Antibiotic combination therapy with 2 antibiotics is used to take advantage of different mechanisms of action and to expand the spectrum of antimicrobial activity. Amoxicillin-metronidazole (250 mg amoxicillin-375 mg metronidazole, 3 times daily for 8 days) is the most common antibiotic combination in periodontics. [ 16]
Full Answer
Which medications are used in the treatment of aggressive periodontitis?
Guerrero A, Griffiths GS, Nibali L, Suvan J, Moles DR, Laurell L, et al. Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive periodontitis: A randomized placebo controlled clinical trial. J Clin Periodontol. 2005;32:1096–107.
Which adjunctive agent (s) should be utilized in periodontal treatment?
Ultimately, clinicians must determine which, if any, adjunctive agent (s) should be utilized in periodontal treatment. Chemotherapeutic agents are used to address the microbial challenge and modulate the host response by targeting elevated levels of pro-inflammatory or destructive mediators.
Which macrolide antibiotics are used for periodontal treatment?
The macrolide antibiotics used for periodontal treatment include erythromycin, spiramycin, and azithromycin. Principle limitation of erythromycin is its poor tissue absorption.
Do antibiotics kill periodontal pathogens?
Although oral bacteria are susceptible to many antibiotics, no single antibiotic at concentrations achieved in body fluids inhibits all putative periodontal pathogens. Indeed, it is suggested that a combination of drugs may be necessary to eliminate all putative pathogens from some periodontal pockets.
What drug is often used for the treatment of periodontitis?
Tetracycline antibiotics – Antibiotics which include tetracycline hydrochloride, doxycycline, and minocycline are the primary drugs used in periodontal treatment. They have antibacterial properties, reduce inflammation and block collagenase (a protein which destroys the connective tissue).
What are three nonsurgical periodontal treatments?
Non-Surgical Periodontal TherapyScaling and Root Planing. ... Localized placement of medications under the gum line to combat “gum” disease. ... Systemic Antimicrobials. ... Laser Therapy.
What are 3 conditions that a periodontist may treat?
Conditions a Periodontist Can TreatPeriodontitist. First and foremost, a “periodontist” treats “periodontitis.” This oral health condition is where the profession derives its name, so you can rest assured that as a periodontist in Kentucky, Dr. ... Gum Recession. ... Bone Loss. ... Loose or Missing Teeth. ... Cosmetic Gum Surgery.
What are the 3 categories of periodontitis?
Three forms of periodontitis have been identified: (1) periodontitis, (2) necrotising periodontitis, (3) periodontitis as a direct manifestation of systemic diseases. A classification system must include complexity and risk factors as well as disease severity.
What are the various types of surgical periodontal therapy?
Three Types of Periodontal SurgeryGingival Flap Surgery. The first type of periodontal surgery is gingival flap surgery, which most patients pertain to as gum lift surgery. ... Mucogingival Surgery. Mucogingival surgery is a more complicated type of periodontal surgery. ... Osseous Surgery.
What is non-surgical periodontal treatment?
Non-surgical periodontal therapy requires a deep cleaning with scaling and root planing. This procedure is a precise cleaning of the root surfaces to eliminate plaque and tartar from those deep periodontal pockets.
How does a periodontist fix receding gums?
To fix receding gums, we can use a procedure called a gum graft. This is a minor surgical procedure that involves taking healthy gum tissue from another part of the mouth and attaching it to where the gums have receded, providing extra tissue to build the gums back up.
Can you reverse deep gum pockets?
The key thing to reversing gum disease is removing the tartar that's present on both the root of your teeth and under your gum line. Periodontitis can't be reversed, only slowed down, while gingivitis can be reversed.
How do you get rid of deep pockets in gums?
Try the following to help prevent periodontal pockets:Brush at least twice daily with a soft-bristle tooth brush or an electric tooth brush.Use a fluoride toothpaste.Use a mouthwash that fights and dissolves plaque.Floss regularly to remove bacteria and food particles from between teeth.More items...
What are the types of periodontal disease?
Periodontal disease is one of the most common diseases in America, affecting nearly 65 million adults over age 30. There are two types of periodontal disease – gingivitis and periodontitis. Each refers to an accumulation of bacteria along the gum line though one is more severe than the other.
What are the AAP classifications?
The Stages are divided into 4 categories: Stage 1-Mild, Stage 2-Moderate, Stage 3-Severe with the potential for tooth loss, and Stage 4-Severe with the potential for dentition loss. The AAP recommends starting by choosing either between Stages 1 and 2, or between Stages 3 and 4.
What is Type 2 periodontal disease?
Stage II periodontitis (moderate disease) patients will have probing depths ≤5 mm, CAL ≤3-4 mm, horizontal bone loss, and will require non-surgical and surgical treatment. No post-treatment tooth loss is expected, indicating the case has a good prognosis going into maintenance.
What is periodontal antibiotic?
During the past two decades, dentists and microbiologists have embraced periodontal antibiotic therapy as a powerful adjunct to conventional mechanical debridement for therapeutic management of the periodontal diseases,[1,2] as the evidence for bacterial specificity in periodontitis has accumulated and strengthened. Antibiotics, are defined as naturally occurring or synthetic organic substances that, in low concentrations, inhibit or kill selective microorganisms.[1]
What are the prime candidates for systemic antimicrobial therapy?
The prime candidates for systemic antimicrobial therapy are those patients exhibiting attachment loss after seemingly adequate conventional therapy, or patients with aggressive forms of periodontitis or associated with predisposing medical conditions or refractory periodontitis. [6] Patients with acute or severe periodontal infections (periodontal abscess, acute necrotizing gingivitis/periodontitis) may also benefit from antibiotic therapy.[3]
How to prevent periodontal attachment loss?
Mechanical and surgical treatment combined with proper oral hygiene measures can arrest or prevent further periodontal attachment loss in most individuals by reducing total supra-subgingival bacterial mass.[4] However, despite diligent dental therapy, some individuals continue to experience periodontal breakdown, may be due to the ability of major periodontal pathogens like Porphyromonasgingivalis, Aggregatibacteractinomycetemcomitans, Fusobacterium-nucleatum, Treponemadenticola, bacteroids, to invade periodontal tissues or to reside in furcations or other tooth structures outside the reach of periodontal instruments, or due to poor host defense mechanisms.[4] In addition, the putative periodontal pathogens (“red complex”) tend to reside in the section of the biofilm attached to the epithelial surface of the periodontal pocket and the patient cannot reach this site during the oral hygiene efforts.[5]
How long does metronidazole last?
The most commonly prescribed regimen is 250 mg tid for 7 days.
Which is more effective, amoxicillin or minocycline?
Minocycline appears to be the most effective antibiotic, which achieves levels that should be completely inhibitory (antibiotic activity = 600%) to most of the periodontal pathogens but may inhibit the growth of beneficial species as well.[10] . Amoxicillin appears almost as effective as minocycline.
What is an antibiotic?
Antibiotics, are defined as naturally occurring or synthetic organic substances that, in low concentrations, inhibit or kill selective microorganisms .[1] The concept of antibiotic periodontal therapy centers upon the pathogenic microbiota, the patient, and the drug.[3] .
Why is systemic antibiotic therapy important?
Therefore, it is important to disrupt this biofilm physically so that the antibiotic agents can have access to the periodontal pathogens.[5]
What is the purpose of regenerative surgery?
The goal of these surgeries is to remove the pockets of space between the teeth and the bone that can be broken down or destroyed with periodontal disease.
How much does it cost to remove tartar from a tooth?
The gums will then be sutured to fit more tightly around the tooth. This procedure typically costs between $1000 and $3000 without insurance.
How much does a bone graft cost?
It will be placed to cover exposed tooth roots. A single procedure for bone or tissue grafts can cost around $600 to $1200. During aftercare, don’t use straws.
What causes periodontal disease?
Periodontal diseases are caused most often by a combination of bacteria and dental plaque. Symptoms may include:
What are the structures that are affected by periodontal disease?
Periodontal diseases are infections in the structures around the teeth, but not in the actual teeth themselves. These structures include the: gums. alveolar bone. periodontal ligament. It can progress from gingivitis, which is the first stage of periodontal disease and only affects the gums, to the other structures.
What is phase 2 of a syringe?
Phase II: The surgical phase. If the more conservative treatments weren’t effective, treatments will move into the surgical phase. This will likely happen if the pockets of infection or plaque and tartar are too deep to clean. This phase will be assessed somewhere between four and eight weeks after the initial treatment.
How to get rid of bacteria in teeth?
Your dentist will carefully detail the oral hygiene practices you need to follow, including brushing your teeth properly and flossing daily. Clean your teeth carefully, making sure not to miss any of the hard-to-reach spots, and use mouthwash to help kill off any leftover bacteria.
What is the best antibiotic for gum disease?
Unlike oral antibiotics, topical treatments deliver relief directly to the affected gum tissue. They can be especially effective when used after deep cleaning procedures like root planing and scaling. Topical antibiotic options come in gel, chip and strip form, and include: 1 Atridox®: This gel conforms to the shape of gum tissue and solidifies, gradually releasing its doxycycline antibiotic medication. 2 PerioChip®: This chip is placed directly into the pockets in gum tissue between the teeth where bacterial colonies grow. A powerful antibacterial, antiseptic chemical called chlorhexidine is slowly released, attacking the infection and reducing pocket depth in many cases of periodontal infection. 3 Actisite®: This thin strip contains tetracycline hydrochloride and resembles dental floss. It is designed to reduce bacteria and pocket depth. The strip is placed between a tooth and infected gum tissue for about 10 days; sometimes multiple threads are placed throughout the mouth. 4 Elyzol®: This unique antibiotic treatment comes in gel and strip form. Equipped with metronidazole, it is able to eliminate both bacteria and parasites. 5 Arestin®: Delivered into the gums after scaling and root planing, this minocycline antibiotic comes in the form of mini-capsules.
How long does actisite last?
It is designed to reduce bacteria and pocket depth. The strip is placed between a tooth and infected gum tissue for about 10 days; sometimes multiple threads are placed throughout the mouth.
What is Arestin delivered into?
Arestin®: Delivered into the gums after scaling and root planing, this minocycline antibiotic comes in the form of mini-capsules.
What is the name of the drug that blocks collagen?
Tetracycline: This family of drugs includes tetracycline hydrochloride, doxycycline and minocycline. They are designed to sooth inflammation and block a protein known as collagenase, which destroys connective tissues that keep teeth rooted in the mouth.
Where is the periochip placed?
PerioChip®: This chip is placed directly into the pockets in gum tissue between the teeth where bacterial colonies grow . A powerful antibacterial, antiseptic chemical called chlorhexidine is slowly released, attacking the infection and reducing pocket depth in many cases of periodontal infection.
Can antibiotics be given in pill form?
Dental antibiotics can be administered in pill form or as a topical gel applied directly into the gum pockets. A prescription may include a low concentration over a long period, or as a strong dose for short-term treatment that deters bacteria recolonization.
Which antibiotic group is best for periodontitis?
Macrolide: This antibiotic group is strong for reducing inflammation and the growth of periodontitis-causing bacteria. Metronidazole: This type of antibiotic is usually paired with amoxicillin or tetracycline, and is designed to combat severe or chronic oral infections by reducing inflammation and bacterial proliferation.
What is the only FDA approved host modulatory agent?
In addition, the only U.S. Food and Drug Administration (FDA)-approved host modulatory agent is a systemically administered subantimicrobial dose of doxycycline (20 mg administered twice daily).
How long does it take for doxycycline to work?
The substantivity of these agents varies from ~7 days for CHX 21 and doxycycline 22 to ~14 to 21 days for minocycline, 23 and patients benefit from the slow delivery of the active ingredient at a higher minimal inhibitory concentration (MIC) than could be achieved by other applications. Site-specific agents have a higher and longer substantivity, and maintain this MIC long enough to reduce the level of pathogens, leading to improvements in the periodontal condition after single or multiple applications.
What are the ingredients in mouth rinses?
The most studied mouthrinses are those containing essential oils, chlorhexidine gluconate (CHX), cetylpyridinium chloride (CPC) and stannous fluoride (SnF 2 ). These agents have been evaluated in preclinical and clinical trials for effectiveness and safety. 7,8 In addition, systematic reviews and meta-analyses help clinicians use evidence-based decision-making when selecting these products. 7,8 All are safe when used as directed. Disadvantages of rinses include taste alterations, staining, burning, and an increase in calculus formation. 9,10 Only mouthrinses containing essential oils carry the American Dental Association (ADA) Seal of Acceptance for the control of plaque and gingivitis. Although some CHX rinses formerly earned the ADA Seal for the control of plaque and gingivitis, the ADA does not currently provide the seal for prescription products. Chemotherapeutic dentifrices in the United States primarily contain triclosan or SnF 2. Here is a brief description of the active ingredients in common chemotherapeutic mouthrinses and dentifrices for the control of plaque and gingivitis.
What are chemotherapeutic agents?
Chemotherapeutic agents are used to address the microbial challenge and modulate the host response by targeting elevated levels of pro-inflammatory or destructive mediators. The term antimicrobial refers to agents that kill microbes or affect the growth and multiplication of microorganisms. 4 Various chemotherapeutic agents, typically in the form of mouthrinses or dentifrices, can help control and reduce supragingival plaque and associated gingivitis. Other agents are available to help control and treat chronic periodontitis, such as locally applied antimicrobials/antibiotics (LAAs) and systemically administered antimicrobials. Desirable qualities in an antimicrobial agent include: 1 Effectiveness against specific pathogens 2 Nontoxicity to oral tissues 3 Will not cause an overgrowth of other organisms 4 Does not contribute to the development of bacterial resistance 5 Substantivity (remains on-site long enough to be effective) 5
What is the best treatment for periodontitis?
Many patients will respond to thorough debridement and self-care therapies; however, for those who do not improve sufficiently or at all — or continue to decline in periodontal health — stronger adjunctive therapies may be necessary. In these cases, clinicians may consider LAAs. At present, three resorbable, site-specific LAA products are FDA approved for treating chronic periodontitis. These include a chlorhexidine-based chip, minocycline microspheres and a doxycycline hyclate gel (Table 1). The chip product is the only antiseptic LAA; it is not an antibiotic. If clinicians recommend an LAA, patients who have an allergy to the tetracycline class of drugs or who are pregnant should use the chip.
What are the disadvantages of mouth rinses?
Disadvantages of rinses include taste alterations, staining, burning, and an increase in calculus formation. 9,10 Only mouthrinses containing essential oils carry the American Dental Association (ADA) Seal of Acceptance for the control of plaque and gingivitis. Although some CHX rinses formerly earned the ADA Seal for the control ...
What is a therapeutic rinse?
Therapeutic rinses designed to reduce plaque and gingivitis contain antiseptic agents. These chemical antimicrobial adjuncts are applied topically or subgingivally to tooth surfaces, the sulcus, mucous membranes, wounds, or intact dermal surfaces to destroy microorganisms and inhibit their reproduction or metabolism. While most antiseptics are bactericidal, some are bacteriostatic.
Why is aggressive periodontitis not responding to conventional therapy?
The presence of periodontal pathogens, specifically A. actinomycetemcomitans, has been implicated as the reason that aggressive periodontitis does not respond to conventional therapy alone. These pathogens are known to remain in the tissues[4] after therapy and re-infect the pocket. The identification of A. actinomycetemcomitansas a major culprit and the discovery that this organism penetrates the tissues offered another perspective to the pathogenesis of aggressive periodontitis and offered new hope for therapeutic success, namely antibiotics. The use of systemic antibiotics was thought to be necessary to eliminate pathogenic bacteria from the tissues.[4]
What is the use of amoxicillin and clavulanate potassium?
It has been found to be useful in the management of localized form of aggressive periodontitis,[11] and also to arrest alveolar bone loss.
What is aggressive periodontitis?
Aggressive periodontitis, by definition, causes rapid destruction of the periodontal attachment apparatus and the supporting alveolar bone. It can present in a localized or generalized form. Two common features of both forms are (1) rapid attachment loss and bone destruction in an otherwise clinically healthy patient and (2) a familial aggregation.[1] These patients often present with limited microbial deposits that seem inconsistent with the severity of tissue destruction. However, the deposits that are present often have elevated levels of Aggregatibacter(formerly Actinobacillus) actinomycetemcomitans,[2] or Porphyromonas gingivalis. These patients may also present with phagocyte abnormalities and a hyperresponsive monocyte/macrophage phenotype. These clinical, microbiological, and immunologic features would suggest that patients diagnosed with aggressive periodontitis would have poor prognosis. The responsiveness of aggressive periodontitis to conventional periodontal treatment is unpredictable, and the overall prognosis for these patients is poorer than for patients with chronic periodontitis.
Why is aggressive periodontitis a challenge?
Aggressive periodontitis is a challenge for the clinician because it is infrequently encountered and the predictability of treatment success varies from one patient to another. These unusual entities often do not respond well to conventional therapy owing to the complex nature of the disease. The best treatment for these patients appears to be a combination of conventional treatment with antimicrobial therapy (systemic and/or local delivery) and close follow-up care. Adjunctive host modulation, although only an emerging are of interest, may prove to be promising in the treatment of patients with aggressive periodontitis.
What is the best treatment for aggressive periodontitis?
A novel approach in the treatment of aggressive periodontitis is the administration of agents that modulate the host response. The use of sub-antimicrobial dose doxycycline (SDD)[18] may help to prevent the destruction of the periodontal attachment by controlling the activation of matrix metalloproteinases, especially collagenase, from both the infiltrating cells and resident cells of the periodontium, primarily neutrophils. SDD, as an adjunct to repeated mechanical debridement, resulted in clinical improvement in patients with generalized aggressive periodontitis. Other agents such as CMT, flubiprofen, indomethacin, and naproxen may reduce inflammatory mediator production. Further research is awaited for the use of such agents.
How long does it take to disinfect your mouth for periodontitis?
The procedure consists of full mouth debridement completed in two appointments within a 24-h period. In addition to scaling and root planing, the tongue is brushed with chlorhexidine gel (1%) for 1 min, the mouth is rinsed with chlorhexidine solution (0.2%) for 2 min, and periodontal pockets are irrigated with chlorhexidine solution (1%). Significant reduction in pocket depth and gain in clinical attachment in patients with aggressive periodontitis up to 8 months after treatment was noted, and also, significant reduction was found in periodontal pathogens up to 8 months after therapy.[17]
What is the prognosis of localized aggressive periodontitis?
Localized aggressive periodontitis usually occurs around the age of puberty and is localized to first molars and incisors.[3] The patient often exhibits a strong serum antibody response to infecting agents, which may contribute to localization of the lesions. When diagnosed early, these can be treated conservatively with OHI and systemic antibiotic therapy, resulting in an excellent prognosis. When more advanced disease occurs, the prognosis can still be good if the lesions are treated with debridement, local and systemic antibiotics, and regenerative therapy. In contrast, patients with generalized form of the disease are also young with generalized interproximal attachment loss and a poor antibody response. Secondary contributing factors such as cigarette smoking are often present. These factors, coupled with alteration in host defense seen in many of these patients, may result in a case that does not respond well to conventional periodontal therapy (scaling with root planing, oral hygiene instruction, and surgical intervention). Therefore, these patients often have a fair, poor, or questionable prognosis, and the use of systemic antibiotics should be considered to help control the disease.
What are the drawbacks of topical antibiotics?
The chief drawbacks of topical antibiotic therapy are an insufficient range of antimicrobial activity for even broad-spectrum antibiotics, a modest and transient clinical effect, possible development of resistant bacteria, adverse host reactions, and high acquisition costs.
What are the dosing recommendations for antibiotics?
The dosing recommendations are for healthy adults with normal weight and must be adjusted for body size to ensure optimal therapeutic effectiveness and safety. Interactions with other medications, toxicity, and hypersensitivity may restrict antibiotic use in individual patients.
What is the best antibiotic for periodontitis?
Amoxicillin-metronidazole (250 mg amoxicillin-375 mg metronidazole, 3 times daily for 8 days) is the most common antibiotic combination in periodontics. [ 16] . Ciprofloxacin-metronidazole (500 mg of each, twice daily for 8 days) is indicated for periodontitis involving a mixture of enteric gram-negative facultative rods and anaerobic bacteria.
What is the tradition of dentistry?
The tradition in dentistry is to treat empirically (eg, institute antibiotic therapy on the basis of the "best estimate" of the most probable pathogen or pathogens and the usual antibiotic susceptibility pattern of the suspected pathogen or pathogens).
What is systemic antibiotic therapy?
Systemic antibiotic therapy for periodontitis aims at reducing or eradicating specific periodontopathic bacteria that are not readily reached by topical therapy , such as pathogens in gingival tissue, in furcation defects, at the base of periodontal pockets, and on the tongue, tonsils and buccal mucosa. The selection of effective and safe antibiotics can be challenging because periodontitis lesions usually harbor a constellation of periodontopathic bacteria that have diverse susceptibility profiles. [ 16] The tradition in dentistry is to treat empirically (eg, institute antibiotic therapy on the basis of the "best estimate" of the most probable pathogen or pathogens and the usual antibiotic susceptibility pattern of the suspected pathogen or pathogens). Microbiological testing with antimicrobial susceptibility profiling allows dentists to move from a trial and error approach to the more predictable targeted therapy, but susceptibility testing depends on complex and relatively expensive culture methods in a reference laboratory.
Does Valacyclovir help with periodontitis?
Valacyclovir (500 mg, twice daily for 10 days) may be prescribed for patients with severe periodontitis, which is virtually always associated with a herpesvirus infection. [ 18] .
How does doxycycline work?
Doxycycline works by preventing the growth of bacteria. Doxycycline periodontal system is placed by your dentist into deep gum pockets next to your teeth and dissolves naturally over seven days. The time release of this medication may continue to occur even after it has dissolved.
What is the best antibiotic for gum disease?
Drugs to Control Plaque and Gingivitis. Chlorhexidine is an antibiotic drug used to control plaque and gingivitis in the mouth or in periodontal pockets (the space between your gum and tooth).
What is the best way to prevent tooth decay?
Drugs Used to Prevent Tooth Decay. Fluoride is a drug used to prevent tooth decay. It is available on a nonprescription basis in many toothpastes. It is absorbed by teeth and helps strengthen teeth to resist acid and block the cavity-forming action of bacteria.
How to review your prescription?
Review the drug information sheet that comes with each prescription. Write down any side effects you have, and call your dentist to discuss them. Update and review your history every time you see your dentist.
What questions should I ask my dentist?
Questions to Ask Your Dentist or Your Pharmacist About Your Medication 1 What is the name of the medication? 2 Why do I need to take it? 3 How often should I take it? 4 What time of day should I take it? 5 Should I take it on an empty stomach or with meals? 6 Where should I store the medication? 7 What should I do if I forget to take a dose? 8 How long should I expect to take the medication? 9 How will I know it is working? 10 What common side effects should I expect? 11 Are there any rare but serious side effects to watch for? 12 Will the medication interfere with driving, working, or other activities? 13 Does the medication interact with any foods, alcohol or other beverages, or other medications, vitamins, supplements, over-the-counter products, herbal products, or eyedrops?
Why do dentists give you analgesics?
Dental analgesics are used in the mouth to relieve pain or irritation caused by many conditions, including toothache and sores in or around the mouth (such as cold sores, canker sores, and fever blisters ). Also, some of these medicines are used to relieve pain or irritation caused by dentures or other dental appliances, including braces.
What is the best way to get rid of bad breath?
Your dentist may recommend the use of an over-the-counter antiseptic mouth rinse product to reduce plaque and gingivitis and kill the germs that cause bad breath.