**4. Conclusion**

*Oral Diseases*

**3.3 Bisphosphonates**

bisphosphonates [83].

**3.4 Statins**

and bone regeneration.

**3.5 Anti-platelet drugs**

Hence, it is concluded that oral contraceptives can no longer be considered to

Bisphosphonates are used widely in the management of primary and metastatic bone cancer, as well as osteoporosis. Bisphosphonates improve bone mineral density, reduce fracture risk, and reduce hypercalcemia of malignancy. Incidents of osteonecrosis of the jaw have been reported in people on bisphosphonates and undergoing invasive dental treatment procedures, including tooth extractions, dental implants, and surgical and nonsurgical periodontal treatment [82]. The risk for bisphosphonate-induced osteonecrosis may be influenced by the route of administration of the drug, the potency and the duration of use. Jaw osteonecrosis appears more associated with the intravenous use of bisphosphonates. A review showed that 94% of the published cases of osteonecrosis correlated with administration of intravenous, nitrogen-containing

Bisphosphonates inhibit bone resorption by acting on osteoclasts to reduce their activity or to increase the rate of apoptosis [84]. The inhibitory effect on osteoclast function, bone formation coupled with resorption results in an overall reduction in the rate of bone remodeling [85]. Moreover, bisphosphonates may antagonize the action of several matrix metalloproteinase involved in breakdown of structural components of periodontal connective tissue [86]. In view of the antiresorptive properties of bisphosphonates and the ability to inhibit cytokines of periodontal tissue destruction, there has been interest in the possible use of bisphosphonates as an adjunct to scaling and root planning in the management of periodontitis [87, 88]. Although bisphosphonates claim its effectiveness in controlling periodontal destruction, clinical use warrants further evidence. A systematic review concluded that bisphosphonates may be used topically as an adjunct to scaling and root planing [89].

Statins, or inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA reductase), are a group of drugs, used mainly to treat hyperlipidemia. In addition to their cholesterol lowering properties they also have strong anti-inflammatory properties and may stimulate bone growth [90]. Statins have anabolic effects on the bone by augmenting bone morphogenetic protein-2 expression and thereby contributing towards the differentiation and activity of osteoblasts [91]. Due to their activity on bone formation statins have been considered as potential agents in improving periodontal treatment outcomes [92]. Limited data is available on the impact of stains on periodontal tissues suggesting a reduction in periodontal destruction and tooth loss [93]. Experimental studies on rats support the potential protective effect of statins on periodontal bone loss. Although these basic data are interesting, further research could extrapolate the use of statins as a potential adjunctive therapeutic agent in periodontal disease

Anti-platelet drugs are widely used for the treatment of established cardiovascular disease, the prevention of atherothrombotic events and the treatment of myocardial infarction. The most commonly prescribed antiplatelets drugs are aspirin

constitute a risk factor for gingivitis or periodontitis [81].

**64**

Several systemic factors are known to contribute to periodontal diseases or conditions and among those are the intake of drugs. The gingival overgrowth associated with medications occur as a side effect of systemic medications. These medications include the anti-seizure drug phenytoin, the immune suppressor cyclosporin A, and certain anti-hypertensive dihydropyridine calcium-channelblockers, most notably nifedipine. It is crucial that health professionals understand the complications that medications can have on the oral health of their patients. In order to properly diagnose and treat patients, a complete medical history including prescription medications, over the counter drugs and dietary supplements must be recorded which will enable the healthcare team to identify the causative agents.
