Treatment modalities and evaluation models for periodontitis

Abstract

Periodontitis is the most common localized dental inflammatory disease related with several pathological conditions like inflammation of gums (gingivitis), degeneration of periodontal ligament, dental cementum and alveolar bone loss. In this perspective, the various preventive and treatment modalities, including oral hygiene, gingival irrigations, mechanical instrumentation, full mouth disinfection, host modulation and antimicrobial therapy, which are used either as adjunctive treatments or as stand-alone therapies in the non-surgical management of periodontal infections, have been discussed. Intra-pocket, sustained release systems have emerged as a novel paradigm for the future research. In this article, special consideration is given to different locally delivered anti-microbial and anti inflammatory medications which are either commercially available or are currently under consideration for Food and Drug Administration (FDA) approval. The various in vitro dissolution models and microbiological strain investigated to impersonate the infected and inflamed periodontal cavity and to predict the in vivo performance of treatment modalities have also been thrashed out. Animal models that have been employed to explore the pathology at the different stages of periodontitis and to evaluate its treatment modalities are enlightened in this proposed review.

Salvadora persica: Nature’s Gift for Periodontal Health

“…Periodontal scaling is the most efficient method for halting this damaging inflammatory process. Dentists use dental scaling techniques to remove soft and hard dental residues, as well as stains, from the affected teeth’s root and crown surfaces [ 27 ]. Scaling and root planning has become the gold standard in nonsurgical periodontitis mechanical therapy.…”

“…Many clinical studies have shown that it significantly decreases the number of microorganisms in periodontal pockets and enhances clinical outcomes such as clinical attachment, bleeding on probing, and probing depths [ 28 ]. Scaling and root planning can be performed with a variety of dental devices, including manual scalers and curettes, as well as sonic and ultrasonic instruments that help reach deeper into pocket depths and into dental root furcations [ 27 ]. Since pathogens may exist inside tissues or deep pockets that are not reachable by instruments, it is not always possible to remove all pathogens during localized scaling and root planning procedures.…”

“…These chemotherapeutic agents all have the ability to mediate the host-immune reaction through various mechanisms, eventually blocking the destructive aspects of inflammation [ 34 ]. These mechanisms include anti-inflammatory mediators inhibiting prostaglandins or pro-inflammatory cytokines, tetracyclines and doxycycline inhibiting collagenase, and bisphosphonates inhibiting osteoclast cell activity [ 27 ].…”

Antimicrobial Effect of Platelet-Rich Plasma againstPorphyromonas gingivalis

“…Scaling and root debridement, according to Tariq et al, are the “gold standard” of nonsurgical periodontal treatment and are indispensable for obtaining a smooth surface that is resistant to bacterial adhesion. When bacteria cannot adhere, their ability to create biofilm and multiply their toxicity decreases, contributing to a prolonged therapeutic effect [30]. At the same time, the combination of mechanical methods and antimicrobial chemical agents is used to increase the effectiveness of the treatment of periodontitis.…”

Halofuginone functions as a therapeutic drug for chronic periodontitis in a mouse model

“… 1 Without appropriate treatment, the periodontitis can progress to teeth loosen, mastication impairment, and teeth loss. 2 , 3 Studies have revealed that periodontitis development is a result of chronic inflammatory interaction between bacterial and host immune system. 4 However, the underlying mechanism is unknown.…”