Periodontal disease begins its life in the mouth with inflammation and breakdown from periodontal bacteria. Abundance of periodontal bacteria cause inflammation and infection. So, it makes sense that, antibiotics specifically geared toward periodontal bacteria, could offer some hope in bringing the disease under control. Antibiotics have been used for decades to fight many diseases but it has only been the past few decades where antibiotics have come to the forefront for the treatment of periodontal disease.
Indications For Antibiotic Use In Periodontal Disease
Indications for the use of antibiotic therapy for periodontal disease include the following:
-Rapidly progressive periodontitis
-Chronic periodontitis with persistent severe gingival inflammation
-Refractory forms of chronic or aggressive periodontitis
-Protection from subacute bacterial endocarditis
-When surgical therapy is not an option
-To control local sites of inflammation
-As an adjunct to conventional mechanical therapy
Some of the common antibiotics used include Amoxicillin, Metronidazole, Clindamycin, Doxycycline, and Azithromycin.
Periodontal disease usually can be attacked in many different ways but the main parts are always in place. This includes Professional cleanings along with maintaining good oral hygiene at home. Without those two elements, no amount of antibiotics will help stop the periodontal disease from progressing. The cause of the problem needs to be addressed first and that includes good oral hygiene at home.
Risks Of Antibiotic Use In Periodontal Disease
There are general and specific risks in the use of antibiotic therapy in periodontal therapy.
-Allergic reactions (delayed or immediate hypersensitivity)
-Development of superinfections by unaffected organisms
-Development of resistant bacterial strains
How Are Antibiotics Delivered?
-Low Dose Antibiotics – The theory behind using low dosages of antibiotics is not to kill the bacteria but change the way the body responds to the presence of infection. An important finding after years of research was that certain antibiotics (for example doxycycline) not only kill the periodontal disease causing bacteria but they also reduce the body’s production of collagenase. Collagenase is an enzyme naturally produced in the body that destroys gingival tissues. The main function of collagenase is to remove older tissue so it can be replaced with new tissues which happens over and over again in the course of a lifetime. However, when periodontal disease is present, the body overproduces collagenase causing the body to destroy old tissues as well as healthy tissues.
Doxycycline is one of those antibiotics that can combat collagenase enzymes even in very small doses. Periostat is commonly prescribed in dental offices for periodontal disease. Periostat is in capsule form containing just 20mg of doxycycline. Periostat has been shown to produce a reduction in inflammation with very limited side effects.
-Local Antibiotic Therapy - While systemic antibiotics have a very limited use in treating typical periodontal disease, there has been increased interest in local antibiotic delivery. If an antibiotic can be delivered directly to the pocket, without the patient having to take regular doses, there are far fewer side effects, and fewer chances of resistant bacteria forming. In addition, with direct local delivery, the concentration of the antibiotic at the diseased site can be 100 times greater than taking the medication orally.
The most used local antibiotic therapy includes Atridox, Arestin, and PerioChip.
Usually local delivery antibiotics are used in the Periodontal Maintenance phase of therapy. This is when isolated areas of the mouth seems to be worsening. Their use is generally not recommended during the active phase of treatment. Certain patient seem to respond better than others, so further research is needed.
It is very important to note that using antibiotics is not the main component in attacking periodontal disease. It is used as an adjunct to the traditional staples like professional cleanings and at home dental hygiene maintenance. Getting periodontal disease under control is the first step to maintaining a healthy smile for a lifetime.