Periodontal pharmacotherapy - an updated review.

Periodontal disease is mainly associated with the activity of bacteria which adhere to the tooth surface and form specific structure of bacterial biofilm. Periodontal bacteria cause inflammation of the gums and aggressive immune response, affecting the periodontium. The first phase of initial therapy - mechanical removal of dental plaque and calculus - is necessary. If this non-surgical therapy has proved to be unsuccessful, an alternative treatment with antimicrobial agents is then considered. Pharmacotherapy is based on systemic or local antibiotics and/or antiseptics, which are applied according to the severity of the disease. A number of recent periodontal studies present some of the pharmacological agents, that are directed against bacteria or a host immune response, are often chosen as an adjunct treatment option, but none of these antimicrobials were established as 'a gold standard' in the periodontal treatment. This review provides some present recommendation of pharmacological strategies, with particular emphasis on systemic and local antimicrobial therapy of periodontal disease.

Evaluation of the influence of ozonotherapy on the clinical parameters and MMP levels in patients with chronic and aggressive periodontitis.

PURPOSE: A comparison of the clinical status and salivary MMP levels after SRP alone or with ozonotherapy in patients with aggressive and chronic periodontitis. MATERIAL/METHODS: The study was performed in 52 generally healthy subjects with chronic or aggressive periodontitis. Group CP-S consisted of 12 patients with chronic periodontitis, who underwent scaling and root planing (SRP). In group CP-O there were 25 patients with chronic periodontitis who additionaly to SRP underwent ozonotherapy. The same therapy was performed in group AP, containing 15 patients with aggressive periodontitis. Plaque index, approximal plaque index, bleeding on probing, sulcus bleeding index, probing pocket depth and clinical attachment loss were measured at baseline, at two weeks and two months post-therapy. The levels of MMP-1, MMP-8 and MMP-9 were estimated in non-stimulated saliva with an ELISA method. RESULTS: All the clinical parameters assessed in the study groups were reduced after treatment. SRP with additional ozonotherapy provided an increase in MMP levels in patients with chronic periodontitis and a reduction in MMP levels in patients with aggressive periodontitis. CONCLUSIONS: SRP followed by ozonotherapy does not lead to further improvement in clinical periodontal parameters in patients with AP and CP.

Assessment of aprotinin influence on periodontal clinical status and matrix metalloproteinases 1, 2 and their tissue inhibitors saliva concentrations in patients with chronic periodontitis.

PURPOSE: Assessment of the effect of treatment with aprotinin-containing drug on the clinical status of the periodontal tissue and on the concentrations of metalloproteinases released in the course of periodontitis (MMP-1, MMP-2) as well as their tissue inhibitors (TIMP-1 and TIMP-2) in the saliva of patients with chronic periodontitis (CP). MATERIAL/METHODS: The study involved 25 subjects with CP (39-68 years), including 16 women and 9 men. The patients were prescribed aprotinin preparation to be taken for 2 weeks. The control group (C) involved 14 healthy subjects (41-65 years), including 10 women and 4 men. Two periodontal indices were assessed: the approximal plaque index (API) and bleeding on probing index (BOP). Periodontal pocket depth and clinical attachment level were also evaluated. The concentrations of MMP-1 and MMP-2 as well as TIMP-1 and TIMP-2 were determined by the ELISA method. RESULTS: The mean salivary MMP-1 concentration in patients with CP was significantly higher before and after treatment, as compared to healthy subjects. The mean salivary MMP-2 concentration in CP patients at baseline was also higher as compared to the C group and increased after treatment. The mean salivary TIMP-1 and TIMP-2 concentration in CP patients was higher as compared to C group and increased after treatment. CONCLUSIONS: Since the mean MMPs levels were found to be growing it can be assumed that aprotinin has no significant effect on the regulation of MMPs in the saliva of CP patients. It thus seems that aprotinin application after scaling has no additional therapeutic effect.

Antioxidant activity of blood serum and saliva in patients with periodontal disease treated due to epilepsy.

PURPOSE: The aim of the study was to estimate the activity of chosen antioxidants in blood serum and saliva in patients with periodontal disease treated due to epilepsy. MATERIAL AND METHODS: Twenty-five epileptics and fifteen control persons were involved in the study. The activity of selected endogenous antioxidants were determined by spectrophotometric assay. Concentrations of vitamin A and vitamin E were measured using liquid chromatography. RESULTS: The analysis of the serum and saliva from patients with overgrown gingiva revealed: reduced activity of superoxide dismutase, glutathione peroxidase and glutathione reductase, elevated lipid peroxides, and decreased concentration of ascorbic acid and alpha-tocopherol. All values were statistically significant. CONCLUSIONS: Our results indicate on the oxidant-antioxidant disturbances in epileptic patients, which can play an important role in the pathomechanism of periodontal disease in these persons. Further studies on the role of antioxidants in patients with epilepsy treated with antiepileptic drugs and afflicted with gingival hyperplasia will be continued.

Assessment of salivary levels of the chosen exoglycosidases in patients with aggressive periodontitis after treatment with doxycycline.

PURPOSE: The aim of the study was the clinical assessment of the periodontium in patients with aggressive periodontitis (AP) after treatment with doxycycline hyclate. Moreover, an attempt was made to evaluate the effect of the treatment on the salivary concentrations of beta-glucuronidase, HEX, HEX A and HEX B in AP patients. MATERIAL AND METHODS: Sixteen patients with aggressive periodontitis, aged 28-45 years, were enrolled in the study. The patients were treated with a doxycycline hyclate preparation (Periostat) for 2 months at a dose of 20 mg twice a day. The clinical examination was performed twice, directly prior to pharmacological treatment and after its termination. The following clinical parameters were evaluated: the plaque index (PI), the sulcus bleeding index (SBI), the pocket probing depth (PPD) and the clinical attachment level (CAL). Biochemical determination of beta-glucuronidase, HEX, HEX A and HEX B concentrations in non-stimulated saliva was performed before and after treatment. RESULTS: In AP patients, the values of PI, SBI and CAL before and after treatment were comparable. The mean pocket probing depth before treatment was 3.5 mm, which decreased significantly after treatment (3.2 mm). The values expressed as pKat/kg protein for specific enzymatic activities of HEX, HEX A, HEX B and beta-glucuronidase in the saliva of AP patients before and after doxycycline treatment were similar. CONCLUSIONS: A 2-month treatment with doxycycline is too short to obtain clinical changes. Although the assessment of the activity of such enzymes as beta-glucuronidase, HEX, HEX A and HEX B in the saliva of AP patients allows detection of periodontal inflammation, it cannot be used to determine the risk of its development and therefore has no practical significance.

Efficacy of local treatment with chlorhexidine gluconate drugs on the clinical status of periodontium in chronic periodontitis patients.

PURPOSE: Chlorhexidine gluconate is a relatively commonly used chemotherapeutic in the treatment of periodontitis (P), exhibiting antimicrobial capabilities against Gram-negative and Gram-positive bacteria, and fungi. This compound is a component of various preparations for topical use in the form of solutions for mouthrinsing or peri-irrigation, gels, varnishes, chips and even chewing gums. The aim of the study was the clinical evaluation of periodontium after treatment with one of the drugs containing chlorhexidine gluconate (Corsodyl) as compared to professional tooth cleaning in patients with chronic periodontitis. MATERAL AND METHODS: Forty subjects enrolled in the study were divided into four groups, 10 in each group, according to the mode of treatment (Corsodyl rinse, Corsodyl gel, Corsodyl gel + surgical dressing, scaling). RESULTS: The greatest differences between baseline and follow-up examinations were observed in the group where surgical dressing was applied in addition to Corsodyl gel and in the group treated with scaling. CONCLUSIONS: Chlorhexidine gluconate should be more frequently used as a drug adjunct to classic periodontal therapy, especially in the forms allowing its direct application to the periodontal pockets.

Evaluation of mCD14 expression on monocytes and the blood level of sCD14 in patients with generalized aggressive periodontitis.

PURPOSE: Lipopolysaccharides (LPS), a major component of the cell membrane of gram-negative bacteria, are the main stimulants of the host immune response, initiating inflammatory changes and responsible for periodontal tissue destruction. The mCD14, which is found primarily on monocytes and macrophages, is the key membranous receptor involved in LPS binding. CD14 is also present in the serum as a soluble form (sCD14) released due to shedding from monocytes. The aim of the study was to assess CD14 expression on peripheral blood monocytes in patients with generalized aggressive periodontitis (GAP). The level of sCD14 was also determined in the serum of GAP patients. MATERIAL AND METHODS: The study group consisted of 16 patients with generalized aggressive periodontitis, the control group had 13 systemically and periodontally healthy subjects. The expression of mCD14 was determined by flow cytometry and expressed as mean intensity of fluorescence (MIF). Serum sCD14 level was examined with ELISA method. RESULTS: The expressions of mCD14 on monocytes in GAP patients and control subjects were comparable. No statistically significant differences were noted in the mean serum sCD14 level between GAP and control subjects. CONCLUSIONS: As periodontitis is a local disorder affecting a small fragment of the oral cavity it seems likely that chronic bacterial infection existing there is not reflected in the peripheral parameters.

A comparative study on the use of Bio-Oss and enamel matrix derivative (Emdogain) in the treatment of periodontal bone defects.

The aim of the study was to evaluate the clinical and radiographic outcome following two different techniques of periodontal bone defects treatment. The study included 24 generally healthy subjects with advanced periodontitis. The patients were divided into two equal groups, according to the method applied. In the first group, a bovine-derived hydroxyapatite xenograft (Bio-Oss) combined with a resorbable collagen membrane (Bio-Gide) was used. The other group was treated with enamel matrix derivative (Emdogain). Clinical and radiographic examinations were performed prior to and 1 yr after surgery. The following parameters were evaluated: plaque index, gingival index, probing pocket depth, clinical attachment level, gingival recession, radiographic defect depth, and defect width. All clinical and radiographic parameters (except plaque index and gingival recession) were significantly reduced after treatment in both groups. No differences were revealed between the two groups of patients in examined parameters after treatment. The results demonstrated that the treatment of periodontal bone defects with both techniques leads to similar and significant improvements in clinical and radiographic parameters.

[Non mucin proteins of saliva with high homology of polypeptide chains]. / Niemucynowe bialka sliny o wysokim stopniu homologii lancucha polipeptydowego.

To non mucin proteins of human saliva belong: cystatins, statherin, histatins and acidic proline-rich protein. These saliva proteins influence hard and soft tissues by forming a pellicle layer on oral mucosa and enamel, by taking part in removing bacteria or initiating of bacterial colonization. Most of them are able to inhibit the formation of dental calculus and control the calcium phosphate homeostasis.

Evaluation of polypeptide growth factors in the process of dental implant osseointegration.

The aim of the present study was to evaluate the concentration of three polypeptide growth factors: transforming growth factor beta (TGF beta), platelet-derived growth factor (PDGF) and fibroblast growth factor (FGF) in the blood of patients treated with Italian Logos system implants. The blood for analysis was collected three times: prior to the surgery, the day after and four months after the procedure before implant exposure for the prosthetic phase. The concentration of growth factors was assayed using ELISA method with R&D kits. The mean serum PDGF concentration on the first day and after 4 months following the procedure were comparable to the preliminary examination. The mean serum concentration of TGF beta in the second examination increased significantly compared to that before surgery. Four months later its mean concentration was lower than in the second examination, but still higher than in the preliminary examination. The mean serum FGF concentration in our patients remained similar throughout the study. Based on presented above data we conclude that inflammation process caused by tissue injure during implantation stimulates TGF beta release what can be detected by increase of it's concentration in blood serum.

Clinical and radiographic evaluation of periodontal therapy using enamel matrix derivative (Emdogain).

The aim of the present study was to evaluate clinical and radiographic outcome following the application of enamel matrix derivative--Emdogain in the treatment of the bone defects due to periodontitis. The study included 25 generally healthy patients with advanced periodontitis. Clinical and radiographic examination was carried out twice: before the procedure and a year after treatment. The following clinical parameters were evaluated: probing pocket depth (PPD), clinical attachment level (CAL) and gingival recession (GR). Defect depth, width and bone defect fill were assessed on the radiographs. A year after surgery the follow-up examination found a significant improvement of clinical parameters. The mean depth of gingival pockets was reduced from 8.76 +/- 1.74 mm to 4.52 +/- 1.56 mm. The mean CAL value was also decreased from 10.72 +/- 1.56 mm to 7.82 +/- 1.68 mm. Analysis of radiographs showed a statistically significant reduction in depth and width of bone defects. Our results indicate a good clinical and radiographic effect following the application of Emdogain in the treatment of periodontal intrabony defects.

Serum levels of interleukin-1 (IL-1), interleukin-6 (IL-6) and interleukin-8 (IL-8) in patients treated with dental implants.

The aim of the present study was to evaluate the levels of proinflammatory interleukins (IL)--IL-1, IL-6 and IL-8 in the blood of patients subjected to dental implant anchorage procedures. The study involved 10 generally healthy people aged 27-52, 4 men and 6 women. The patients were characterised by normal oral hygiene and lack of clinical symptoms of oral inflammation. Surgical procedures used Italian Logos system dental implants. The blood for analysis was collected three times: prior to surgery, one day and four months after the procedure before implant exposure. Interleukin levels were assayed with the ELISA method. The results were subjected to statistical analysis using Wicoxon's test. In all the cases examined soft tissue healing following the procedure was uneventful. The three consecutive examinations revealed similar IL-1 blood levels. Mean serum concentrations of IL-6 and IL-8 increased significantly in the second examination and returned to the close-to-initial values after 4 months. Increase of blood serum levels of IL-6 and IL-8 in the first day after implantation reflects local inflammation process caused by tissue impair.

Interleukin 6, tumor necrosis factor alpha and their soluble receptors in the blood serum of patients with denture stomatitis and fungal infection.

Determinations of the blood serum levels of interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha) and their soluble receptors (sIL-6R, sTNFR) in denture stomatitis patients (DS) were performed. Serum levels of interleukins and their soluble receptors were measured using the ELISA method. In all examined patients mycological diagnostics were conducted using API 20C AUX stripe tests and an automatic ATB machine. Results were compared with those of healthy denture wearers (D), and controls (C). In DS patients, yeasts were isolated in 90.9%, in D in 66.7% of cases. The most often isolated species in both groups was Candida albicans. Mean concentrations of IL-6 and TNF-alpha were statistically significantly higher in DS and D groups compared to controls. Mean concentrations of sIL-6R were similar in all groups; however, concentrations of sTNFR in both DS and D groups were significantly lower compared to controls. There were no correlations found between values of IL-6 and TNF-alpha nor between examined interleukins and their soluble receptors.

Polypeptide growth factors in the course of surgical periodontal treatment.

The aim of the study was to evaluate the behaviour of certain polypeptide growth factors in patients with rapidly progressive periodontitis (RPP) during periodontal therapy using alloplastic grafts. Concentrations of epidermal growth factor (EGF), fibroblastic growth factor (FGF), platelet-derived growth factor (PDGF) and transforming growth factor beta (TGF beta) were assayed in blood serum and saliva. Significant differences in the behaviour of growth factors in blood referred to EGF and PDGF. Their mean concentrations in serum of RPP patients were higher both in the preliminary examination and in the final investigation after 3 months compared with control group. However, mean FGF concentrations in serum were significantly higher only in the distant examination. In saliva, the concentrations of EGF, PDGF and FGF were not significantly different compared with control group. Salivary TGF beta in patients with RPP was significantly higher than in controls and increased in the final examination. The differences observed in the concentrations of growth factors in the serum and saliva of patients with RPP indicate that these factors can be involved in inflammation, destruction and regeneration of periodontal tissues.

An assessment of the structure of perception in people with bruxism.

The aim of the study was to assess the structure of perception in people with bruxism. 50 people with a diagnosis of bruxism (B), in whom primary evidence of oclusal disharmony and temporomandibular disorders were excluded, were included in the study. The control group (C) consisted of 50 people with no evidence of parafunctional abnormalities of the chewing mechanism. Shalit's diagram was used to assess the structure of perception. The primary indices: discriminability (D), articulation (A), affective load+ (AL+) and affective load- (AL-) and secondary indices: reduction (R), emotionality (E), intensity (I) were derived from Shalit's diagram. A significant reduction in the mean value of the primary indices D and AL+ was noted, as well as in the secondary indices E and I in people with bruxism, in comparison to the control group. Assessment of the structure of perception in people with bruxism through the analysis of the primary and secondary indices, makes it possible to predict behavior which has a negative effect on the individual's own health and provides the opportunity for changing such behavior to be more pro-health oriented.

Interleukin 6 and its soluble receptor in periodontitis.

The paper presents the evaluation of interleukin 6 (IL-6) and interleukin 6 soluble receptor (sIL-6R) values in the blood serum of patients with various forms of periodontitis (P), as confronted with local state. The study involved a group of 15 patients with P, including 4 patients with rapidly progressive periodontitis (RPP), 10 with adult periodontitis (AP) and 1 with juvenile periodontitis (JP). The concentration of IL-6 and its soluble receptor in blood serum were assessed using the immunoenzymatic ELISA method. The clinical state was estimated with the following periodontal indices: plaque index (PI), oral hygiene index (OHI), sulcus bleeding index (SBI), probing pocket depth and probing attachment loss. The P group showed an insignificant decrease in the IL-6 level in serum and a significant increase in sIL-6R concentration, compared with controls. A correlation was found between the level of IL-6 and PI, OHI and SBI.