcus mutans. (3,5) Considering that coconut water has been proven effective against Klebsiella pneumoniae, a Gram-negative bacterium (6) , as well as the important role of A. actinomycetemcomitans, which is also a Gramnegative bacterium, in development of periodontal disease, and the availability and convenient application of coconut water as compared with its oil, we sought to investigate the antimicrobial effects of coconut water and coconut oil on A. actinomycetemcomitans.…”

Pyroptosis-Mediated Periodontal Disease

“…Clinically, it seems more realistic to remove pathogens and their virulence factors from the periodontal pockets and thereby reduce, or even prevent, pyroptosis-mediated inflammation and tissue damage. In support of the previous affirmation, professional use of local antimicrobial agents, in conjunction with scaling and root debridement, provides significant benefits in periodontal therapy [ 122 ]. Moreover, reducing the microbial charge lowers the chance of disseminating periodontal pathogens and their virulence factors into the periphery [ 114 ].…”

Polysaccharide-Based Drug Delivery Systems for the Treatment of Periodontitis

“…[ 16 ]. The administration can be done in the form of suspensions, toothpaste, or by direct injection into the periodontal pocket [ 80 ]. The advantages of using these type of systems include the following: ensuring a controlled release, increasing patient compliance, and achieving a sustained therapeutic effect.…”