Local Drug Delivery: A Current Concept in Periodonlogy

Periodontal diseases are bacterial infections characterized by inflammation and destruction of the attachment apparatus, often leading to tooth loss. The most common forms of periodontal diseases, gingivitis and periodontitis are caused by bacteria adjacent to or associated with periodontal structures. These bacteria, along with calculus and other local factors, are the principal components that perpetuate the disease process [1]. The start and progression of the periodontal disease of the periodontium is given by the response of the immune system of the host to periodontal pathogens. These bacteria produce some enzymes (proteases, hyaluronidases and collagenases) which lead to a series of cellular events that induce the production of proinflammatory molecules: cytokines (interleukin-1b) and prostanoids (prostaglandins) causing tissue destruction. PGE2 is a proinflammatoryagent resulting from the cascade of the arachidonic acid. IL-1b and TNF are powerful stimulants of PGE2 through cyclooxygenase pathway COX2 in the human gingival fibroblast when attacked by lipopolysaccharides present in the periodontopathic bacteria [2].