Antimicrobial Advances in Treating Periodontal Diseases

Abstract

Antibiotics are generally an efficient means of treating bacterial infections, and therefore are an obvious candidate in the treatment of periodontal diseases. Systemically and locally administered antimicrobial agents of all kinds have been evaluated in multiple clinical trials. The vast majority of studies have tested antibiotics as adjuncts to non-surgical debridement. No regime has demonstrated superiority over systemically administered amoxicillin and metronidazole in the treatment of any clinically or microbiologically defined variant of periodontal disease. The frequency and consequences of adverse effects of antibiotics have always to be balanced against the potential consequences of not rapidly suppressing a periodontal infection. Proposed strategies to reduce the risk of bacterial antimicrobial resistance include: prescribing two drugs with a synergistic or complementary effect, the administration of antibiotics at a high dose for a short period, a combined approach with mechanical debridement to disrupt biofilms, and the focus on therapeutic rather than prophylactic use. Derivatives of existing antibiotic classes and new compounds that act on unique targets are the subject of preclinical investigations with a focus on action against antibiotic-resistant medical pathogens. In light of the excellent results of a combination therapy with well-established drugs that are cheap and efficient, clinical trials should compare newly proposed protocols for periodontal therapy to a positive control. Future studies should focus not only on the action against the microorganisms directly involved in periodontal diseases, but also on those relevant to other medical concerns.

Validation of Antibiotic Efficacy on In Vitro Subgingival Biofilms

“…Although these effects do not eradicate the subgingival biofilms as such, they may facilitate their disruption, by reducing the load of specific species. The most potent effect in the present in vitro experimental system is exerted by the combination of amoxicillin and metronidazole, a finding that supports the clinically proven treatment superiority of this regimen 11 . Whether prior detection of these species should guide the clinical decision for the selection of one, or any, of these antibiotic schemes cannot be deduced from this study, but there is merit for consideration in clinical investigations.…”

“…Detection of high numbers of the red‐complex species ( Porphyromonas gingivalis , Tannerella forsythia , and Treponema denticola ) would be a suitable indication for the administration of metronidazole alone or (preferably) in combination with amoxicillin, a regimen that is also effective against Aggregatibacter actinomycetemcomitans and Gram‐positive pathogens 9,10 . Indeed, the systemic co‐administration of amoxicillin and metronidazole has demonstrated superiority over other antibiotic regimens in the treatment of clinically or microbiologically defined variants of periodontal disease 11,12 …”

The predominant bacteria isolated from radicular cysts

“…Antiseptic mouthwashes [18] and antibiotics is used to reduce the number of microorganisms [19]. In the case of administration of antibiotics, it is reported that antibiotics penetrated into the periapical lesions [20] and radicular cysts [21] in jaws.…”

Improving Scaling And Root Planing Over The Past 40 Years: A Meta-Analysis

“…Most evidence seems to exist for the beneficial effect of adjunctive systemic antibiotics and particularly for the combination of amoxicillin and metronidazole to non-surgical periodontal therapy [8,9,[69][70][71][72]. It has to be underlined that the systemic administration of antibiotics is only recommended in combination with mechanical debridement of the root surfaces i.e.…”