Antimicrobial Therapy

What Is It?
What It's Used For
Preparation
How It's Done
Follow-up
Risks When To Call a Professional

What Is It?

Antimicrobial therapy is the use of chemicals to kill or slow down the growth of bacteria that cause periodontal (gum) disease. The two most common forms of this therapy are antiseptics and antibiotics.

Antiseptics are found in mouth rinses. They usually are used to help prevent periodontal disease.

Antibiotics are used to kill specific bacteria. They are placed under the gums or given as pills to treat gum disease. Antibiotic pills typically are given only for acute (sudden and short-term) infections. Acute and long-term (chronic) gum infections require a procedure called scaling and root planing. Some people also need periodontal surgery.

One of the newest ways to kill bacteria is laser therapy. Dentists now use lasers to kill bacteria in the gum pockets around teeth. This treatment also seems to stimulate healing.

What It's Used For

Periodontal disease is caused by specific types of bacteria. Killing these bacteria can help to prevent and treat the disease.

Antiseptics
Bacteria can grow and form clusters or colonies on the tongue and tonsils and in the saliva. Mouth rinses can control the excess growth of bacteria. The goal is to prevent them from causing disease. These rinses contain:

• Alcohol
• Chlorhexidine
• Povodine iodine
• 0.1% sodium hypochloride

Rinses also can be used at home to wash out the pockets around the teeth with irrigation devices.

Antibiotics
Dentists often prescribe antibiotics to treat an acute gum infection called an abscess. A periodontist also may use antibiotics for some cases of gum disease that are hard to treat. They include:

• Necrotizing ulcerative gingivitis (NUG), a rare form of periodontal disease that becomes severe very quickly
• Severe forms of periodontitis (advanced gum disease)
• Periodontal disease that has not improved with other types of treatment
• Periodontal disease in people who have weakened immune systems

The type of antibiotic prescribed depends upon the exact type of the bacteria. Several antibiotics have been used to treat aggressive periodontal disease. They include:

• Penicillins
• Tetracyclines-HCL
• Doxycycline
• Metronidazole
• Ciprofloxacin
• Clindamycin

Most of the time, the first treatment for periodontal disease is scaling and root planing. This combined approach can successfully treat many forms of periodontal disease.

Bacteria cause periodontal diseases, but dentists don't routinely use antibiotics to treat them. That's because today many bacteria can resist antibiotics. This makes it harder to cure some infections. Resistance develops when antibiotics are used too much or when people don't take them exactly as instructed. Most forms of gingivitis and periodontitis can be treated without antibiotics. Therefore, dentists avoid using them unless absolutely necessary.

Preparation

First, you will have scaling and root planing. This procedure removes plaque and calculus (tartar) from under your gum line and along exposed roots. Plaque can build up easily in these areas.

Scaling and root planing can be somewhat uncomfortable. That's because it is designed to remove diseased gum tissue as well as debris and calculus. Therefore, you will be given a shot to numb the area.

How It's Done

Your dentist may prescribe a specific antiseptic rinse. You can buy some rinses over the counter. You do not need a prescription for them.

If you are given antibiotics in oral (pill) form, you will take them for 7 to 10 days.

Your dentist also can place an antibiotic directly into the affected parts of your mouth. This is called local therapy. It can take several forms, 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.
• Powder — Your dentist squirts a powder containing minocycline under your gums. The powder dissolves over three weeks.

Periostat is another type of pill that sometimes is used. It contains doxcycline at very low levels. It does not kill bacteria. Instead, it reduces the body's immune-system response to the bacteria. This response is what causes gums and bone to become inflamed and damaged. Reducing the immune response helps to stop bone from dissolving. Patients usually take Periostat for 6 months or more to control bone loss.

If your dentist owns a dental laser, it will be used after root planing and scaling. The dentist places the laser tip in the space between your tooth and gum, then moves it around the entire tooth. This process begins from the base of each pocket. The dentist can treat your whole mouth at one time. This will eliminate the bacteria in the pockets throughout your mouth.

Follow-up

Oral therapy
It is extremely important that you take ideal care of your teeth and gums. Brush at least twice a day. Brush for at least two minutes each time. Floss at least once a day.

Take your medicine exactly as directed. Take it for the full amount of time prescribed. This reduces the risk that surviving bacteria will become resistant to the medicine. Preventing resistance will help to make sure that the medicine works.

Local antibiotic therapy
After antibiotics are placed, you may feel something under your gums, but it shouldn't be uncomfortable. Avoid flossing the treated teeth so you do not dislodge the medicine. 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 dentist will examine you again in 7 to 10 days. He or she will remove the periodontal pack and any remaining antibiotic. After this, you can resume your standard brushing and flossing routine.

All types of antimicrobial therapy Your dentist will check you again after two or three months to see if the treatment helped. If not, the next step will depend on several factors, including the severity of your disease. Your dentist may need to prescribe a different antibiotic. Or you may need gum surgery.

It's important to help keep your periodontal disease under control. You will need to make regular visits to your dentist or periodontist. These visits can include:

• Evaluation of your brushing and flossing, and advice on ways to improve
• A periodontal examination, which measures the height of bone around each tooth
• Cleaning and polishing of your teeth
• X-rays every few years

Risks

The major risk of antibiotic treatment is an allergic reaction to the medicine. Be sure to tell your dentist if you are allergic to certain antibiotics. If you have a rash, hives, stomach upset or other reaction after you take an antibiotic, stop taking it. Contact your dentist. You may need to switch to another drug.

Both you and your dentist can help to prevent bacteria from becoming resistant to antibiotics. It is up to your dentist to use antibiotics appropriately. Your role is to follow instructions and take all of the medicine as prescribed.

When To Call a Professional

Report any side effects to your dentist right away.