Prof. David Herrera

Periodontitis are inflammatory diseases of infectious nature, due to the presence of bacterial biofilms in the subgingival area. In a healthy situation, dental biofilms will coexist in homeostasis with the periodontal tissues, and their immune system. However, different factors can lead to the dysbiosis between the bacterial species present in the subgingival pocket and the host immune system, that will finally leads to the progressive destruction of the periodontal tissues.

Periodontitis can have severe consequences at the oral level (e.g. tooth loss) and at a systemic level (association with diabetes or cardiovascular diseases).

However, periodontal therapy has clearly demonstrated that it can stop periodontal disease progression, with a relevant impact in different periodontal and oral health outcomes. Arresting periodontitis progression is able to keep teeth in health in a long-term basis.
But, in addition to oral health benefits (including aesthetics and function), treating periodontitis and maintaining a healthy periodontal status have been associated with improvements in quality of life indicators, including less anxiety and frustration.

Thus, periodontal therapy may help to improve oral health, but the reasons to justify it go beyond oral health, including systemic health and quality of life.

Periodontitis are inflammatory diseases of infectious nature, associated with the presence of specific bacterial species in the subgingival area, organized in bacterial biofilms. In order to stop disease progression, periodontal therapy is directed to control the infectious process and re-establish homeostasis. Supra- and sub-gingival biofilm debridement represents the basic component of initial periodontal therapy. However, some limitations influence the clinical outcomes, including a limited microbiological effect, especially on some periodontal pathogens. In order to overcome some of these limitations, different approaches have been proposed, including the use of adjunctive therapies. Among them, the use of local and/or systemic antimicrobials is the most frequently used. Specifically, the use of systemic antimicrobials has been frequently evaluated.

However, the use of systemic antimicrobials is not free of problems and two relevant aspects should be highlighted: at the individual level, adverse effects are frequent and significant alterations of the microbiome can be expected; at the public health level, the increase in bacterial resistance represents an enormous problem, which is a major challenge in health in the XXI century.

Therefore, a very responsible and cautious use of systemic antimicrobial must be recommended, limiting their use to very specific situations and under the most optimal conditions.