Host Modulation And Treatment Of Periodontal Disease

Host Modulation And Treatment Of Periodontal Disease

Discuss host modulation therapy in periodontal disease management.
Answer. Concept of host modulation was first introduced by William (1990) and Golub et al (1992).

• William introduces the concept of NSAIDs and host modulation with tetracycline while Golub et al introduce chemically modified analogues.
• Here term ‘modulation’ refers to the alteration of function or status of something in response to a stimulus or an altered physical or chemical environment.
• Concept of host modulation in periodontics is the treatment concept which aims to decrease tissue destruction and also the regeneration of periodontium by modifying the destructive aspects of the host response and upregulating protective or regenerative process.
• For fighting against the pathogenic bacteria, normal defensive immune-inflammatory reaction is essential but ameliorating excessively elevated inflammatory process to enhance the opportunities for wound healing is the host modulation therapy.
• Matrix metalloproteinases (MMPs) are a family of proteolytic enzymes which involve in the physiological degradation of extracellular matrix and basement membrane. Other stimulators of bone resorption are parathyroid hormone (PTH), macrophage colony stimulating factor (M-CSF), receptor activator of NFab (RANK), RANK ligand and 1,25-dihydroxy vitamin D3.
• Several inhibitors are there to combat the stimulators of bone resorption; they are interferon gamma (IFN -γ), osteoprotegerin, estrogens, androgens, calcitonin and IL-1ra (receptor antagonist).
• Modulation of such host responses is possible and beneficial. Basically, there are three potential approaches to the host modulation:
  • Use of anti-inflammatory drugs for blocking prostaglandins and proinflammatory cytokines.
  • Inhibiting MMPs with antiproteinases.
  • Inhibiting activation of osteoclast with sparing agents.

Drugs Leading to Host Modulation

• NSAIDs: They play an important role in treatment of periodontal disease. There mechanism of action includes decreased PMNL migration; decrease in vascular permeability and decreased platelet aggregation. Various drugs which are studied are ibuprofen, flurbiprofen, mefenamic acid and naproxen.
• Bisphosphonates: They inhibit bone resorption by disrupting the osteoclastic activity. E.g. alendronate.
• Tetracyclines (Subantimicrobial dose doxycycline): 20 mg of doxycycline is indicated as an adjunct to scaling and root planning. It has anti-collagenase effect. It is taken twice daily for 3 months or till 9 months. It is marketed as periostat.
• Growth factors, bone morphogenic protein and enamel matrix proteins: Currently approved by FDA for adjunctive use during surgery. Most commonly marketed brand is Emdogain.