Disadvantages Of Systemic Therapy

The emergence of modern chemotherapy was first established by Erhlich, who found targeted toxicity of distant microbial organisms through the use of microbe specific drugs that he called magic bullets. As a result of this concept, the design of agents to affect disease etiology with low toxicity to the host has dramatically reduced or abated the mortality of numerous diseases.

The selection of systemically administered agents to prevent, suppress, or reverse periodontal attachment loss has been approached by either reducing the bacteria found in the gingival sulcus or modulating the response of the host to the bacteria found in the gingival sulcus.5

Chemotherapy It is the treatment of systemic infection and malignancy with specific drug

Systemically administered antibiotics penetrate the periodontal tissues and the pocket via serum. There they can reach the microorganisms which are inaccessible to scaling instruments and local antibiotic therapy.

Systemically administered antibiotics show a statistically significantly greater gain in attachment and reduction in depth of periodontal pockets, regardless of initial probing methods or therapeutic modalities, antibiotic therapy alone or in conjunction with scaling and root planing or in conjunction with scaling and root planning plus surgical therapy.7

Disadvantages of systemic therapy relates to the fact that the drug is dissolved by dispersal over the whole body, and a small portion of the total dose actually reaches the subgingival microflora in the periodontal pocket. Local drug delivery systems are means of drug application to confined areas. For the treatment of periodontal diseases, local delivery of antimicrobial drug ranges from simple pocket irrigation, placement of drug containing ointment and gels in the pockets to sophisticated devices for sustained release of antimicrobial agents.8

SELECTION OF

Metronidazole's spectrum of activity is relatively specific for obligate anaerobes. Chlorhexidineis an antiseptic, which adheres to organic matter and demonstrates low toxicity when applied topically and not adsorbed well into the tissues.10

SERIAL AND COMBINATION ANTIBIOTIC THERAPY

Periodontal infection may contain a wide diversity of bacteria, no single antibiotic is effective against all putative pathogens. This ‘mixed’ infection can include a variety of aerobic, microaerophilic and both Gram +ve and gram –ve anaerobic bacteria. In this case it may be necessary to use more than one antibiotic, either serially or in combination.4

A combination of metronidazole and amoxicillin (MA) has shown to be an effective antibiotic regime to combat Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis-associated periodontal