Periodontal Disease and Overall Health: A Clinician's Guide

CHAPTER 3 Infection and Inflammation 39Figure 4. Schematic Illustration of Lipid-Mediated Pro-Inflammatory andFigure 4. Pro-Resolution Pathways(DHA). EPA and DHA can be metabolizedby aspirin-modified COX-2 pathways toform resolvins, while DHA can be convertedto protectins via an LO-mediated pathway(Figure 4).Another aspect of current anti-inflammatorystrategies was the discovery that disruptionof biosynthesis of these pro-resolutionmediators by either COX-2 or LOinhibitors may lead to a “resolution deficit”phenotype, which is characterized by impairedphagocyte removal, delayed resolution,and prolonged inflammation. This mayexplain why several anti-inflammatory agents,such as selective COX-2 inhibitors and certainLO inhibitors, have been shown to impairresolution of inflammation and lead to systemicinflammatory complications.Summary of Part IIITheoretically, combining pro- resolutionmediators and anti-inflammatory agents suchas aspirin and statins—agents that decreasethe extent of inflammation without inter -fering with the endogenous pro- resolu tionprocesses—may be a useful strategy to controlexcessive inflammation and restore homeo -stasis. More research is necessary to obtainsolid information on the efficacy and safetyof these interventions in humans. However,it is possible that in the future we can expectthat new treatment strategies will be availablefor the treatment of periodontal diseaseand its systemic complications.Supplemental ReadingsSerhan CN, Chiang N, Van Dyke TE. Resolving inflammation:dual anti-inflammatory and pro-resolutionlipid mediators. Nat Rev Immunol 2008;8(5):349–61.Madianos PN, Bobetsis YA, Kinane DF. Generation ofinflammatory stimuli: how bacteria set up inflammatoryresponses in the gingiva. J Clin Periodontol 2005;32(Suppl 6):57–71.Loos BG. Systemic markers of inflammation in perio -dontitis. J Periodontol 2005;76(Suppl 11):2106–2115.Ridker PM, Silvertown JD. Inflammation, C-reactiveprotein, and atherothrombosis. J Periodontol 2008;79(Suppl 8):1544–1551.REFERENCES1. Löe H, Theilade E, Jensen SB. Experimental gingivitisin man. J Periodontol 1965;36:177–187.