Periodontal disease poses a challenge to a competent clinician when they either do not respond to standard treatment plans or recur at certain sites despite comprehensive therapy and good maintenance. Second surgery does not seem to be a good option due to financial aspects as well as patient’s unwillingness to go for it again.
Repeated doses or long term use of broad-spectrum antibiotics have their own adverse effects. The routine use of antibiotics over long periods of time is contra-indicated because of the development of resistant bacterial strains and possible systemic side-effects.
One can try topical administration of antibacterial mouthwashes, but they are effective in controlling supragingival plaque only, with a limited access to the the subgingival bacteria residing in periodontal pocket. Therefore they are ineffective in controlling periodontal disease progression.
You can try to overcome this through local delivery of chemotherapeutic agents (irrigation of chlorhexidine, Betadine etc.) into the pockets via a syringe or a special irrigating device to alter the subgingival flora. But their effect in halting the periodontal disease would be negligible due to the short contact time between the irrigating solution and the pocket environment.
In order to solve this problem, it becomes essential, at this point, to understand the complexity of Periodontal diseases – especially the various types of periodontitis. The subgingival plaque bacteria are primary causative agents. However, the nature, severity and extent of the ultimate tissue damage depends to a large extent on the interaction between the bacteria, the response of the host’s defense mechanisms to the bacterial assault and the environmental factors like Diabetes Mellitus, smoking etc.
Basically periodontal diseases manifest in a susceptible individual in whom harmful bacteria (gram negative anaerobic) have increased and benefic bacteria have reduced in the periodontal tissues and gingival sulcus. The clinicians should aim to reverse this balance and allow the host defense mechanisms to take over and establish a healthy periodontium.
Hence, we need an agent that reaches the deepest part of the pocket and specifically targets these harmful bacteria by being in contact with them for sufficient amount of time. The vehicle (usually a polymer matrix containing the drug) used to carry the antimicrobial inside adheres to the tissues and allows the slow release of the drug.
Although many therapeutic agents have been approved to be applied via different delivery devices, need of the hour is to have simple, cost effective devices that are easy to be used by the clinicians.
30% Ornidazole gel is one such local antimicrobial treatment modality, recently developed to answer the above mentioned challenges faced by the clinicians.
.
