Pharmacologic adjuncts to conventional periodontal therapy

Periodontal disease refers to a group of inflammatory conditions that affect the tissues around the teeth.

The mildest form of periodontal disease is gingivitis and, if left untreated, gingivitis can progress to periodontitis.

Now, the primary goal of periodontal therapy is to save the natural dentition and periodontium but also to prevent recurrence of the periodontal disease.

The conventional treatment is based on mechanical therapy like using curettes to scale and root plane or surgical procedures.

However, not all patients respond well to conventional therapy, so pharmacological agents can be a useful adjunct in these cases.

Now, based on the type of delivery, medications used in the treatment of periodontitis can be subdivided into topical, local, and systemic medications.

The most common topically-delivered medications are antiplaque agents, which are usually delivered in the form of mouthwashes.

Based on their antimicrobial and antiplaque effect, these agents are subdivided into three generations.

First-generation agents include fluoride, oxygenating agents, phenolic compounds, quaternary ammonium compounds among other antimicrobials.

Second-generation agents like chlorhexidine gluconate have prolonged antibacterial activity.

Finally, we have third-generation agents that interfere with the ability of the bacteria to attach to the teeth.

The main representative of this group is delmopinol hydrochloride.

Now, switching gears and moving on to local delivery medications, which can be subdivided into oral irrigation and local sustained delivery.

An oral irrigator is a device that directs a stream of pressurized water or solutions along the gingival margin and between teeth.

The stream of water disrupts the formation of the dental biofilm and decreases gingival inflammation.

Oral irrigation is further subdivided into supragingival and subgingival irrigation.