Shilpi Paul*
Shilpi Paul
Pritam Datta
Priyanka Choudhary
Bhaskar Saha
Periodontitis is a leading cause of tooth loss. It is a chronic, multifactorial infectious disease that affects the supporting tissues of the teeth, caused by periodontopathogens that accumulate in dental plaque, leading to infection. [1] It is characterized by inflammation of the periodontal ligament, associated with microbial activity and the host’s immune response. This inflammation results in the loss of periodontal attachment and subsequently alveolar bone.[2, 3] It is relatively common worldwide, impacting nearly 60% of the elderly and 50% of adults.[4] The 2022 global report by the World Health Organization (WHO) on oral health status estimated that oral diseases affect nearly 3.5 billion people worldwide. Among these, two billion individuals have dental caries in their permanent teeth. Additionally, periodontal diseases impact about 19% of the global adult population, accounting for over one billion cases. In European countries, the report indicates that more than 50% of the population may experience some form of periodontitis, with over 10% suffering from its severe form. The prevalence of periodontitis increases significantly in older adults, reaching 70–85% among those aged 60 to 65 years.[5]
The primary cause that drives toward periodontal destruction are the poor oral hygiene and the host’s defence against the microbial infection along with the composition of the periodontal microflora. Various associated risk factors are smoking and diabetes mellitus, modulate the onset and progression of the disease.[6] Once diagnosed individual with periodontitis, the treatment aims to resolve inflammation and infection that to reduce further tissue damage and regenerate lost bone structures to restore health and normal function of teeth. The routine treatment options for periodontitis are use of surgical and non-surgical methods based on harshness of the disease. The various non-surgical method includes scaling, root planning and obeying of best oral hygiene practices from qualified dentistry whereas surgical options are grafting of bone at the diseased site of mouth cavity, removing the diseased tissue and cleaning of tooth roots (flap surgery).[7]
However, following a mechanical debridement of periodontitis either surgical and non-surgical treatment approach, as an adjunct systemic antimicrobial therapy help to cure periodontitis completely. Several antibiotics based on proper microbial diagnosis and sensitivity testing are prescribed for the management of periodontitis diseases are likely tetracyclines, doxycycline, minocycline, clavulanic acids, amoxicillin etc. The effective concentration of the antibiotic may not achievable at the periodontal disease site (gingival crevicular fluid) leading to poor therapeutic response. Further, the repeated or long past use of the antibiotics (for some other infections/diseases) may lead to the development antimicrobial resistance by producing resistant strains of microorganisms and other side effects.[8, 9]. So some alternatives to antibiotics are much required. Various literatures stated that statins may be used for the management of periodontitis other than antibiotics. Statins, a class of drugs that inhibit 3-hydroxy 3-methylglutaryl coenzyme A (HMG-CoA) reductase introduced in 1987 [10], commonly used to lower blood cholesterol levels in patients with hyperlipidaemia and atherosclerosis, thereby reducing the risk of cardiovascular events. Statins are exhibiting, which include anti-inflammatory, antioxidant properties, and their potential effects pleiotropic effects on epithelization and wound healing. Additionally, they possess antimicrobial, antiviral, and fungicidal properties actions beyond their lipid-lowering capabilities, may contribute to the management of periodontal disease. As stated by Tahamtan S. et al. (2020) Statins have notable effects in the management of oral health including chronic periodontitis, alveolar bone loss due to either extraction or chronic periodontitis, osseointegration of implants, dental pulp cells, orthodontic tooth movement, and orthodontic relapse, wound and/or bone healing, salivary gland function. Henceforth, the statins may be considered as novel, safe, inexpensive, and widely-accessible therapeutic moiety in dentistry and dental treatments. The statins like simvastatin, rosuvastatin, atorvastatin is reported to use adjunct in the periodontal diseases. The Statins, helps to control periodontal inflammation through inhibition of proinflammatory cytokines and promotion of anti-inflammatory and/or proresolution molecule release, mainly, through the ERK, MAPK, PI3-Akt, and NF-κB pathways. Moreover, they are able to modulate the host response activated by bacterial challenge, to prevent inflammation-mediated bone resorption and to promote bone formation. Furthermore, they reduce bacterial growth, disrupt bacterial membrane stability, and increase bacterial clearance, thus averting the exacerbation of infection. Local statin delivery as adjunct to both nonsurgical and surgical periodontal therapies results in better periodontal treatment outcomes compared to systemic delivery. Moreover, combination of statin therapy with other regenerative agents improves periodontal healing response. Therefore, statins could be proposed as a potential adjuvant to periodontal therapy, alternative to antibiotics. It is also requiring alternative way to treat the periodontitis other that oral route of administration locally to increase the drug concentration at the periodontal disease site. The local drug delivery has been emerged as a significant strategy of periodontal treatment, allowing for applying the drug locally and directly to the periodontal pocket of the oral cavity.[11] This method increases exposure to the medication and kill periodontal pathogens more effectively with reduced dose resulting in improved therapeutic outcomes than orally administered tablets or capsules. The local drug delivery for the periodontitis disease solves different issues like drug distribution (reduce systemic exposure), drug concentration (increase drug concentration), therapeutic potential (may act better locally), frequeny (reduce frequency of administration), Super infection (limited in compare to systemic therapy) etc. Thus, the local drug delivery addresses the issues and complications associated with systemic antibiotics.[9] The various local rug delivery usually are fibers, strips, films, and microparticulate systems, are available for treating periodontitis. However, the various local drug delivery for the treatment of periodontitis For instance, patients have reported discomfort and varying degrees of gingival redness when removing fibers.[12] Using non-biodegradable polymers in strips poses another significant disadvantage, as they offer only temporary clinical improvements after treatment completion. Additionally, preparing films presents challenges related to their thickness and adhesiveness, while microparticulate systems struggle with poor retention within the periodontal pocket. The strategic disadvantages of local drug delivery may be overcome by delivering drugs, including statins, to treat periodontal diseases by administering the drug in in-situ mucoadhesive gel form. In-situ gels are a drug delivery system where the formulation is initially liquid or solution. Still, upon contact with the body, it undergoes a sol-to-gel transition by change of temperature, pH, or ionic concentration, allowing for targeted and sustained drug delivery. Using biodegradable and water-soluble polymers in these formulations enhances their acceptance and effectiveness for drug delivery.[13] In situ mucoadhesive gels, thus, when applied to the periodontal pockets, due to muco-adhesiveness, produce local and sustained delivery of the incorporated drug. Thus, in situ mucoadhesive gels may be a promising local drug delivery method because they can maintain high drug levels in the gingival crevicular fluid for extended periods, resulting in desired clinical benefits.[14] These gels are administered as precursors that transform into a gel at the action sites.[15] Numerous in situ gels, including temperature-sensitive, light-responsive, and pH-dependent gels, have demonstrated potential in managing periodontal diseases.[16] Here in this review, we have focused on insights into periodontitis treatment, the pathophysiology of periodontitis, and the research and/or clinical trials status of statins in the treatment of periodontal diseases, an insight of in situ gel in the management, particularly periodontitis
10.5281/zenodo.15248784