Periodontal Disease - Other Treatments

Other Treatments

Standard Nonsteroidal Anti-inflammatory Drugs (NSAIDs). NSAIDs are agents that block factors that cause inflammation and pain.

• Over-the-counter NSAIDs include aspirin, ibuprofen (Motrin IB, Advil, Nuprin, Rufen), naproxen (Aleve), ketoprofen (Actron, Orudis KT).
• Prescription NSAIDs include ibuprofen (Motrin), naproxen (Naprosyn, Anaprox), diclofenac (Voltaren), tolmetin (Tolectin), ketoprofen (Orudis, Oruvail), indomethacin (Indocin).

The agents have been investigated not only for pain relief in periodontal disease but in slowing the disease process. NSAIDs block inflammatory enzymes triggered by cytokines, the important immune factors in periodontal disease. A number of NSAIDs have been investigated and have been shown to reduce gingivitis and slow progression of periodontal disease.

In one study, long-term use of oral flurbiprofen (Ansaid) resulted in significantly lower bone loss, although disease progression returned when the drug was stopped.

Investigators are studying rinses, creams, and other topical forms of NSAIDs. For example a cream containing ketoprofen appeared to reduce bone loss. (Ketoprofen is of particular interest because it not only blocks COXs but also another pathway involved in the disease process.)

Warning about NSAIDs:Although NSAIDs work well, long-term use can cause stomach problems, such as ulcers and bleeding, and possible heart problems.In April 2005, the FDA asked drug manufacturers of NSAIDs to include a warning label on theirproduct that alertsusers of an increased risk for cardiovascular events and gastrointestinal bleeding.

Bisphosphonates

Bisphosphonates, including alendronate (Fosamax) are bone-restoring agents used for osteoporosis. There is some evidence they also may reduce bone loss in the structures that support the teeth. Alendronate (Fosamax) and risedronate (Actonel) are currently the standard oral bisphosphonates. Some researchers are studying administering bisphosphonates topically directly on the gums.

Growth Factors

Gels containing growth factors, included substances called recombinant human (rh) platelet-derived growth factor-BB (PDGF-BB) and (rh) insulin-like growth factor-I (IGF-I) are also showing promise for restoring bone.

Vaccines

Research is under way to find a vaccine against periodontal disease. To date, animal studies show promise, but an effective vaccine for people is years away.

Photodynamic Therapy

Researchers are investigating the use of photodynamic therapy (PDT) as an alternative to antibiotic drugs. PDT destroys periodontal bacteria by applying photosensitive drugs to oral regions and exposing the drug-treated area to a light or laser. Research appears promising but is still in preliminary stages.