Controlled Release Periodontal Chemotherapy

Added to Handbook: Prior to June 2005
Updated: September 2013

PURPOSE

To provide guidelines on the use of controlled-release chemotherapeutic agents by dental hygienists.

BACKGROUND

The aim of incorporating locally delivered antimicrobial agents is to control gingivitis and periodontitis by decreasing the bacterial load and pathogenic potential. The use of dentifrices, mouth rinses and irrigation for the treatment of periodontitis is impaired by the inability of these delivery systems to reach the base of periodontal pockets and/or maintain agents for sufficient duration at requisite concentrations, which is why locally delivered agents were introduced. Chemotherapeutics alone are unlikely to be effective in the presence of subgingival calculus, underscoring the importance of subgingival mechanical debridement.

The only clinically efficacious means of administering antimicrobial agents for the treatment of periodontal disease are by systemic administration and controlled release devices. The local delivery of controlled release antimicrobials provides a means of professionally administering chemotherapeutic agents directly into the periodontal pocket in order to provide slow release of the drug. With the direct placement of the drug in the periodontal pocket, the chance of drug resistance is decreased. The goal of chemotherapy is to alter the periodontal flora or inhibit the host response in such a way that the periodontal status improves. Doxycycline hyclate gel (Atridox®), Minocycline HCl microspheres (Arestin®), and Chlorhexidine gluconate chip (PerioChip®) are examples of such devices.

Results of present studies suggest that most local delivery systems used in conjunction with subgingival debridement appear to be capable of reducing probing depths and achieving modest gains in clinical attachment.

POLICY

The delivery of subgingival, controlled-release chemotherapeutic delivery systems is within the dental hygiene scope of practice, provided that appropriate education is obtained, along with consideration for case selection and precautions and contraindications related to the product being used. For all products, the manufacturer's directions need to be followed.

The prescription of a chemotherapeutic agent is not within the dental hygiene scope of practice. Documentation of the prescription from the client's dentist must be included in the client's chart.

The dental hygienist's decision to use locally delivered antimicrobials should be based upon consideration of the client's medical and dental history, clinical assessment findings, scientific evidence, and client preferences.

REFERENCES

  • American Academy Of Periodontology Statement On Local Delivery Of Sustained Or Controlled Release Antimicrobials As Adjunctive Therapy In The Treatment Of Periodontitis. Journal of Periodontology [Internet]. 2006 [cited 2013 July 25]; 77:(8):1458-1458. Available from:
    joponline.org (pdf)
  • Darby LM, Walsh MM. Dental Hygiene Theory And Practice. 3rd ed. St. Louis: Saunders Elsevier; 2010.
  • Matesanz-Pérez P, García-Gargallo M, Figuero E, Bascones-Martínez A, Sanz M, Herrera D. A Systematic Review On The Effects Of Local Antimicrobials As Adjuncts To Subgingival Debridement, Compared With Subgingival Debridement Alone, In The Treatment Of Chronic Periodontitis. J Clin Periodontol 2013; 40(3):227-241.
  • Newman MG, Takei HH, Klokkevold PR, & Carranza FA. Carranza's Clinical Periodontology. 11th ed. St, Louis: Elsevier; 2012.