Anti‐infective treatment of severe periodontitis: Hypothetical implementation

BACKGROUND: The primary objective of periodontology is to prevent and treat gingivitis and periodontitis to avoid tooth loss and focal infection of periodontal origin. The connection between periodontitis and serious systemic diseases underscores the need to extend periodontal healthcare to individuals across all income levels. A public health initiative needs to employ anti-infective treatment that effectively targets key periodontal pathogens, delivers long-term benefits, and is safe and affordable. MATERIALS AND METHODS: Research papers by experienced researchers in clinical periodontics show shortcomings with traditional (mechanical) treatment of moderate-to-severe periodontitis (stage 3/4), most likely because of an inability to eradicate periodontal pathogens residing within inflamed gingiva and deep furcation sites. This article proposes augmenting current treatment of severe periodontitis with systemic and local chemotherapeutics against major periodontal pathogens, including active herpesviruses, various anaerobic bacteria, and dental biofilm microorganisms. The therapeutic effectiveness of the individual parts of the suggested therapy is well recognized. RESULTS: The recommended treatment protocol includes (i) valacyclovir for periodontal herpesviruses on treatment days 1-4, (ii) a pause in pharmacotherapy on days 5-6 to prevent adverse drug interactions, (iii) antibacterial antibiotics like ciprofloxacin-metronidazole on days 7-11, and (iv) biofilm antiseptics such as sodium hypochlorite for ultrasonic scaling and patient self-care. The professional anti-infective therapy may be completed during two office visits on treatment days 1 and 7. Published studies show promising therapeutic outcomes. CONCLUSIONS: The suggested anti-infective treatment is readily integrated into clinical practice and can be performed as a standalone or an adjunct to traditional periodontal treatment. The treatment is effective, highly safe, and affordable. Dental hygienists can perform a major part of the periodontal therapy. CLINICAL RELEVANCE: This article highlights a decade-long paradigm shift in periodontology, moving from almost purely physical cleaning to an integrated approach of traditional periodontal methods and targeted pharmaceutical therapies. The hypothetical anti-infective chemotherapy presented here is low-cost and effective against periodontal pathogens involved in severe periodontitis, peri-implantitis, and probably also periodontal-related systemic diseases. Research is encouraged on the potential of this and future anti-infective treatments to arrest severe periodontitis and reduce the incidence and severity of systemic diseases related to periodontal disease.