The use of antimicrobials for periodontal patients

by

TABLE OF CONTENTS

CHAPTER # 2: LITERATURE REVIEW1

Introduction1

Aims1

Antimicrobial advances in treating periodontal disease3

Antimicrobial peptides in periodontal innate defense4

New Horizons for Management of Periodontal Disease in General Practice6

Treating periodontal disease with local antimicrobials8

Conclusion12

REFERENCES13

CHAPTER # 2: LITERATURE REVIEW

Introduction

The aim of this chapter is to provide a brief review of literature on periodontal pharmacotherapy and Antimicrobial advances in treating periodontal disease. This chapter also provides a brief description of Antimicrobial advances in treating periodontal disease. This chapter also highlights the new horizons for management of periodontal disease in general practice.

Aims

The aim of this review is to elaborate the use of antimicrobials for periodontal patients and to provide the effectiveness of antimicrobials for the treatment of periodontal disease.

Periodontal Pharmacotherapy

Periodontal disease is an inflammatory disease of the periodontium, the supporting and surrounding structures of teeth, which can lead to bone loss and eventual loss of teeth. Periodontitis is characterized by clinical attachment loss, alveolar bone loss and bleeding upon probing (Sullivan et al 2007 455). It is most often classified as chronic or aggressive, localized or generalized, and is further distinguished by the severity or extent of destruction (Smith 2007 18). The breakdown of the periodontium affects not only the condition of the oral cavity, but also overall quality of life. Surveys in the United Kingdom, as well as around the world, have revealed that periodontitis affects people of all ethnicities, ages and socioeconomic standings. In conjunction with regular in-office maintenance, proper home hygiene and sometimes surgical therapy, treatment is often successful. However, in some cases the disease may relapse and in refractory cases, the disease may persist despite all efforts.

The most recent report from the National Health and Nutrition Examination Survey (NHANES) in 1999-2004 revealed that the prevalence of moderate or severe periodontitis amongst Americans is up to 10.73% (Dellinger et al. 2005 9). However, a recent critique of the survey found that the prevalence of the disease reported by the NHANES may in actuality underestimate its true prevalence. Armitage (2010) evaluated 456 subjects by both a full mouth periodontal exam (FMPE) and a partial mouth periodontal exam (PMPE) as per the parameters of the NHANES 2001-2004 exam, using the same CDC definition of periodontal disease and comparing the percent of subjects diagnosed with periodontitis based on the different types of measurement.

The researchers found that the prevalence using the FMPE on their sample population was 22.4% versus the 9.7% prevalence found using the PMPE of the NHANES 2001-2004 protocol such that the estimated prevalence of periodontal disease as reported using the 2001-2004 NHANES parameters underestimated the true prevalence of periodontitis by 12.7% for a relative bias of 56.9%. According to the latest report from the surgeon general (May 25, 2000, Oral Health in America: A Report of the Surgeon General), the proportion of adults with moderate periodontitis ranged from 3.0-64.6% with severe periodontitis ranging from 0.2%-29.5% (Sullivan et al 2007 455). In both cases, the lowest incidence was found in the youngest age group (18-24 yrs old) while the ...