Systemic Antibiotic Therapy
When given, these antibiotics affect the whole body. Surgeons usually administer them in pill form when used in periodontal treatment. Systemic antibiotics treat acute infections, like gum abscess. They’re also used before treatment when patients have medical conditions such as mitral valve prolapse. We recommend systemic antibiotics for two weeks after regeneration procedures and when implants are placed. This ensures no infection during the healing stages.
Interestingly, the effects of antibiotics do little when treating the infection of periodontal disease. Once antibiotics are discontinued, the bacteria involved reforms immediately. That’s why periodontal cleanings done to remove calculus and plaque appear to be as effective as antibiotics in controlling the infection of the disease.
Systemic antibiotics are rarely of great use for most periodontal conditions. They can, at times, eradicate very specific harmful bacteria in advanced cases. However, in situations where traditional treatments do not produce expected results, the surgeon may culture the mouth to discover the type of bacteria present. This information guides the therapist as to which antibiotic provides the optimal result.
Low Dose Antibiotics
The dose of these antibiotics is so low that instead of killing the bacteria, they actually change the way the body responds to infection.
These antibiotics in particular also reduce the body’s production of collagenase, an enzyme that destroys gingival tissues. When older tissue is removed and replaced with new tissue, we need this special enzyme. Periodontal disease can unfortunately lead to an overproduction of collagenase, forcing the body to destroy healthy gum tissue. We’ve found that extremely small doses of doxycycline can be given to combat these enzymes. These low doses yield a great reduction in the chance of resistant bacterial strains forming with fewer side effects.
Clinical studies prove that patients who take two daily capsules of Periostat, a 20 mg capsule of doxycycline, see a measurable reduction in clinical inflammation. Since the low dosage does not qualify as an antibiotic, there is no known effect on the pocket bacteria. That means that Periostat must be used in conjunction with other therapies that address bacteria removal.
Periodontists have also seen a recent interest in local antibiotic delivery. Antibiotics that can be delivered directly to the pocket results in far fewer side effects and less chance of resistant bacteria forming. Direct local delivery also allows for the concentration of the antibiotic at the diseases site to be 100 times greater than taking the medication orally. Still, these medications are not used as stand-alone treatments and are recommended as adjuncts to scaling and root debridement.
It’s often difficult with local antibiotics to keep them at the site for the several days necessary to kill the bacteria. Normal pocket fluids flush the antibiotic out of the pocket in less than two minutes and simply rinsing the pocket itself does little. Over the last decade, four new products have been developed to allow prolonged drug delivery directly into the pocket. Actisite, a string embedded with tetracycline, has been known to kill many of the bacteria that cause periodontal disease. After placed in the pocket and left for 10 days, high concentrations of tetracycline are released. Inflammation gradually subsides once the string is removed from the pocket. As the tissues tighten around the tooth, the pocket shrinks. The placement of Actisite may cause some minor discomfort, requiring a drop of anesthesia. While in place though, the amount of discomfort is minimal.
Atridox (controlled released doxycycline hyclate, 10%)
The gel-based Atridox can be injected directly into a pocket. Atridox hardens quickly and slowly dissolves over the course of a week, releasing doxycycline. Cases vary in which the entire pocket is filled with the antibiotic.
Atridox comes in two syringes of liquid polymer and doxycycline hyclate, an antibiotic effective against most periodontal pathogens. After the syringes are mixed, the material is injected under the gum and into the pocket. No anesthesia is needed in most cases.
Atridox quickly takes on a wax-like consistency and remains in the pocket for seven days. The material then dissolves and the antibiotic is slowly released.
Super glue may be applied to the gum margin to help prevent the product from extruding from the pocket. To help retention, a periodontal dressing may be placed in some cases. Chlorhexidine is typically recommended and patients should avoid from brushing and flossing this area for two weeks.
Studies have shown that when Atridox is used in conjunction with scaling and planing, patients experience a decreased probing depth, reduced bleeding and improved attachment levels.
This is a thin wafer that contains Chlorhexidine. Although not an antibiotic, Chlorhexidine is a powerful antiseptic and kills most pathogens. PerioChip slides under the gum edge and into the pocket. Over several days, the wafer dissolves and does not have to be removed.
Arestin, the most recent local antibiotic therapy introduced, consists of a derivative of tetracycline. It’s highly effective in killing bacteria thought to cause periodontal disease. Plus, it’s easy to use. Spheres are contained in a small blunt plastic needle and injected into the pocket, without the need for anesthesia. Because the spheres are bioadhesive, they stick to the pocket wall where they slowly release minocycline over a three-week period. The spheres do not require removal since they are biodegradable.
Overall, local delivery antibiotics are used in the periodontal maintenance therapy phase, when isolated areas of the mouth seem to be worsening. Surgeons generally don’t recommend them during the active phase of treatment. Patients should be aware that there is uncertainty with the long-term results of local delivery antibiotics. Your periodontist will advise you whether you would be a good candidate for these treatments.