The use of chemotherapeutic agents in the prevention of periodontal disease.

Abstract

In the introduction it was pointed out that a wealth of scientific evidence implicates the essential role microbial plaque plays in the etiology of periodontal disease .. The present concepts of the role of microbial plaque in the etiology of this disease were presented.. The oral microorganisms, their origin, pathogenicity, the environmental factors which influence them were described. The histopathology in the onset of periodontal disease and the relationship plaque microorganisms bears to it was put forward. The literature of Chlorherldine and antibiotics pertinent to their use in the prevention of periodontal disease was reviewed. Only three antibiotics were reviewed, namely Spiramycin, Vancomycin and CCl.0232. Studies with Spiramycin are extremely limited. One, uncontrolled, clinical study (Harvey, 1961} described promising results with this antibiotic in the field of preventive periodontics. A short-term, clinical trial on Syrian hamsters (Keyes et al, 1966) indicated that Spiramycin incorporated in the diet of these experimental animals controlled the development of periodontal lesions. Investigations with Spiramycin were carried no further. More studies have been carried out with Vancomycin. Clinical studies (Mitchell and Holmes, 1965; Mitchell et al, 1967; Scopp et al, 1967) pointed out that Vanoomyci.11 is useful in supporting conventional periodontal therapy. These studies were controlled and double-blind. A similar study (Mitchell and Barker, 1968) recommended its use in the treatment of Acute .Necrotizing Ulcerative/Ulcerative Gingivitis. Studies carried out in Denmark (Loe et al, 1967; Jensen et al, 1967; Jensen et al, 1969) carried out more sensitive clinical trials showing that Vancomycin was ineffective negative microorganisms, which alone were plaque and elicit gingivitis. These studies are more reliable in studying the earliest manifestations of the disease. An animal study al, 1966) that was more effective than Vancomycin in control of periodontal disease. CCl0232 was the only antimicrobial agent the five investigated which significantly controlled plaque and gingivitis. This human, controlled, double-blind clinical trial (Volpe et al, 1969) followed a pattern similar to those carried out Aarhaus, Denmark by Loe and his associates. Results with Vancomycin, one of the agents investigated, agreed with those of Loe and his associates. A similar study (Stallard et al, 1969) agreed that CC10232 was effective in controlling plaque, calculus and • The effectiveness of CC10232 in controlling calculus was investigated in a twelve month clinical trial (Volpe et al, 1970). Results were promising. Schissal et al {1969) pointed out that this antibiotic depressed both Gram positive and Gram negative micro-organisms

Chlorhexidine was investigated (Loe and Schiott, 1970; Schiott et al, 1970) shown in human, controlled, double-blind clinical trials to effectively' eliminate plaque and gingivitis. A study in vitro (Rolla et al, 1970) and in vivo (Davies et al, 1970) showed that chlorhexidine reacted with tooth substance. These two studies were instigated the microbiological results in the previous study (Schiott et al, 1970) showing that though saliva marginal gingiva were colonized by bacteria the tooth surfaces were virtually free. Further work (Gjermo et al, 1970) corroborated this finding by showing that effectiveness of eleven antimicrobial agents in plaque elimination was not related to their bactericidal properties in vitro. The study of chemotherapeutic agents in the prevention of periodontal disease is in its infancy. More human, well-controlled, clinical trials by different investigators using agreed criteria for sampling, assessing results etc are required. Long-term effects on the ecology of the oral microflora need considerably more investigation. As no specific system or microorganisms can be implicated in the development or plaque, the antimicrobials used have to be broad spectrum. This was displayed in the case of Vancomycin. Ir1duction of resistance and of superinfection of the oral microorganisms have to be investigated exhaustively as these agents have to be constantly used to be effective.