The therapeutic use of antimicrobial agents in patients with periodontal disease.

Periodontal disease is the collective term given to a variety of inflammatory conditions in the tissue that supports and secures the teeth to the jawbone. The inflammatory response is to bacterial products and/or bacteria that enter the tissue from the dental plaque. The dental plaque is a complex microbial community containing over 190 different taxa that exist on the tooth surfaces. In periodontitis the majority of the plaque bacteria are anaerobes including the black pigmented bacteroides species and motile forms such as spirochetes. This suggested that a systemic antimicrobial specific for anaerobes might be of value in the treatment of periodontitis. Two double blind studies are reviewed which indicate that metronidazole plus mechanical debridement of the root surfaces is significantly better than placebo plus mechanical debridement in the treatment of advanced cases of periodontitis especially when the periodontal pockets are 6 mm or more in depth.