Chemotherapy involves treatment with a drug or chemical agent. Chemotherapy is classified depending of the way the drug is delivered. The drug delivery systems used in periodontal treatment involve; systemic, topical and controlled-release.
Systemic antibiotics show a parabolic response with peak concentrations 2-3 hours after oral administration. This system theoretically reaches all periodontal pockets. The majority of the agent concentrates in serum. Systemic antibiotics require repeated doses and patient compliance.
The topical delivery system involves oral rinses, dentrifices and gels. They show an exponential concentration profile, where drug levels decline exponentially and rapidly. Serum and gingival crevicular fluid levels are undetectable. Drug sustantivity may further enhance any sustained effect. One disadvantage of this system is that it fails to reach the base of the periodontal pocket. Irrigation devices can deliver agents into deep pockets. A number of studies indicate that supragingival irrigation does not routinely project solutions into deep pockets. This form of therapy can be beneficial in treating gingivitis, but may not be very effective in the treatment of periodontitis. The objective of subgingival irrigation is to directly reduce the pocket microflora in an effort to prevent initiation of periodontitis or to facilitate its reduction. Calculus, irrigation tip designs, and irrigation force may affect the drug delivery.
Another type of delivery system is the controlled-release. This theoretically produces more constant, prolonged concentration profiles. The controlled-release system utilize synthetic polymers to control drug administration. In periodontics, both controlled-release and topical delivery systems have been termed ³local delivery².
Recently research is trying to elucidate the interaction between the susceptible host and periodontal pathogens in periodontal disease progression. Researchers are trying to find out if pharmacological control of the host/parasite interaction can be an additional way to treat periodontal disease. The goal of chemotherapy is to alter the periodontal flora or inhibit the host response in such a way that the periodontal status improves.
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