Antimicrobial Therapy For Periodontal Disease

Because periodontal diseases are basically due to bacterial infections, periodontists occasionally use antibiotics to treat them. Abscesses ("gum boils") are probably the most common situation for which your periodontist might prescribe antibiotics. Other circumstances that might warrant their use are very severe forms of periodontitis or poor responses to conventional modes of periodontal therapy. If antibiotics are indicated, your periodontist will prescribe one of the medications that are known to be effective against the bacterial organisms that cause periodontal disease. You should not take antibiotics left over from your last throat infection or any other prescription antibiotic that has not been specifically prescribed by the periodontist to treat gum disease.

What It Involves

Periodontal antibiotic treatment can be administered two ways: locally and systemically.

Local antibiotic treatments are those that are applied directly to the infected area, much as you might put an antibiotic cream on a finger cut. Common reasons for the use of local antibiotic treatments include periodontal infections involving one or a few teeth in an otherwise healthy mouth or recurrence of disease following periodontal treatment. Because saliva would wash away any typical cream or ointment, the delivery methods for local antibiotics are cleverly devised. One of the more popular locally-delivered products is a doxycycline-containing gel that is injected into a periodontal pocket and then eventually hardens. Your periodontist may cover the treated teeth with a periodontal pack. Over the next seven to 10 days, the antibiotic is slowly released, helping to eliminate the bacterial infection. Typically, locally delivered antibiotics are inserted after the teeth have been treated with scaling and root planing.

Systemic antibiotic treatments are those taken by pill. They are called systemic because they affect the whole system (body). The pill is dissolved in the stomach and the antibiotics are absorbed into the bloodstream and circulated throughout the body. The benefit is that the antibiotic can kill bacteria anywhere in the mouth (as well as throughout the body), including any bugs hiding deep in the pockets or elsewhere in the mouth. Because there are several different types of bacteria in the mouth that can cause periodontitis, the doctor often will take a sampling of the plaque in your mouth, send it to a laboratory for testing, and then prescribe an antibiotic effective against the particular bacteria in your mouth.

Discomfort Factor The insertion of locally delivered antibiotics may cause some pain and is therefore usually done under local anesthesia. Following the placement, you may feel something under your gums, but it shouldn't be uncomfortable.

Aftercare As with all other forms of periodontal therapy, practicing ideal oral hygiene is a must. This is not a problem when systemic antibiotics have been prescribed. In the case of locally delivered antibiotics, if a periodontal pack has not been placed, you will want to gently clean the treated teeth so as not to disturb the medication. Your periodontist will want to reexamine you seven to 10 days after placement of a locally-delivered antibiotic and remove any residual pieces of the hardened medication. For systemic antibiotics, the medication needs to be taken exactly as directed for the full amount of time prescribed in order to lessen the risk that surviving bacteria may become resistant to those medications and to assure that the medication works as intended. Report any side effects to your periodontist immediately.

Side Effects Of Treatment

Antibiotics can cause side effects in some people. The most common side effects are nausea, diarrhea and stomach upset. An allergic reaction, mainly a rash and itching, can occur. Make sure your periodontist is aware of any medication allergies you may have. If you are concerned about any side effects, contact your periodontist.

Antimicrobial Therapy For Periodontal Disease

Antimicrobial therapy is the use of antibiotics to help fight periodontal (gum) disease which is caused by certain oral bacteria. Typically, antibiotics are used in conjunction with scaling and root planing. Some dentists use antimicrobial therapy only as a last resort, while others use it more frequently. In some cases, antimicrobial therapy can eliminate the periodontal disease. In others, periodontal surgery still is needed.

Most people with periodontal disease do not receive antimicrobial therapy. This form of therapy generally is used for certain situations, including:

Necrotizing ulcerative gingivitis (NUG), a rare, aggressive form of periodontal disease that occurs mostly in people aged 15 to 35
Rapidly progressive periodontal disease
Periodontal disease that has not responded to other types of treatment
Patients who have weakened immune systems or other serious medical conditions

Types Of Antimicrobial Therapy
Some of the antibiotics used to treat periodontal disease include penicillin (sold under numerous brand names), amoxicillin (Amoxil, Trimox and other brand names), metronidazole (Flagyl and other brand names), amoxicillin with clavulanic acid (Augmentin), tetracycline (sold under numerous brand names), doxycycline (Atridox, Doxy-Caps, Vibramycin and others), chlorhexidine (Peridex, PerioGard, PerioChip), minocycline (Arestin, Dynacin, Minocin), clindamycin (Cleocin) and ciprofloxacin (Cipro, Floxin).

Before choosing which antibiotic to use, your dentist may decide to take a sample of the bacteria in your mouth and send it to a lab. The lab grows the bacteria, identifies them, and determines which antibiotics work best against them. Your dentist or periodontist will then use this information to prescribe the antibiotic that is most effective for your infection.

Antimicrobial therapy for periodontal disease can be given systemically or locally. Systemic therapy involves taking antibiotic pills over seven to10 days. The antibiotic is distributed throughout your body by your bloodstream.

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 to prevent leakage. After seven 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 seven to 10 days.
Powder — Your dentist squirts a powder containing minocycline under your gums. The powder dissolves over a three-week period.
Ribbon — Your dentist places a flosslike fiber under your gums that slowly releases tetracycline. The ribbon is removed after about 10 days.

Antimicrobial therapy usually lasts one to two weeks. Once your dentist has decided on an antibiotic, you first will undergo 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 easily accumulate.

After scaling and root planing, your dentist will prescribe antibiotic pills or administer some type of local antimicrobial therapy.

Aftercare
Your dentist will recheck you 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. Others need to be on long-term antibiotic therapy to keep their disease under control.

Once you have undergone successful treatment for periodontal disease, it's important to help prevent recurrence. Maintenance therapy involves regular visits to your dentist or periodontist; this is usually every two to four months for people treated for periodontitis and every six months for people treated for gingivitis. The office visits can include:

Cleaning and polishing of your teeth
Evaluation of your oral hygiene and review of the proper techniques for brushing and flossing
A periodontal examination. If periodontal disease is found, your dentist or periodontist will decide how to treat it
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 inform your dentist. If you are unaware of an allergy and experience any adverse reactions (such as rash, hives or stomach upset) after you have taken an antibiotic, immediately stop taking the drug and contact your dentist. In many situations, you will need to switch to another antibiotic.

As with other types of infections, inappropriate use of antibiotics can lead to organisms becoming resistant to the effects of these medications. Therefore, it is up to your dental professional to use antibiotics judiciously. It also is important for you to follow instructions for taking the medication and take all of the medication prescribed.

Maintenance Therapy

Periodontal disease is a chronic problem and can recur without regular dental care and careful attention to oral hygiene at home. Therefore, one of the keys to successful surgical or nonsurgical treatment for periodontal disease is regular follow-up care.

Maintenance therapy appointments are usually one-visit sessions with your dentist or periodontist or their hygienists. These visits can be scheduled between two and four times a year depending on the severity of your periodontal condition, whether you have a history of recurrent periodontal disease, and whether you demonstrate an increased susceptibility to the disease. You also may need more frequent visits if you smoke or have a systemic disease that increases your risk of periodontal disease.

A typical maintenance visit will include:

A periodontal examination
Evaluation of the amount of plaque on your teeth and your oral hygiene; a review of the proper techniques for brushing, flossing or other cleaning techniques, when needed
Cleaning and polishing of your teeth, including the removal of plaque, calculus (tartar) and stains
X-rays, if needed
Treatment to manage tooth sensitivity, if needed

If you have teeth that are very sensitive, your dental professional may need to apply a dental anesthetic in order to clean them. Either a topical or an injectable anesthetic can be used.

If your dentist or periodontist determines during your maintenance appointment that your periodontal disease is recurring, he or she will discuss appropriate treatment with you. Proper follow-up care should minimize the likelihood of the disease recurring. Also, if your disease does recur, it tends to be extremely localized and more easily treated than in people who forgo maintenance care for long periods of time.

Goals Of Periodontal Treatment

Gum disease is the main reason people need periodontal treatment, but other gum conditions require treatment, too. Here is an overview of treatment for various conditions.

Treatment Of Gum Disease

Gum (or periodontal) disease includes a number of conditions caused by bacterial infections of the soft tissue and bone that supports the teeth within jawbones. The disease can cause destruction of this tissue and bone, and can lead to tooth loss.

A combination of professional treatment and your efforts can stop the progression of gum disease and prevent further tissue destruction. Depending on the stage of gum disease, treatment ranges from a thorough cleaning to sophisticated types of dental surgery.

Treatment at any stage of periodontal disease can make your gums healthier. Some people assume that losing teeth is a natural part of aging, but if you work with your dental professional to keep your gums healthy, you should be able to keep your teeth for a lifetime.

The main goals of periodontal treatment are to:

Eliminate the bacterial infections that cause gum disease
Control the inflammatory process that is responsible for destruction of the tissues anchoring the teeth to the jawbones
Create a healthy periodontal environment that is easy for you and your dental professional to maintain

The earliest stage of gum disease, gingivitis, usually can be stopped before it causes significant destruction of soft tissue or bone. Your general dentist can treat most cases of gingivitis with a combination of in-office cleanings and instruction in good oral hygiene.

In some people, gingivitis will progress to the more advanced stages of gum disease that involve loss of the structures that anchor the teeth to the jawbones. These more advanced stages are known as periodontitis and usually require more aggressive forms of treatment than gingivitis. In this case, it is likely that your dentist will refer you to a periodontist (a gum specialist) for treatment.

Treatment Of Gum Recession
Gums can recede, or shrink, even if there's no bacterial infection. One of the main causes of gum recession is improper brushing. Using a hard- or medium-bristled toothbrush can cause gums to wear away. Using too much force can also cause gums to recede over time. As the gums recede, the roots of the teeth are exposed to the oral environment. This may cause the teeth to become sensitive to hot and cold temperatures. In addition, teeth with significant amounts of gum recession are more prone to developing root cavities. Periodontists can treat recession by taking gum tissue from one part of your mouth and moving it to the area where the gums have receded. This is known as a soft-tissue graft.

Treatment Of Gum Overgrowth
For some people, the problem isn't too little gum tissue, but too much. Some people have what is known as a "gummy smile," in which the teeth look very small and the gums seem very large. Also, some medications, such as phenytoin (Dilantin and other brand names), cyclosporine (Neoral, Sandimmune) and nifedipine (Adalat, Cardizem), can cause an overgrowth of gum tissue. Periodontists can remove excess gum tissue through a procedure known as gingivectomy.