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<p>Periodontal chemotherapeutics: systemic and local antibiotics<br>Lieutenant Commander Joyce Y. Turner, DC, USN and Captain Thu Getka, DC, USN<br><br>Introduction<br>The primary etiology of periodontitis is bacterial plaque in a susceptible host. Periodontal therapy is tailored according to individual patient's needs and there is not a universal treatment plan for all periodontitis patients.<br><br>Periodontal pathogens are complex and heterogenous, with at least 500 species culturable from periodontal pockets. The most commonly identified are anaerobic Gram negative rods such as P. gingivalis, P. intermedia, F. nucleatum. The remaining consist of Gram-postive facultative and anerobic cocci and rods and Gram-negative facultative rods. A.actinomycetemcomitans, a well known periodontal pathogen, possesses numerous virulence factors including the ability to penetrate into soft tissue and evade the host defense mechanisms. Mechanical debridement alone will not be sufficient; surgical and/or  chemotherapeutic approaches should be considered. <br><br>Goals for periodontal therapy include: 1) removal of pathogenic bacterial plaque and calculus, 2) disruption of the subgingival plaque biofilm, 3) surgical procedures to reduce probing depths and/or regenerate lost periodontium, 4) maintaining a healthy periodontium. Studies show that elimination or suppression of periodontal pathogens will decrease probing depths and bleeding upon probing. Due to limited visibility and access to subgingival areas and the tenacious character of calculus, reduction of pathogenic bacteria to the level compatable with health can be difficult to achieve.<br><br>Chemotherapeutics were introduced to assist in reducing microflora and optimizing the host response. The purpose of this update is to describe the rationale and recommended protocol for use of systemic, localized delivery antibiotics and subantimicrobial dose doxycycline in periodontics.
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<br>Subjects: Anti-Bacterial Agents; peridontics; Bacteria; Biofilms;  Debridement;  Doxycycline</div>
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U.S. Navy. Naval Postgraduate Dental School</div>
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