Periodontal Disease: Therapeutic Strategies Elimination of bacterial infection –mechanical removal of infectious agent –Triclosan toothpaste –Antiseptic rinse/irrigation –surgical reduction of periodontal pockets –topical antimicrobials Actisite® Periochip Atridox® Arestin –systemic antimicrobials Modulation of host response –systemic delivery of host- modulating drugs NSAIDS Periostat® (SDD) Bisphosphonates –local delivery of host modulating drugs Emdogain Growth Factors BMPs These Strategies are Complementary Modulation of risk factors –smoking cessation –diabetic control –improved oral hygiene –corrective dentistry –improved nutrition –stress reduction –weight loss

Colgate Total Only toothpaste to contain triclosan, an antibacterial ingredient –Adheres to oral mucosa (soft and hard tissues) for up to 12 hours Only toothpaste approved by FDA and Accepted by ADA for treatment of gingivitis, plaque, caries, calculus and oral malodor.

Colgate Total Placebo controlled studies in smokers (Kerdvongbundit and Wikesjo, J Clin Periodontol. 2003;30(12): ) and subjects with recurrent periodontitis (Furuichi et al., J Clin Periodontol. 1999;26(2):63-6) suggest that an oral hygiene regimen including a triclosan/copolymer dentrifice may sustain the short-term effect of non-surgical therapy in smokers and improve on healing after non-surgical treatment of recurrent periodontitis as measured by improvements in gingival inflammation, probing depth reductions and probing attachment levels.

Colgate Total Triclosan in vitro has anti-inflammatory effects inhibiting cytokine (IL-  and TNF-  stimulated production of prostanoinds (PGE 2 ) from monocytes and reducing the activity of an enzyme responsible for the production of prostanoids (COX-2) in culture, as well as inhibiting bone resorption in a parathyroid- hormone-induced release of calcium from bone cultures.

Intervention Can periodontal therapy affect glycemic control in people with diabetes? The first case series to demonstrate this was published in 1960 where type 1 diabetics with periodontitis had a reduction in required insulin doses following: –Scaling and root planing –Localized gingivectomy –Selected tooth extraction –Combined with penicillin and streptomycin Williams and Mahan, JAMA, 1960

Preliminary Intervention Trials Meta-analysis of 10 intervention trials included 456 patients The decrease in absolute HbA1c values was ~0.4% The addition of systemic antibiotics resulted in an average absolute reduction of 0.7% Numerous deficiencies –Small sample sizes –Mixing type 1 and 2 diabetics –Confounding effects of smoking, BMI, medications, etc. Additional studies are needed to determine whether periodontal therapy provides a significant benefit on glycemic control Janket S-J et al., J Dent Res, 2005

Raising The Bar Glycated Hemoglobin –Lower and lower to prevent diabetic complications Oral Care –Optimal to reduce insulin resistance and to allow for metabolic control –Improved to prevent long term complications –What is complete treatment, who is well controlled? Is a 5 mm probing depth too much disease? Is gingivitis too much disease?