**Author details**

Anahita Punj<sup>1</sup> \* and Manav Chaturvedi<sup>2</sup>

1 Department of Periodontics, Army College of Dental Sciences, Secunderabad, India

2 Partha Dental, Hyderabad, India

\*Address all correspondence to: anahitapunj@gmail.com

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**C**

**46**

Br-Bl

Br

Bl-Gy–Br-Bl Bl-Gy–Br-Bl *C, color; Cr, contour; Cs, consistency; T, texture; S, size; P, position; L, lesion; lab and H/P, laboratory procedures and histopathology;* *gingiva; W, white; PR, pink to reddish; B-Br, black to brown; R-Gy, red to gray; RP, reddish pink; BR, bright red; Pi, pink; Pl, pale pink; Pr, purple; Bl, blue; OHI, oral hygiene instruction; CHX, chlorhexidine;*

*increased; , slightly decreased; , decreased; /+, may increase or decrease; =, remains the same.*

**Table 4.**

*Clinical features for diagnosis and treatment of* 

*non-plaque-induced*

 *gingival diseases.*

No change No change No change

=

H/P: discrete granules in

connective tissue

 *add sym, additional symptoms; D, diagnosis; Rx, treatment; FR, fiery red; G, same as surrounding*

No change No change No change

 No change Firm

 No change

=

 Mandibular facial gingiva

> =

Diffuse pigmentation

 No change No change No change

 **Cr**

 **Cs**

 **T**

**S**

=

 **P**

**L**

**Lab & H/P** Pigmented deposits in

the epithelium and

connective tissue H/P: pigmented macules

seen in section

**Add Sym** Addison's disease,

Gingival pigmentation

 Not required

*Oral Diseases*

Albright syndrome,

Peutz-Jeghers

syndrome

Smoker's melanosis

Drug-induced pigmentation (antimalarial,

Cessation of drug if

required

minocycline)

Amalgam tattoo

 Removal of amalgam debris and replacement

of amalgam if required

 *+, slightly increased; ++,*

 Smoking cessation for

2 weeks

**D**

### **References**

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[2] Newman MG, Takei HH, Klokkevold PR, Carranza FA. Newman and Carranza's Clinical Periodontology. 13th ed. Philadelphia: Elsevier Saunders; 2019. pp. 248-302

[3] Caton J, Armitage G, Berglundh T, et al. A new classification scheme for periodontal and periimplant diseases and conditions—Introduction and key changes from the 1999 classification. Journal of Clinical Periodontology. 2018; **45**(Suppl 20):S1-S8. DOI: 10.1111/ jcpe.12935

[4] Chapple ILC. Dental plaque–induced gingival conditions. Journal of Clinical Periodontology. 2018;**45**(Suppl 20): S17-S27. DOI: 10.1111/jcpe.12937

[5] Newman MG, Takei HH, Klokkevold PR, Carranza FA. Newman and Carranza's Clinical Periodontology. 13th ed. Philadelphia: Elsevier Saunders; 2019. pp. 378-396

[6] Mani A, Anarthe R, Marawar PP, Mustilwar RG, Bhosale A. Diagnostic kits: An aid to periodontal diagnosis. Journal of Dental Research and Review. 2016;**3**:107-113

[7] Holmstrup P, Plemons J, Meyle J. Non–plaque-induced gingival diseases. Journal of Clinical Periodontology. 2018; **45**(Suppl 20):S28-S43. DOI: 10.1111/ jcpe.12938

[8] Greenberg MS, Glick M. Burket's Oral Medicine Diagnosis & Treatment. 10th ed. Ontario: BC Decker Inc; 2003. pp. 50-118

[9] Greenberg MS, Glick M. Burket's Oral Medicine Diagnosis & Treatment. 10th ed. Ontario: BC Decker Inc; 2003. pp. 441-490

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**49**

healing at the surgical site.

**Chapter 4**

**Abstract**

enzymes

chronic inflammation.

**1. Introduction**

this process.

Host Modulation

*Wael I. Ibraheem and Reghunathan S. Preethanath*

Host modulation is considered to be new research area in dentistry. In medicine, host modulation was introduced way before dentistry in treating arthritis and osteoporosis. It is mainly focusing on the host part during host-bacteria interaction. Although there are many agents introduced for this purpose, the most well-studied host modulation therapy in dentistry is doxycycline. It shows less tissue destruction when used for few months along with periodontal therapy. It has anticollagenase properties which shows a promising effect when used to treat

**Keywords:** host modulation, doxycycline, anticollagenase, matrix metalloproteinases

Host modulation therapy is a newly introduced term to the field of dentistry. Host refers to the body hosting the disease while modulation refers to changing the

In periodontal diseases, bacteria/microbes are the main pathogen in initiating the disease while the host is the body hosting the bacteria. Host modulation therapy is the chemical agent that can be used as an adjunct to the systematized periodontal therapy to improve the diseased state and inhibit the tissue destruction. As proved in many studies, bacteria cause direct tissue destruction by releasing enzymes and other virulent factors and indirectly by letting the host tissue to release collagenases which in turn destruct the tissue. Host modulation is working on the indirect arm of

Host modulation was introduced in dentistry by William [1] and Golub et al. [2] in the 1990s. Both discussed the idea of having a chemical agent that modulate the host response and improve the periodontal health. The response to the periodontal disease as well as the progression of the periodontal disease varies considerably among individuals. Some patients are susceptible to a disease more than others

Host modulation can be used to reduce levels of enzymes, collagenases, and proinflammatory cytokines. Moreover, it can modify osteoclast and osteoblast activities (**Figure 1**). It has a role in modifiable risk factors (e.g., smoking, diabetes) and unmodifiable risk factors (e.g., genetic susceptibility) as it help the body to overcome those risk factors. In systemic host modulation, it has the effect on multiple sites on the oral cavity with 'sub-antimicrobial-dose doxycycline' (SDD) and locally with agents such as bone morphogenic proteins (BMP) to improve wound

which make, the host modulation therapy preferable in such cases.

status of something in response to external modifier.
