Clindamycin: An Unsung Hero in the management of periodontitis.

Abstract

Periodontitis is a polymicrobial multifactorial disease with dental plaque playing a key role in its initiation and progression. Most cases with periodontitis can be managed with nonsurgical therapy alone or followed by surgical periodontal therapy. But in some cases, after traditional periodontal therapy, there is a greater chance for recolonization of tissue-invasive microbes such as gram negative anaerobic rods and cocci. In such cases, systemic antimicrobials can serve as an adjuvant to conventional periodontal treatment. Drugs like amoxicillin, tetracycline, azithromycin, doxycycline, moxifloxacin, etc., are usually given in such cases. Clindamycin, belonging to the lincosamide class of drugs, has remarkable potential in the management of periodontitis, particularly in 
cases of refractory periodontitis, acting on anaerobic bacteria. It can also be used in patients with penicillin allergies and in patients who are not responding to tetracycline therapy. Despite its serious side effects, like pseudomembranous colitis, its efficiency in refractory periodontitis is remarkable. It is one of the few antimicrobials that has both anti-microbial and immunomodulatory activity.  The potential for clindamycin as a Local drug delivery in the management of periodontitis also been explored. Even though it has many positive attributes, it is still an underdog in periodontal treatment due to some notable but preventable side effects. This review considers the potential of clindamycin in the management of refractory periodontitis, along with its notable positive effects, such as immunomodulatory and bone-binding properties.