Medical Health Encyclopedia

There is growing bacterial resistance to many of these antibiotics, such as roxithromycin and metronidazole, which limits their use in periodontal disease. One study indicated however that 3 months after antibiotic administration, the percentage of bacteria that could be eliminated with standard antibiotics returned to normal.

Direct Delivery of Antibiotics to the Gums

Topical application of antibiotics to the gum surface does not affect the entire body like oral antibiotics do, and they are preferred whenever possible. Studies suggest that in combination with scaling and planing any of these approaches are very effective for periodontal health.

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A number of different topical applications are showing promise. They include the following:

• Atridox is a doxycycline gel that conforms to the gum surface and then solidifies. Over the next few days, it releases the antibiotics.
• Elyzol is a gel or strip applied to the gum that is composed of metronidazole. This agent has unique actions that are effective against parasites as well as bacteria. Studies are suggesting, however, that Atridox, which contains doxycycline, may be more effective than Elyzol. (In one study, however, the doxycycline gel worked faster but metronidazole achieved a greater bacterial reduction.)
• PerioChip is a chip that is placed into the gum pocket after scaling. Over time, it slowly releases chlorhexidine, a powerful bacteria-killing antiseptic. Early studies are reporting benefits in reducing pocket depths, but it is still not known whether these improvements are sustained.
• Minocycline microspheres (Arestin) involve antibiotic contained tiny capsules, which are applied to the gums after scaling and planing. Studies are now reporting that they are more effective in reducing pocket depth and bone loss than standard periodontal maintenance. Patients obtain these benefits regardless of their smoking status, age gender, or extent of the periodontal disease.
• Actisite is a thin strip similar to dental floss, which is treated with tetracycline hydrochloride. The treated thread is temporarily inserted between the tooth and gum. (Using multiple strips may be more beneficial than using a single strip.) This was one of the first topical applications of antibiotics. Other topical approaches are being increasingly used.

Low-Dose and Chemically Modified Tetracyclines