REVIEWS Drug Discovery Today  Volume 13, Numbers 21/22  November 2008 Therapeutic strategies for effective management of periodontal disease. Recent approaches for the treatment of periodontitis Nilu Jain, Gaurav K. Jain, Shamama Javed, Zeenat Iqbal, Sushama Talegaonkar, Farhan J. Ahmad and Roop K. Khar Department of Pharmaceutics, Faculty of Pharmacy, Jamia Hamdard, New Delhi 110062, India Periodontal disease is a localised inflammatory response caused by the infection of a periodontal pocket arising from the accumulation of subgingival plaque. Periodontal disease has been considered as a possible risk factor for other systemic diseases such as cardiovascular diseases and pre-term low birth weight infants. Advances in understanding the aetiology, epidemiology and microbiology of periodontal pocket flora have revolutionised the therapeutic strategies for the management of periodontal disease progression. This review summarises the recent developments in the field of intra-pocket drug delivery systems and identifies areas where further research may lead to a clinically effective intra-pocket delivery system. Periodontal disease is a collective term ascribed to several pathological conditions characterised by degeneration and inflammation of gums, periodontal ligaments, alveolar bone and dental cementum [1]. It is a localised inflammatory response caused by bacterial infection of a period- ontal pocket associated with subgingival plaque [2]. Although bacteria are the primary cause of periodontal disease, the expression of microbial pathogenic factors alone may not be sufficient to cause periodontitis. Periodontal pathogens produce harmful by-products and enzymes that break extracellular matrices as well as host cell membranes to produce nutrients for their growth. In doing so, they initiate damage directly or indirectly by triggering host-mediated responses that lead to self-injury [1]. In the early phase of the disease (gingivitis), inflammation is confined to the gingiva but extends to deeper tissues in periodontitis, leading to gingival swelling, bleeding and bad breath. In the late phase of the disease, the supporting collagen of the periodontium is degenerated, alveolar bone begins to resorb and gingival epithelium migrates along the tooth surface forming a ‘periodontal pocket’ [2,3]. This periodontal pocket provides ideal conditions for the proliferation of microorganisms: primarily Gram negative, facultative anaerobic species. Prominent amongst these are Bacteroides spp.: B. intermedius and B. gingivalis; fusiform organisms: Actinobacillus actinomycetemcomitans, Wolinella recta and Eikenella spp.; and various bacilli and cocci; spiro- chetes; amoebas and trichomonads [2]. The periodontal pocket, however, remains and if it Reviews  KEYNOTE REVIEW Nilu Jain was born in Sagar, India, on 24 August 1977. She gained her Bachelors Hons degree in 1999 and her Masters degree in 2001 at Dr H.S. Gour University, Sagar, India. Presently, she is working as a Ph.D. research fellow in the Department of Pharmaceutics, Jamia Hamdard, India for Dr Farhan J. Ahmad and Prof. Roop K. Khar. She is also involved in the design and development of nanoparticulate drug delivery sys- tems. Her research work focuses predominantly on intra-pocket drug delivery through nanomatric approaches. She has published her research findings in various peer-reviewed journals. Gaurav K. Jain is a well-known academician and a young research scientist. He was a university gold medalist for standing first in M. Pharm. Presently, he is working as a lecturer in the Depart- ment of Pharmaceutics, Faculty of Pharmacy, Jamia Hamdard, New Delhi. He has teaching experience at U.G. and P.G. level. Gaurav Jain also works as a research fellow in Jamia Hamdard under the supervision of Dr Farhan J. Ahmad. He has worked in Ranbaxy Research Laboratories, Gurgaon and, at present, is intensively involved in the devel- opment of nano-sized drug delivery systems. Gaurav is a member of various professional bodies such as IPA and IPGA and has published his research findings in various peer-reviewed journals of international repute. Corresponding author: Jain, G.K. (drgkjain@gmail.com) 932 www.drugdiscoverytoday.com 1359-6446/06/$ - see front matter ß 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.drudis.2008.07.010