23: Role of Antimicrobial Therapy in Periodontal Diseases

23

Role of antimicrobial therapy in periodontal diseases

Figure 23.1 Advantages and disadvantages of using antimicrobials for periodontal diseases.

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Periodontal disease has a bacterial aetiology and therefore much work has been done to investigate the potential role of antimicrobial drugs in the management of periodontal diseases. Mechanical therapy can not always access all subgingival deposits or reach bacteria that may have invaded soft tissue or dentinal tubules. Also, treated sites can be recolonised by pathogens from non-dental sites. Antimicrobial agents can be delivered by systemic or local routes.

Systemic antimicrobial therapy

Systemic antimicrobial agents have a role in periodontal therapy in a few specific clinical situations:

• Aggressive periodontitis.
• Necrotising ulcerative gingivitis and periodontitis.
• Acute periodontal abscess.

They are not indicated for the treatment of chronic periodontitis.

Aggressive periodontitis

Systemic antimicrobials can be used as an adjunct to root surface debridement. It is important to remove the plaque biofilm in order for antimicrobials to be most effective. Although root surface debridement in these cases can improve the clinical condition, a number of studies have shown that this alone can fail to significantly reduce the number of Aggregatibacter actinomycetemcomitans in the subgingival flora. The use of systemic antimicrobials can be effective in reducing A. actinomycetemcomitans. The effectiveness of treatment may be enhanced if debridement can be completed in a short time period while the drug is being taken.

Antibiotic regimes that are supported by the literature include:

• Tetracycline 250 mg four times daily for 14 days.
• Doxycycline (in the tetracycline family) 200 mg loading; 100 mg daily for 13 days – this is more convenient but there is less evidence of benefit.
• Metronidazole 250 mg (200 mg in UK) + amoxicillin 375 mg (250 or 500 mg in UK) three times daily for 7 days.

Antibiotics can also be used in combination with surgery in aggressive periodontitis.

Necrotising ulcerative gingivitis and periodontitis

• Necrotising ulcerative gingivitis (NUG) is an endogenous infection by mainly anaerobi/>

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Jan 14, 2015 | Posted by in Periodontics | Comments Off on 23: Role of Antimicrobial Therapy in Periodontal Diseases
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