Antibiotics and Gum Disease

Gum disease is caused by the action of dental plaque bacteria. The toxins produced by bacteria cause initially the inflammation of the gums and, if not treated, the infection of periodontal tissues results in loss of bone and connective tissues that keep teeth in place and finally in tooth loss. The purpose of antimicrobial treatment is to decrease the amount of bacteria in the mouth that cause periodontal disease.

Antiseptics which are mainly used for prevention and mild gingivitis have bacteriostatic action. They suppress the metabolism of bacteria cells inhibiting or slowing down the growth of dental plaque. Antibiotics have bactericidal action; they work by killing bacteria. Antibiotic therapy is used for the treatment of advanced periodontitis.

However, antimicrobial therapy alone is not enough for eliminating dental plaque or treating gum disease. The preventive action of antiseptics is effective only if combined with daily oral hygiene. Antibiotics can not provide treatment of periodontal disease unless used in conjunction with tooth scaling and root planing and/or surgical gum disease treatments. They are also prescribed for acute types of periodontal disease such as aggressive juvenile periodontitis and acute necrotizing ulcerative gingivitis (ANUG).

Dentists prescribe or use different types of antibacterial therapy depending on the type and stage of gum disease. Antimicrobial medications may be topically applied to a specific area of the mouth, taken internally as a pill or a liquid, or applied in the form of a toothpaste or a mouth rinse.

The type of antibiotic treatment that is more suitable for each case depends upon the types of bacteria in the patient’s mouth. For this reason, sometimes a dentist may take a sample from the infected area and send it to a lab in order to determine the exact type of the harmful bacteria and prescribe the most effective antibiotic for the treatment of periodontal disease.

Different forms of antimicrobial medications include:

Antibacterial toothpaste

Most of the modern toothpastes, especially those against gum disease, include one or more antibacterial ingredients such as triclosan or peroxide. Only low concentrations of antimicrobial agents are allowed in toothpastes. Their role is to minimize the growth of bacteria for some hours until the next tooth brushing.

Antibacterial mouthwash

Many over the counter mouth rinses for everyday use contain similar antibacterial agents like toothpastes. They are both prescribed by dentists in order to help patients in the prevention of periodontal diseases.

Antibiotic mouthwash

Some mouth rinses contain stronger antibiotic medications such as chlorhexidine. These mouthwashes are prescribed for a short period of time, in order to control the population of bacteria in cases of aggressive periodontitis and prevent infections after tooth scaling and root planing or/and after surgical treatment of periodontal disease.

Antibiotic pills or capsules

Antibiotics are usually prescribed for the treatment of dental abscesses. They may be also prescribed for a period of 7 to 10 days to treat moderate to severe periodontitis.

Local antibiotic therapy

In this form of antimicrobial periodontal treatment the dentist places the antibiotic medication directly into the affected mouth tissues. The material dissolves slowly releasing a controlled dose of the antibiotic for a period of a few days.

There are several types of local antibiotic therapy, including:

• Gel – A gel containing antibiotic is injected into periodontal pockets under the gums and sealed with a periodontal pack which is removed after 7 to 10 days along with any remaining gel.
• Atridox is such a gel containing doxycycline.
• Elyzol is a gel applied to the gum that is composed of metronidazole.
• Powder — The dentist places the antibiotic in the form of a powder under the gums. The powder dissolves in about three weeks.
• Chip - Chips containing antibiotic is placed under the gums and into the periodontal pockets. The chip dissolves over 7 to 10 days.
• Periochip is a small piece of gelatin filled with chlorhexidine.
• Actisite is a thread-like fiber similar to dental floss that contains tetracycline hydrochloride.
• Arestin contains tiny round particles with the antibiotic minocycline.

Periostat (Doxycycline)

Periostat is another type of systemic medication, containing doxycycline, that is used in the treatment of gum disease. Doxycycline in low doses has been shown to suppress the overproduction by the immune system of collagenase, an enzyme that destroys the jaw bone and the connective tissues that form the periodontal ligaments that hold teeth in place.

Periostat is taken twice a day for a period up to 12 months. Although doxycycline is an antibiotic, the concentration in Periostat is very low decreasing the risk of bacterial resistance. Periostat can only lower the destructive effects of periodontal disease. Other treatments must be used to eliminate dental plaque and gum infection.

Antibiotic therapy can help in the treatment of periodontal disease but it can not substitute daily oral hygiene. Brushing teeth at least twice a day and flossing are still needed for successful treatment.

• Antibiotic pills - Always take the medication according to the dentist’s instruction. Do not change the recommended dosage or extend the length of treatment.
• Local antibiotic therapy - Some discomfort is expected in the area where the antibiotic is placed. You should avoid brushing and flossing close to that area to avoid removing the periodontal pack or dislodging the antibiotic. A dentist examination is usually arranged after 7 to 10 days. The periodontal pack and any remaining antibiotic are removed.

Allergic reaction to the antibiotic medication is the most important side effect of a antimicrobial periodontal disease treatment. Patients may experience rashes, itchiness, facial swelling and, in severe cases, difficulty breathing, upset stomach, light headedness and drowsiness.

But the major risk, as in any antibiotic treatment, is the development of bacteria strains resistant to antibiotics. It is important that patients follow exactly the instructions of the dentist regarding the doses and length of treatment. The patient must take the antibiotic long enough to kill the harmful bacteria but not for more because that could destroy the natural bacterial flora of the mouth and allow the growth of other types of harmful microorganisms. In both cases there is the risk of bacteria to develop resistance to antibiotics. If more and more bacteria become resistant to antibiotics, bacteria infections in the future will become increasingly difficult to treat.

Most forms of gingivitis and periodontitis can be treated without antibiotics. Therefore, dentists prescribe antibiotics only when absolutely necessary. Topical antibiotic medications do not affect the entire body like oral antibiotics do, and they are preferred in periodontal disease treatment whenever possible.