Department of Periodontics, Dental College of Georgia, Augusta University, Augusta, GA 30912, USA.
Int J Mol Sci. 2021 Jun 16;22(12):6459. doi: 10.3390/ijms22126459.
Traditional antimicrobial therapies for periodontitis (PD) have long focused on non-selective and direct approaches. Professional cleaning of the subgingival biofilm by instrumentation of dental root surfaces, known as scaling and root planning (SRP), is the mainstay of periodontal therapy and is indisputably effective. Non-physical approaches used as adjuncts to SRP, such as chemical and biological agents, will be the focus of this review. In this regard, traditional agents such as oral antiseptics and antibiotics, delivered either locally or systemically, were briefly reviewed as a backdrop. While generally effective in winning the "battle" against PD in the short term, by reducing its signs and symptoms, patients receiving such therapies are more susceptible to recurrence of PD. Moreover, the long-term consequences of such therapies are still in question. In particular, concern about chronic use of systemic antibiotics and their influence on the oral and gut microbiota is warranted, considering antibiotic resistance plasmids, and potential transfer between oral and non-oral microbes. In the interest of winning the "battle and the war", new more selective and targeted antimicrobials and biologics for PD are being studied. These are principally indirect, blocking pathways involved in bacterial colonization, nutrient acquisition, inflammation or cellular invasion without directly killing the pathogens. This review will focus on current and prospective antimicrobial therapies for PD, emphasizing therapies that act indirectly on the microbiota, with clearly defined cellular and molecular targets.
传统的牙周炎（PD）抗菌治疗方法长期以来一直侧重于非选择性和直接方法。通过器械清洁牙根部的龈下生物膜，即所谓的刮治和根面平整（SRP），是牙周病治疗的主要方法，这是无可争议的。作为 SRP 的辅助手段，非物理方法，如化学和生物制剂，将成为本次综述的重点。在这方面，简要回顾了作为背景的传统制剂，如局部或全身使用的口腔防腐剂和抗生素。虽然这些治疗方法在短期内通过减轻 PD 的症状和体征在赢得“对抗 PD 的战役”中通常是有效的，但接受这些治疗的患者更容易复发 PD。此外，此类治疗的长期后果仍存在疑问。特别是，考虑到抗生素耐药质粒和口腔与非口腔微生物之间的潜在转移，需要关注慢性使用全身抗生素及其对口腔和肠道微生物群的影响。为了赢得“战役和战争”，正在研究针对 PD 的新的更具选择性和靶向性的抗菌药物和生物制剂。这些主要是间接的，通过阻断细菌定植、营养物质获取、炎症或细胞侵袭的途径起作用，而不会直接杀死病原体。本文将重点介绍针对 PD 的当前和有前景的抗菌治疗方法，强调对微生物群起间接作用的治疗方法，这些方法具有明确的细胞和分子靶标。
