Contemporary use of agents in the control of progressive periodontitis

Mechanical treatment of periodontitis is effective in most cases. However, there are cases which respond poorly and in which chemotherapy may be appropriate. Topical antibacterials applied supragingivally have limited or no effect upon established periodontitis caused by subgingival plaque. Subgingival application of antibacterial agents have in some studies shown a certain effect upon the inflammatory response particularly when applied in addition to conventional mechanical treatment. Long term results are not convincing. Speculation that some forms of periodontitis may be regarded as specific infections have led to the use of antibiotics in the treatment of such conditions. The drugs most often recommended are tetracyclines and imidazoles, and there are reports indicating arrest or retardation of further disease progression when they are applied as an adjunct to conventional mechanical treatment. Recently, local application of antibiotics in slow release devices has been claimed to be effective in combating periodontitis. Data presented so far have mostly shown reduced inflammation, while the effect upon the progression of the disease remains largely unknown. There seems to be general agreement that use of antibiotics in some cases of periodontitis is advantageous, but only if it is used as an adjunct to scaling and root planing.