Metronidazole is an imidazole known to be most active against obligate anaerobes. So if we apply this principle to periodontal diseases, we should use it only at the base of deep periodontal pockets, where we find obligate anaerobes. In the superficial areas of the pocket, obligate anaerobes would be absent. So the only place from where we can eliminate/ reduce the obligatory anaerobes is by professionally applying subgingival local drug delivery systems that reach the base of the pocket and deliver the drug continuously. My question is about those metronidazole gels, which are NOT the professionally applied local drug delivery systems, but the gels that are applied by the patients themselves on the inflamed gingival areas. Do they really work?
I doubt that the drug will be retained at the site of application if simple gel is applied by the patients on inflamed gingiva. Reasons being it will be diluted by saliva and will be ingested where it can affect GI flora. To reach the base of inflamed gingival pocket we need to have a special drug delivery system that can ensure adequate concentration and continuous release of the drug at the dezired site of action. Simple gel would not be as effective as it should be.
One study demonstrated that the peri-implant diseases can be positively resolved by using the metronidazole dental gel 25% topical antibiotic. This drug led to a 60-70% decrease of Gram-, and 40-50% increase for Gram+, bringing these back to normal values in almost all the patients. Moreover, a good recovery of the peri-implants soft tissues has been observed.
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