Antimicrobial Therapy for Periodontal Disease

What Is It?

Antimicrobial therapy refers to the use of chemical agents that either kill or inhibit the growth of bacteria that cause periodontal (gum) disease. The two most common forms of antimicrobial therapy are antiseptics and antibiotics. Products containing antiseptics are usually used to help prevent periodontal disease, while antibiotics are used to treat periodontal disease. Antiseptics are found in oral rinses. This article presents information on antibiotics that are placed under the gums or given as pills, typically in conjunction with a procedure called scaling and root planing.

What It’s Used For

Because periodontal diseases are caused by bacteria, dentists and periodontists (who specialize in treating gum disease) may use antibiotics to help treat them. In dentistry, antibiotics are commonly prescribed for the treatment of an acute (sudden and short-term) infection in the gums called an abscess. Antibiotics are also used to treat other conditions, including:

• Necrotizing ulcerative gingivitis (NUG), a rare, aggressive form of periodontal disease
• Rapidly progressive, aggressive forms of periodontitis (advanced gum disease)
• Periodontal disease that has not responded to other types of treatment
• Periodontal disease in people who have weakened immune systems or other serious medical conditions

Antibiotics usually are given to supplement the beneficial effects of scaling and root planing, a common treatment for periodontal disease. Although many forms of periodontal disease are successfully treated using this combined approach, other situations may require additional treatment, including periodontal surgery.

Because periodontal diseases are caused by bacteria, you may be wondering why antibiotics aren’t considered a routine part of periodontal therapy. In today’s world, health professionals are extremely concerned about bacteria becoming resistant to the effects of antibiotics. This can happen when antibiotics are overused or when prescriptions are not taken exactly as instructed by your dentist or physician. Therefore, because most forms of gingivitis and periodontitis can be successfully treated without antibiotics, these drugs are avoided unless absolutely necessary.

Preparation

Once your dentist has decided on an antibiotic, you will have scaling and root planing. This procedure removes plaque and calculus (tartar) from under your gum line and smoothes any bumps or irregular areas on your tooth roots, where plaque can accumulate easily.

Because scaling and root planing, as well as local delivery of antibiotics, can be somewhat uncomfortable, these procedures usually are done under local anesthesia. You will be given an injection to numb the area.

How It’s Done

Antimicrobial therapy for periodontal disease can be given in pill form or applied directly. If you are given antibiotics in pill form, you will take them for 7 to 10 days.

Local therapy is given in the dentist’s chair and involves placing the antibiotic directly into the affected parts of your mouth. There are several types of local therapy, including:

• Gel — Your dentist injects a gel containing doxycycline under your gums. The area is sealed and covered with a special bandage called a periodontal pack. After 7 to 10 days, your dentist removes the bandage and any remaining gel.

• Chip — Your dentist places a chip containing chlorhexidine under your gums. The chip dissolves over 7 to 10 days.

• Powder — Your dentist squirts a powder containing minocycline under your gums. The powder dissolves over three weeks.

Follow-up

Oral therapy

It is extremely important that you practice ideal oral hygiene. Brush at least twice a day for at least two minutes per session, and floss at least once a day.

Take your medication exactly as directed for the full amount of time prescribed. This reduces the risk that surviving bacteria will become resistant to the medication, and helps to make sure that the medication works as intended.
Local antibiotic therapy
After the placement of local antibiotics, you may feel something under your gums, but it shouldn’t be uncomfortable. Avoid flossing the treated teeth so you do not dislodge the medication. Sometimes the dentist will place a covering called a periodontal pack around the gums. If you receive a periodontal pack, do not disturb it. Your periodontist will want to examine you again in 7 to 10 days to remove the periodontal pack and/or the remnants of the antibiotic. After this, you can resume your standard brushing and flossing routine.

Both types of antimicrobial therapy
Your dentist will check you again after two or three months to see if the therapy is helping. If your disease does not respond to antibiotics, the next step will depend on several factors, including the severity of your disease. Your dentist can prescribe a different antibiotic or schedule periodontal surgery. Some people may receive several rounds of antibiotics before their disease responds.

Once you have had successful treatment for periodontal disease, it’s important to help keep the disease under control. Maintenance therapy involves regular visits to your dentist or periodontist, which can include:

* Evaluation of your oral hygiene and review of the proper techniques for brushing and flossing
* A periodontal examination
* Cleaning and polishing of your teeth
* X-rays every few years

Risks

The major risk of antibiotic therapy is an allergic reaction to the medication. If you know you are allergic to certain antibiotics, it is important that you tell your dentist. If you are not aware of an allergy and experience any adverse reaction (such as rash, hives or stomach upset) after you have taken an antibiotic, stop taking the drug and contact your dentist. You may need to switch to another antibiotic.

Inappropriate use of antibiotics can lead to the bacteria becoming resistant to the antibiotics’ effects. Therefore, it is up to your dental professional to use antibiotics appropriately. It also is important for you to follow instructions for taking the medication and take all of the medication prescribed.

When To Call a Professional

Report any side effects of antimicrobial therapy to your periodontist immediately.

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