Local & Systemic Antibiotic Therapy

What is an antimicrobial?

Antimicrobials are substances such as antibiotics, antiseptics and other disinfectants that inhibit or eliminate the growth of a microorganism.  

What are antiseptics?

Antiseptics are chemical disinfectants that are applied at the gum surface or under the gum line to inhibit the growth of microorganisms.  A mouthwash is a type of antiseptic.

What is an antibiotic?

An antibiotic is a substance that is injected or taken orally to eliminate or prevent infection.  It can prevent an existing organism from growing further and destroy current growth.

Some studies suggest that scaling and root planing with antimicrobial support will eliminate the need for periodontal surgery, and that it is a more cost-effective, user-friendly means of periodontal treatment.  However, other recent studies have concluded that surgery may provide a better long-term outcome with less need for additional treatments than non-surgical therapy.  The American Academy of Periodontology (AAP) is concerned that these studies have initiated debate that is confusing for practitioners and patients and may thwart thoughtful discussion and better understanding of the key issue: What is the most effective means to keep periodontal diseases at bay for each individual patient?

Our Office Philosophy: Periodontal health should be achieved in the
least invasive and most cost-effective manner.

AAP treatment guidelines have always stressed that periodontal health should be achieved in the least invasive and most cost-effective manner.  This is often accomplished through non-surgical periodontal treatment, including scaling and root planing (a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins), followed by adjunctive therapy such as systemic and local delivery antimicrobials and host modulation, on a case-by-case basis.  Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment, including surgical therapy.  However, the majority of patients will require ongoing maintenance (re-care) therapy to sustain a stable periodontal condition.  Non-surgical treatment does have its limitations, however, and when it does not achieve periodontal stability, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate more effective oral hygiene practices.

Some studies propose that all patients receive antibiotics at the time of scaling and root planing.  This blanket use of medication is not necessary for most patients, because they usually respond well to non-surgical treatment without antibiotics.  Blanket antibiotic use disregards the Centers for Disease Control (CDC) recommendations for appropriate antibiotic use for healthcare providers.  As healthcare providers, it is important for all periodontists and dentists to consider antibiotic usage guidelines in treatment planning so that the effectiveness of their use is preserved for patients who do not initially respond to therapy.  In this way we avoid contributing to one of the world's most pressing health problems: antibiotic resistance.

The AAP continually monitors emerging research to identify therapies that further its members' understanding of cost-effective, minimally invasive procedures in the treatment of periodontal diseases.  Unfortunately, when the overly simplistic dispute over non-surgical versus surgical procedures arises, it often misleads patients and the dental community into thinking it's an "either-or" debate, when in fact the procedures are complementary.  Each has its own place in treatment, and each has its limitations.

What is Local Delivery of Antimicrobial Drugs (LDD)?

Specific bacteria play a central role in the cause and promotion of destructive gum disease.  Under suitable conditions, the bacteria (bugs) grow under the gum into a mass or colony of bacteria that are strongly embedded to the tooth root surfaces.  This invisible mass or colony is what we call plaque.  Successful treatment of the disease depends on our ability to remove the bacteria from the root and detoxify the root surface.  Scaling and root planing (deep scraping) is the foundation procedure that is designed to transform the toxic root surface into a clean smooth root that can be returned to stable periodontal condition.

After scaling and root planing is completed, routine periodontal maintenance (re-care) therapy is recommended.  In isolated areas of deep pockets during maintenance therapy, antibiotics may be administered to help control or eliminate the bacteria causing periodontal disease.  However, it is important to note that antibiotics alone do not control or eliminate the bacteria; it is the combination of the periodontal maintenance (re-care) therapy and a selective use of antibiotics that promote periodontal stability.  Please ask your periodontist and/or dentists for more information regarding Local Delivery of Antimicrobial Drugs (LDD).

Current brands of LDDs include the following:

• Actisite
• Atridox
• Arestin
• Periochip

*Antibiotics aid in the treatment of periodontal and dental infections.  They are not a cure for periodontal (gum) disease.