Periodontal Disease

Antibiotics and Antimicrobials

What Is An Anti-Microbial?

Anti-microbials are substances that will inhibit or eliminate the growth of a microorganism. They include antibiotics, antiseptics and other disinfectants.

What Are Antiseptics?

Antiseptics are chemical disinfectants that are applied at the gum surface or under the gum-line to inhibit the growth of microorganisms. A mouthwash is an antiseptic.

What Is An Anti-Biotic?

An anti-biotic is a substance that is taken orally or is injected and it passes through the entire body in order to get to a site of infection or is used to prevent infection. An antibiotic prevents the existing organism from growing further or destroys the current growth.

Some studies suggest that hand scaling and root planing with anti-microbial support will eliminate the need for periodontal surgery, and that it is a more cost-effective, user-friendly means of periodontal treatment. However, other recent studies have concluded that surgery may provide a better long-term outcome with less need for additional treatments than non-surgical therapy. The American Academy of Periodontology (AAP) is concerned that these studies have initiated debate that is confusing for practitioners and patients and may thwart thoughtful discussion and better understanding of the key issue: what is the most effective means to keep periodontal diseases at-bay for each individual patient?

Periodontal health should be achieved in the least invasive
and most cost-effective manner.

AAP treatment guidelines have always stressed that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment, including scaling and root planing (a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins), followed by adjunctive therapy such as systemic and local delivery antimicrobials and host modulation, as needed and on a case-by-case basis. Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment, including surgical therapy. However, the majority of patients will require ongoing maintenance therapy to sustain health. Non-surgical treatment does have its limitations, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices.

Some studies propose that patients receive antibiotics at the time of hand scaling and root planing. This blanket use

of antibiotics is not necessary for most patients because they usually respond well to non-surgical treatment without antibiotics. Blanket antibiotic use disregards the Centers for Disease Control recommendations for appropriate antibiotic use for healthcare providers. As healthcare providers, it is important for all dentists to consider antibiotic usage guidelines in treatment planning, so that the effectiveness of their use is preserved for patients who do not initially respond to therapy; and to avoid contributing to one of the world's most pressing health problems namely, antibiotic resistance.

The AAP continually monitors emerging research to identify therapies that further its members' understanding of cost-effective, minimally invasive procedures in the treatment of periodontal diseases. Unfortunately, when the overly simplistic dispute over non-surgical versus surgical procedures arises, it often misleads patients and the dental community into thinking it's an "either-or" debate. In fact, the procedures are complementary, with each having their place in treatment, and each having their limitations.