Drugs Used In Treatment Of Periodontal Diseases

Drugs Used In Treatment Of Periodontal Diseases.

• Antiplaque and anticalculus agents
• Antibiotics used to treat periodontal diseases
• Anti-inflammatory drugs.

Classification of Drugs Depending on AntimicrobialEfficacy and Substantivity

• First generation agents: Reduce plaque score by 20 to 50%, efficacy is limited due to poor substantivity. For example, quaternary ammonium compounds and antibiotics.
• Second generation agents: Retained longer in tissues and their slow release property provide overall reduction in plaque score up to 79–90%. For example, chlorhexidine, triclosan.
• Third generation agents: Effective against specific periodontopathic organisms. For example, delmopinol.

Drugs for Supragingival Plaque Control

• Phenol: They have non-specific antibacterial action which depends on ability of the drug to penetrate its lipid content of cell wall of gram-negative organism.
• Quaternary ammonium compounds: Quaternary ammonium compounds are cationic antiseptics and surface-active agents. Quaternary ammonium compounds tend to be more effective against gram-positive than gram-negative organisms. This may suggest that these compounds are most effective as antiplaque agents when used against early developing plaque, which predominantly contains gram-positive bacteria.

Quaternary ammonium compounds include:

• Benzethonium chloride.
• Benzalkonium chloride.
• Cetylpyridinium chloride—CPC.
• Domiphen bromide.

Drugs for Supragingival Plaque Control Mechanism of Action

They have some similarities in their mechanism of action to chlorhexidine; the molecules possess both hydrophobic and hydrophilic groups allowing for ionic and hydrophobic interactions. It is assumed that the interaction with bacteria occurs with cationic binding, to the phosphate groups in the cell wall, teichoic acid in the gram-positive bacteria and to the phosphate groups of the cell wall and in general to the membrane lipopolysaccharide of gram-negative bacteria.

The membrane integrity may subsequently be disrupted by interaction with the lipophilic portion of the molecule, causing disturbance of membrane functions and leakage of cytoplasmic material.

Antibiotics in Periodontal Therapy

Following are the antibiotics are used commonly in the periodontal therapy:

• The drugs more extensively investigated for systemic use include tetracycline, minocycline and doxycycline, erythromycin, clindamycin, ampicillin, amoxicillin and the nitroimidazole compounds, metronidazole and ornidazole.

The drugs investigated for local application include tetracycline, minocycline, doxycycline, metronidazole and chlorhexidine.

Penicillins

• The penicillins were the first group of antimicrobials used in periodontal therapy.
• Penicillins are bactericidal but induce allergic reactions.

Tetracyclines

• Tetracycline HCl became a popular choice during 1970s due to its broader spectrum of activity than penicillins, ability to inhibit collagenase activity, which is thought to interfere with the breakdown of periodontal tissues, firm adsorption to tooth surfaces and slow release over time.
• Most of subgingival microorganisms are susceptible to tetracyclines at a minimum inhibitory concentration of 1-2 mg/ mL.

Doxycyclines

• Doxycyclines are the semisynthetic tetracyclines.
• Doxycycline as compared to tetracyclines does not absorbed by calcium, milk and antacids and show better compliance.
• Doxycyclines is recommended in a 100 mg dosage twice daily for first day and then 100 mg four times a day.

Metronidazole

• Metronidazole is a powerful amoebicide.
• The drug has selective antimicrobial features against the obligate anaerobes.
• Metronidazole should be given 200 mg for four times a day for one week or 400mg three times a day for one week.
• Metronidazole is the first choice of drug to treat ANUG and aggressive periodontitis.

Azithromycin

• Azithromycin is taken up by gingival epithelial cells and penetrates fibroblasts and phagocytes. It is transported and released directly into site of inflammation through phagocytosis.
• Azithromycin initial loading dose is 500 mg followed by 250 mg/day for 5 days.

Chlorhexidine

Chlorhexidine has most positive antibacterial result.

Two daily rinses with 10 mL of 0.2% aqueous solution of chlorhexidine digluconate almost completely inhibited the development of dental plaque, calculus and gingivitis.

Periodontal Diseases Disadvantages

• Locally reversible side effects to chlorhexidine use may occur, primarily brown staining of the teeth, tongue and silicate as well as resin restorations.
• Transient impairment of taste perception
• Painful, desquamative lesions on the oral mucosa may be associated with burning sensation.

Chlorhexidine Mechanism of Action

Chlorhexidine has a broad spectrum of antibacterial activity.

• Gram-positive bacteria are more susceptible than gramnegative.
• In relatively high concentration it is bacteriocidal but in low concentration it may be bacteriostatic.
• Cationic molecules of chlorhexidine bind readily to the oppositely charged cell wall and interfere with the membrane transport initiating a leakage of low molecular weight substances.
• In high concentration chlorhexidine penetrates the cell and causes precipitation of cytoplasm (Bactericidal action).

Triclosan

• Triclosan is a phenol derivative, it is synthetic and is nonionic.
• It has a broad spectrum of activity against gram positive and gram negative bacteria.

Triclosan Mechanism of Action

• Triclosan acts over the microbial cytoplasmic membrane and it induces leakage of cellular constituents and leads to bacteriolysis.
• Triclosan also delays plaque maturation and inhibit formation of prostaglandin and leukotrienes which are the mediators of inflammation.

Metallic Ions

Salts of zinc and copper are most commonly used metal ions.

Metallic Ions Mechanism of Action

They reduce glycolytic activity in microorganisms and inhibit bacterial as well as crystal growth.

Sanguinarine

• Sanguinarine is effective against wide variety of gram-negative microorganisms.
• Sanguinarine undergoes retention with plaque when used as mouthwash.

Enzymes

• These are mucinase, dehydrated pancreas, dextranase and thiocynate synthetase.
• Various proteolytic enzymes are bactericidal and are effective when applied in the mouth.
• Enzymes act as active agents and they breakdown already formed matrix of plaque and calculus.

Povidone Iodine

• Povidone Iodine does not show significant plaque inhibition activity when used as 1% mouthwash.
• Various studies show that it reduces inflammation and progression of periodontal disease.

Delmopinol

• Delmopinol is a low molecular weight amino alcohol.
• Inhibit growth of plaque and reduce the chances of gingivitis.

Mechanism of Action

• Delmopinol target dextran in extracellular matrix by blocking the synthesis, reducing the viscosity and selectively inhibiting dextran producing streptococci.
• Delmopinol also undergoes interference with plaque matrix formation and reduces bacterial adherence. It causes weak binding of plaque to tooth surface and aid in easy removal of plaque.