PRINCIPLES OF PHARMACOLOGICAL INTERVENTION

Compared to studies with conventional maintenance, relatively few stud ies have been conducted that have tested pharmacologic intervention as a means for supportive periodontal care. Despite the scarcity of data , several principles have begun to emerge. First, it is clear that rem oval of subgingival calculus is necessary for the highest level of a l ong-term effectiveness. Hence, pharmacologic intervention appears best suited as an adjunctive therapy directed toward ''problem sites''; si tes that fail to respond adequately to conventional maintenance proced ures. Intrapocket drug delivery systems appear to offer particular pro mise since therapy can be directed to selected sites that appear to be failing. Additional effectiveness may also be obtained by use of chlo rhexidine mouth rinses for short periods of time during healing to con trol re-infection. Eradication of reservoirs of infection throughout t he mouth also appears to be an important principle related to long-ter m stabilization. Studies to date suggest that superior clinical respon se can be obtained by intrapocket delivery systems. Furthermore, up to 2 years of periodontal stabilization can be achieved by these means a nd longer disease-free maintenance intervals can be established. Addit ional clinical trials will be necessary to fully optimize and understa nd this therapeutic approach, but initial studies have reported promis ing results.