What
Is It?
Antimicrobial
therapy refers to the use of chemical agents that either kill or inhibit
the growth of bacteria that cause
periodontal
(gum) disease. The two most common forms of antimicrobial therapy
are antiseptics and antibiotics. Products containing antiseptics are
usually used to help prevent periodontal disease, while antibiotics are
used to treat periodontal disease. Antiseptics are found in oral rinses.
This article presents information on antibiotics that are placed under
the gums or given as pills, typically in conjunction with a procedure
called
scaling
and root planing.
What's It's Used For
Because periodontal diseases are caused by bacteria, dentists and periodontists
(who specialize in treating gum disease) may use antibiotics to help treat
them. In dentistry, antibiotics are commonly prescribed for the treatment
of an acute (sudden and short-term) infection in the gums called an abscess.
Antibiotics are also used to treat other conditions, including:
- Necrotizing
ulcerative gingivitis (NUG), a rare, aggressive form of periodontal
disease
- Rapidly progressive, aggressive forms of periodontitis (advanced gum
disease)
- Periodontal disease that has not responded to other types of treatment
- Periodontal disease in people who have weakened immune systems or other
serious medical conditions
Antibiotics usually are given to supplement the beneficial effects of scaling
and root planing, a common treatment for periodontal disease. Although many
forms of periodontal disease are successfully treated using this combined
approach, other situations may require additional treatment, including periodontal
surgery.
Because periodontal diseases are caused by bacteria, you may be wondering
why antibiotics aren't considered a routine part of periodontal therapy.
In today's world, health professionals are extremely concerned about bacteria
becoming resistant to the effects of antibiotics. This can happen when antibiotics
are overused or when prescriptions are not taken exactly as instructed by
your dentist or physician. Therefore, because most forms of gingivitis and
periodontitis can be successfully treated without antibiotics, these drugs
are avoided unless absolutely necessary.
Preparation
Once your dentist has decided on an antibiotic, you will have 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 accumulate easily.
Because scaling and root planing, as well as local delivery of antibiotics,
can be somewhat uncomfortable, these procedures usually are done under local
anesthesia. You will be given an injection to numb the area.
How It's Done
Antimicrobial therapy for periodontal disease can be given in pill form or
applied directly. If you are given antibiotics in pill form, you will take
them for 7 to 10 days.
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
called a periodontal pack. After 7 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 7 to 10 days.
- Powder — Your dentist squirts a powder containing
minocycline under your gums. The powder dissolves over three weeks.
Follow-up
Oral therapy
It is extremely important that you practice ideal oral hygiene. Brush
at least twice a day for at least two minutes per session, and floss
at least once a day.
Take your medication exactly as directed for the full amount of time prescribed.
This reduces the risk that surviving bacteria will become resistant to the
medication, and helps to make sure that the medication works as intended.
Local antibiotic
therapy
After the placement of local antibiotics, you may feel something
under your gums, but it shouldn't be uncomfortable. Avoid flossing the treated
teeth so you do not dislodge the medication. Sometimes the dentist will place
a covering called a periodontal pack around the gums. If you receive a periodontal
pack, do not disturb it. Your periodontist will want to examine you again in
7 to 10 days to remove the periodontal pack and/or the remnants of the antibiotic.
After this, you can resume your standard brushing and flossing routine.
Both
types of antimicrobial therapy
Your dentist will check you again 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.
Once you have had successful treatment for periodontal disease, it's important
to help keep the disease under control. Maintenance
therapy involves regular visits to your dentist or periodontist, which
can include:
- Evaluation of your oral hygiene and review of the proper techniques for
brushing and flossing
- A periodontal
examination
- Cleaning and polishing of your teeth
- 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 tell your dentist. If you are not aware of an allergy and experience
any adverse reaction (such as rash, hives or stomach upset) after you have
taken an antibiotic, stop taking the drug and contact your dentist. You may
need to switch to another antibiotic.
Inappropriate use of antibiotics can lead to the bacteria becoming resistant
to the antibiotics' effects. Therefore, it is up to your dental professional
to use antibiotics appropriately. It also is important for you to follow
instructions for taking the medication and take all of the medication prescribed.
When To Call a Professional
Report any side effects of antimicrobial therapy to your periodontist immediately.
©2001-2007 Aetna All rights reserved.
