Since discovery of endothelial-derived relaxing factor EDRF) at 1980, which was named nitric oxide (NO) later, many attempts were done to elucidate the fact and reality of this multi potential molecule. Indeed many controversies are raised when its contrasting role in health and disease status was observed. Up to the current knowledge, this double-edged sword is involved in many pathophysiologic processes with an immunoprotective role to a very potent destructive property. Periodontitis may be reviewed as a localized vasculopathy with possible involvement of the arginine-NO pathway, vascular endothelial growth factor (VEGF) over production and release of reactive oxygen species (ROS) with ultimate tissue damage and bone loss. There is a considerable body of evidence in the medical literature that manipulation of nitric oxide pathway, inhibition of VEGF and reinforcement of antioxidant systems has improved the affected tissue when NO, VEGF or ROS are suspected as causative factors. In this context, possible therapeutic targets to treat periodontitis are discussed with a glance at the current medications for the systemic diseases with somewhat similar underlying pathophysiology to periodontitis. |