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Periodontal disease begins its life in the mouth with inflammation and breakdown from periodontal bacteria. Abundance of periodontal bacteria  cause inflammation and infection. So, it makes sense that, antibiotics specifically geared toward periodontal bacteria, could offer some hope in bringing the disease under control. Antibiotics have been used for decades to fight many diseases but it has only been the past few decades where antibiotics have come to the forefront for the treatment of periodontal disease.

Indications For Antibiotic Use In Periodontal Disease

Indications for the use of antibiotic therapy in periodontal disease include the following:

-Periodontal abscess

-Juvenile periodontitis

-Rapidly progressive periodontitis

-Chronic periodontitis with persistent severe gingival inflammation

-Refractory forms of chronic or aggressive periodontitis

-Protection from subacute bacterial endocarditis

-When surgical therapy is not an option

-To control local sites of inflammation

-As an adjunct to conventional mechanical therapy

Some of the common antibiotics used include Amoxicillin, Metronidazole, Clindamycin, Doxycycline, and Azithromycin.

Periodontal disease usually can be attacked in many different ways but the main parts are always in place. This includes Professional cleanings along with maintaining good oral hygiene at home. Without those two elements, no amount of antibiotics will help stop the periodontal disease from progressing. The cause of the problem needs to be addressed first and that includes good oral hygiene at home.

Risks Of Antibiotic Use In Periodontal Disease

There are general and specific risks in the use of antibiotic therapy in periodontal therapy. These include:

-Allergic reactions (delayed or immediate hypersensitivity)

-Gastrointestinal problems

-Development of superinfections by unaffected organisms

-Development of resistant bacterial strains

How Are Antibiotics Delivered?

-Low Does Antibiotics – The theory behind using low dosages of antibiotics is not to kill the bacteria but change the way the body responds to the presence of infection. An important finding after years of research was that certain antibiotics (for example doxycycline) not only kill the periodontal disease causing bacteria but they also reduce the body’s production of collagenase. Collagenase is an enzyme naturally produced in the body that destroys gingival tissues. The main function of collagenase is to remove older tissue so it can be replaced with new tissues which happens over and over again in the course of a lifetime. However, when periodontal disease is present, the body overproduces collagenase causing the body to destroy old tissues as well as healthy tissues.

Doxycycline is one of those antibiotics that can combat collagenase enzymes even in very small doses. Periostat is commonly prescribed in dental offices for periodontal disease. Periostat is in capsule form containing just 20mg of doxycycline. Periostat has been shown to produce a reduction in inflammation with very limited side effects.

-Local Antibiotic Therapy - While systemic antibiotics have a very limited use in treating typical periodontal disease, there has been increased interest in local antibiotic delivery. If an antibiotic can be delivered directly to the pocket, without the patient having to take regular doses, there are far fewer side effects, and fewer chances of resistant bacteria forming. In addition, with direct local delivery, the concentration of the antibiotic at the diseased site can be 100 times greater than taking the medication orally.

The most used local antibiotic therapy includes Atridox, Arestin, and PerioChip.

Usually local delivery antibiotics are used in the Periodontal Maintenance phase of therapy. This is when isolated areas of the mouth seems to be worsening. Their use is generally not recommended during the active phase of treatment. Certain patient seem to respond better than others, so further research is needed.

Conclusion

It is very important to note that using antibiotics is not the main component in attacking periodontal disease. It is used as an adjunct to the traditional staples like professional cleanings and at home dental hygiene maintenance. Getting periodontal disease under control is the first step to maintaining a healthy smile for a lifetime.

Cosmetic dentistry gives the dentist the ability to mask tetracycline staining. Tetracycline, doxycycline, minocycline are types of antibiotic that are absorbed into developing teeth causing deep stains (tetracycline staining). If tetracycline is taken by someone during functional tooth development years (age 3-10), tetracycline stains are likely to occur. Permanent teeth start developing at around three years of age and continue into the teenage years (last teeth to erupt are the wisdom teeth).  Once the teeth erupt into the mouth,

they are no longer susceptible to tetracycline staining.  A teenager can take the antibiotic and not get tetracycline staining. This is not the case for a younger person with teeth developing inside the jaw. They will get permanent tetracycline staining. Because of this, the medical community has stopped prescribing tetracycline to children under the age of 10 years old or to pregnant women (whose developing baby can also be affected by tetracycline staining). The stains have no medical implications but are very unaesthetic. Tetracycline leaves behind a dark stain that can be either striated in nature or cover the entire tooth surface. Tetracycline stained teeth are usually brown or grayish in color.

When tetracycline was approved for human use, it was not known that tetracycline would permanently stain teeth in development.  Tetracycline was developed as an alternative to Penicillin. Tetracycline is most often used to treat urinary tract infections, genital infections, acne, skin infections, and infections that cause stomach ulcers.  The tetracycline became incorporated inside the developing teeth and left the teeth permanently dark in color.

Before the development of modern cosmetic dentistry there were few alternatives to cover this esthetically.

Cosmetic dentistry has a few ways of dealing with this condition. These include teeth whitening and porcelain veneers.

Teeth Whitening and Tetracycline Staining

Teeth Whitening Tetracycline staining

Cosmetic Dentistry – Teeth Whitening for Tetracycline Staining

Teeth whitening can be very successful with tetracycline stained teeth when the staining is not very dark. Patients with minimal tetracycline staining on their teeth may have to continue to use the bleaching material daily for up to 6 months for noticeable results that will last.  There are in office and at home whitening options in cosmetic dentistry for treating these stains. Over -the -counter type whitening will not be effective at all in teeth with tetracycline staining. The longer period of whitening at home can cause sensitivity and gum problems. This procedure needs to be closely monitored by the cosmetic dentist to ensure there is no damage to the enamel or gum tissue. In some cases of more severe tetracycline staining, teeth whitening is an insufficient treatment. This is due to how deeply embedded the staining is in the patient’s tooth enamel.  Instead, porcelain veneers or dental bonding would be the standard approach to cover the remaining tetracycline staining after whitening procedures are complete.

Dental Bonding and Tetracycline Staining

Your cosmetic dentist may use dental bonding to cover the tetracycline staining that is present. By using dental bonding techniques your cosmetic dentist can mask the stains and create a new color as well as shape to your teeth. However, if the tetracycline stains are too deep and dark in the teeth, the staining may show through the dental bonding. This will create a lighter gray tooth rather than the bright, white teeth you may want. When this is the case, teeth whitening to remove as much of the tetracycline staining as possible, followed by dental bonding is a very good cosmetic dentistry treatment option.

 

Porcelain Veneers and Tetracycline Staining

Porcelain veneers are the best option we have in cosmetic dentistry for the treatment of tetracycline staining. Porcelain veneers are wafer thin and custom designed to reshape your teeth and color just the way you want it. With porcelain veneers,,  we are able to adjust the opacity of the porcelain to allow the cosmetic dentist the ability to truly mask the tetracycline staining,(pre-whitening may still be necessary for the best overall result).

Thanks to cosmetic dentistry patients no longer have to suffer from tetracycline staining. Now these patients can fully smile just like everyone else without feeling self conscious. A smile can be the first thing people notice. With cosmetic dentistry’s many advances, you no longer have to settle for tetracycline stained teeth. You now have options that can help you smile full of self confidence.

 

Tetracycline Staining

Tetracycline Staining Before Cosmetic Dentistry

tetracycline staining after cosmetic dentistry

Tetracycline Staining after Cosmetic Dentistry