Host Modulatory Therapy

Host modulatory therapy is new and emerging treatment concept for the management of periodontitis. The goal is to reduce the destruction of tissue and provide stability and regenerate the periodontium through a modification of the host’s response. Periodontal disease, or gum disease, is a group of inflammatory conditions which impact the tissues that surround the teeth. In the early forms, which is called gingivitis, the gums are swollen, red, and may occasionally bleed. In the more severe form, it is called periodontitis, and can cause the gums to pull away from the teeth, the loss of bone, and loose teeth which may even fall out. It can also result in bad breath.

In the past, the treatment of periodontitis primarily focused on the reduction of the bacterial challenge. The outcomes, however, of these conventional treatment procedures such as scaling and root planning (SRP) were not consistently predictable or stable. The management of periodontal disease is a balance between two components. These include a bacterial challenge and the pro-inflammatory destructive events in the tissue, in addition to resolving inflammation and the downregulation of destructive processes. The goal with periodontitis is to maximize the treatment response through reducing inflammation and inhibiting destructive processes in the tissues. This helps enhance the stability of the periodontium following the traditional treatment methods.

Host modulatory therapy works by treating the host's bacterial interaction. The term host–pathogen interaction is used to describe how microbes or viruses sustain themselves within host organisms. This can be on a molecular, cellular, organismal or entire population level. While this term is typically used to describe disease-causing microorganisms, they may not all cause illness in the host.

Agents

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a specific type of a drug which is used to reduce pain, minimize fever, and prevent blood clots. In higher doses, NSAIDS can also be used to decrease inflammation. While the side effects vary based on the specific drug, they can include an increased risk of gastrointestinal ulcers or bleeds, heart attack, and kidney disease.

They inhibit the formation of prostaglandin E2 (PGE2). PGE2 is produced by neutrophils, fibroblasts and gingival epithelial cells in their response to fight off bacteria. PGE2 also upregulates bone resorption by osteoclasts and levels are found to be higher in patients with periodontal disease.

Bisphosphonates are a class of drugs which are used to prevent the loss of bone density. They are often used to treat osteoporosis and other similar diseases. These drugs are most commonly prescribed in the treatment of osteoporosis. The drugs are called bisphosphonates as they contain two phosphonate (PO(OH)2) groups. In addition, they are also called diphosphonates (bis- or di- + phosphonate).

Sub antimicrobial doxycycline is used in the treatment of chronic periodontitis. It includes 20 mg doxycycline or Periostat approved and is commonly used alongside with scaling and root planning. It is typically taken twice daily for three months can cannot be used for more than nine months. Rather than being antimicrobial, this dosage of doxycycline contains cytokine and osteoclasts inhibitory action.

These agents not only aid in improving the healing of wounds, but also stimulate the regeneration of lost bone, periodontal ligament and cementum. This aids in restoring the complete periodontal attachment apparatus. Emdogain is the only type of host modulatory agent which is currently approved.