Medications

Antibiotics are being investigated in combination with surgery, curettage, or alone to eliminate or prevent disease-causing bacteria after periodontal procedures. A number of antibiotic treatments are being used to help this problem and are proving to reduce the need for surgery.

They are being investigated in oral forms in short-term standard doses and very doses as well as in topical forms that are applied directly to the gum. Increasingly, dental professionals are finding that local application of antibiotics is more effective than periodontal surgery alone. They may even prove to be an alternative to surgery.

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Some experts are concerned that long-term use of antibiotics increases the risk of bacterial resistance to these drugs, which is a growing health problem in general. Of some encouragement was a 2000 review of four studies, which indicated that low dose antibiotics do not increase the risk of bacterial resistance. However, long-term studies are still needed

Oral Antibiotics at Standard Doses

Antibiotic given orally and at standard doses have some limited applications for periodontal disease. They are typically given for an acute infection. Long-term use of antibiotics is advised for the control of juvenile periodontitis, refractory periodontitis, rapidly progressing periodontitis, and prepubertal periodontitis. Specific antibiotics used in periodontal disease include the following:

• Tetracycline antibiotics, which include tetracycline hydrochloride, doxycycline, and minocycline, are the primary agents used. They not only have anti-bacterial actions, but also, they reduce inflammation and help block collagenase, the protein that destroys connective tissue and bone, even in low doses. In fact, it is these two actions, rather than their antibacterial properties, which seem to contribute most to periodontal protection. Short-term use of standard-dose doxycycline (a ten-day treatment) is used for treating acute periodontal infections and for eliminating inflammation. Topical application and long-term use of these antibiotics are showing particular promise.
• Some macrolide antibiotics (e.g., roxithromycin) may have actions against inflammation and growth involved in periodontal disease.
• Some quinolone antibiotics (e.g., moxifloxacin, ciprofloxacin) may specifically target A. actinomycetemcomitans, an important bacteria in periodontal disease.
• Metronidazole (Flagyl) in combination with tetracycline or amoxicillin (a penicillin). Such combinations may be used for severe and chronic periodontal disease. There is growing resistance to these agents, however.