Periodontal Disease

Description

Alternative Names

Other Treatments

Standard Nonsteroidal Anti-inflammatory Drugs (NSAIDs). NSAIDs are agents that block factors that cause inflammation and pain. The most common NSAIDs are the following:

• Over-the-counter NSAIDs include aspirin, ibuprofen (Motrin IB, Advil, Nuprin, Rufen), naproxen (Aleve), ketoprofen (Actron, Orudis KT). One study suggested that ibuprofen or naproxen is more effective than aspirin or acetaminophen for acute tension-type headache.
• 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 enzymes called cyclocoxygenases (COXs), which are 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. Long-term use of NSAIDs, however, is associated with a high risk of gastrointestinal bleeding and ulcers as well as possible kidney and liver impairment.

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.)

COX-2 Inhibitors (Coxibs). Celecoxib (Celebrex), rofecoxib (Vioxx), and valdecoxib (Bextra) are known as COX-2 (cyclooxygenase-2) inhibitors, or coxibs. They inhibit only the COX enzyme that produces inflammation; they appear to have less harmful effects on the gastrointestinal tract. These agents are also being studied for periodontal disease.

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.