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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.


Peri-implantitis – is a destructive  process affecting the gums and bone surrounding dental implants. The various periodontal bacteria found surrounding failing dental implants (those affected by peri-implantitis) are very similar to those found in association with various forms of periodontal disease.

Peri-implantitis is a unique complication when dealing with dental implants. Dental implants have a very high success rate but do fail for various reasons. These can include failure to integrate with bone, poor oral hygiene by patient, rejection by the body, trauma, or peri-implantitis. Peri-implantitis becomes a factor in patients with poor oral hygiene, diabetes, smoking, and when there is residual cement stuck to the implant surface.  Peri-implantitis will cause the destruction of bone and gum tissue exposing part of the dental implant to the outside. This will cause the possibility for the dental implant to become less stable and cause the patient to lose the implant and restoration if not treated in a timely manner.

How Is It Diagnosed?

A dentist will use x-rays and measuring instruments to determine the level of the bone surrounding the dental implant. If it is found there is some level of bone loss beyond normal surrounding the dental implant, then the diagnosis becomes that of peri-implantitis. It is normal to see some minor bone loss 1-2 years out following placement of the dental implants. It should be no more than 1-1.5 mm in the first year and no more than 0.2 mm in each subsequent year. As stated earlier peri-implantitis of a  dental implant that goes undiagnosed will lead to complete failure and have to be removed.

Peri-implantitis can be diagnosed early or once clear clinical evidence has developed. The most common signs and symptoms are:

– Color changes of the gum tissue around the implant.

– Bleeding during brushing, probing or measuring.

– Increased pocket depth around the implant.

– Pus drainage from around the dental implant.

– Thinning of the tissue causing transparency around the implant..

– Progressive loss of bone height around the implant.

-X-rays showing loss of bone around the implant.

Peri-Implantitis Treatment Options

The course and success of treatment revolves around when the peri-implantitis is diagnosed. If the initial bone loss is limited there will be a higher chance of success in saving the dental implant. However, the later treatment begins the lower the chance of saving the dental implants. There are various methods used to treat peri-implantitis. All have varying degrees of success. These include the following:

-Mechanical Debridement (professional cleaning using instruments). A patient with dental implants must follow normal treatment schedules to maintain his/her dental implants. This includes regular dental visits. At these visits radiographs will be taken to ensure the dental implant and surrounding tissues are in a  healthy state. At these visits the patient will also undergo a professional cleaning for the dental implants and/or natural teeth. Dental implants require special tools for cleanings. The standard dental implant instruments used for cleaning include plastic, graphite, or gold tipped instruments. Ultrasonic tips may be used. The goal in cleaning the implant is to remove debris and bacteria without damaging the exterior coating of the dental implant.

Perioscope. A microscope guided cleaning deep below the tissues to remove debris and otherwise  undetectable cement residue.

-Localized Drug Delivery. Since dental implants by nature have rough surfaces (to allow better integration with surrounding bone), removing infection tends to be quite a challenge using just hand instruments. It is recommended that a chemical anti microbial agent be used along side hand instrumentation. Recent studies have shown the combination of hand instruments and chemical agents have proven effective in eliminating peri-implantitis in its earliest stages. Drugs used can include chlorhexidine rinse, oral antibiotics such as tetracycline, minocycline, doxycycline hyclate, or Arestin, an antibiotic placed directly into the pocket.

-Bone regrowth factors. Emdogain can be placed along with bone grafting material to help stimulate new bone growth.

Conclusion

The primary goal once peri-implantitis has been diagnosed is to stop the disease process from progressing. If untreated, it will ultimately lead to loss of the dental implants. The #1 goal should be to see your dentist regularly to avoid the complication of peri-implantitis. It is important to note any signs that may be occurring so you can be proactive about your dental health.