Periodontal disease is a chronic inflammatory condition that affects the supporting tissues of the teeth.
In recent decades, research has shown a strong link between bacterial infections and the progression of periodontal disease. In this context, the use of antibiotics in the treatment of periodontal disease has become a topic of interest for the medical community.
This article aims to explore the efficacy of antibiotics in the control of periodontal disease, the risks associated with their use, and current approaches to the management of these drugs.
Periodontal disease is a common condition affecting millions of people globally. It is characterized by inflammation of the gums, destruction of bone tissue and progressive tooth loss. Bacterial infections play a crucial role in the etiology and progression of periodontal disease, and control of these infections is essential for optimal oral health.
Rationale for the use of antibiotics in periodontal disease: Antibiotics are a powerful therapeutic tool in combating bacterial infections associated with periodontal disease. They can act effectively against pathogenic bacteria and help reduce inflammation and control infection. The use of antibiotics in the treatment of periodontal disease may be considered in cases of severe disease or resistant to conventional therapies.
Clinical evidence on antibiotic efficacy: Clinical trials have investigated the effects of antibiotic therapy in periodontal disease and have provided mixed results. Antibiotics administered in combination with mechanical therapy (scaling, professional brushing) can lead to significant improvements in reducing periodontal sulcus depth and levels of pathogenic bacteria. However, there is also increased antibiotic resistance in certain bacterial communities, which may limit the effectiveness of antibiotic treatment.
Risks and side effects associated with antibiotic use: The use of antibiotics in the treatment of periodontal disease may be associated with some risks and side effects. These may include the development of bacterial resistance, gastrointestinal disorders, allergic reactions and imbalances in the normal bacterial flora. Therefore, both the benefits and risks associated with the use of antibiotics need to be considered on a case-by-case basis.
Current approaches to antibiotic management in periodontal disease:
5.1 Adjuvant therapy: The use of antibiotics in the treatment of periodontal disease is often combined with mechanical therapy, including scaling and professional brushing. This combined approach can improve the effectiveness of treatment by removing bacterial biofilm and reducing inflammation. Antibiotics can be prescribed on a short-term basis (usually 7-14 days) and can be administered orally or as a gel applied locally to the periodontal grooves.
5.2. Systemic antibiotics: In some cases, severe periodontal disease or disease resistant to conventional treatment may require systemic antibiotics. Systemic antibiotics are prescribed for a limited period and may include penicillin, tetracyclines, macrolides and metronidazole. It is important that these antibiotics are administered under the supervision of a dentist and that possible drug interactions and individual antibiotic sensitivity are taken into account.
5.3. Local antibiotics: Topical administration of antibiotics in the form of gels, controlled-release substances or antibiotic-soaked sutures may be an option in some cases. This approach allows the high concentration of antibiotic to be delivered directly to the infected area, minimizing overall exposure of the body to the drug and reducing the risk of bacterial resistance developing.
5.4. Selecting the right antibiotic: The choice of the right antibiotic in the treatment of periodontal disease should be based on the bacterial sensitivity and resistance profile of the bacteria involved. It is therefore important to carry out bacterial sensitivity tests before antibiotics are administered and to take into account current clinical recommendations and treatment guidelines.
5.5 Monitoring and prevention of bacterial resistance:
Given the increasing problem of bacterial resistance, monitoring and prevention of bacterial resistance are key issues in the use of antibiotics in periodontal disease. Dentists must be aware of the risk of developing bacterial resistance and take steps to minimize this risk by using antibiotics only when necessary and by adhering to the recommended duration and dosage.
The use of antibiotics in periodontal disease can be an effective therapeutic strategy in certain cases, especially in severe or conventionally resistant forms. However, both the benefits and the risks associated with antibiotic use should be considered, including the risk of developing bacterial resistance and possible side effects. Antibiotic therapy should always be individualized, taking into account the bacterial susceptibility, resistance profile and specific needs of each patient.
In addition, it is important to combine antibiotic therapy with appropriate mechanical therapy and to promote rigorous oral hygiene to achieve optimal results in the treatment of periodontal disease. Also, close monitoring of patients and regular assessment of response to treatment are essential to adjust and tailor therapy.
In the future, research into periodontal disease and the use of antibiotics must continue, given the evolution of bacterial resistance and the need for new therapeutic strategies. The development of more effective antibiotics with a more specific spectrum of action and the use of innovative technologies for local antibiotic delivery may be promising directions in this respect.
In everyday life, antibiotics are prescribed for a range of conditions that interfere with the body’s normal activity.
Pathogens are found everywhere in the body and when the body’s defenses are breached, infection sets in. Bacteria multiply easily under favorable conditions and can build up defense mechanisms that are increasingly resistant to antibiotic therapy.
On the other hand, giving antibiotics that are not targeted at the bacteria responsible for triggering the infection, or giving them when they are not needed, is to be avoided.
Caution should be exercised when administering antibiotics because any abuse may lead to increased resistance of the bacteria in the future and subsequent treatments will prove ineffective.
Antibiotics are also used in dentistry. In endodontics, at the time of periapical infections, in surgery in extensive interventions to prevent infection of the intervention site but also in periodontology in particular, antibiotic therapy has good results, complementing dental treatment.
Antibiotics can be administered topically or generally. General, systemic administration is aimed at metabolism in the liver and passage to the site of infection via the bloodstream.
Local treatments, on the other hand, are less invasive and act on a limited area.
In periodontology, for example, antibiotics can be administered topically to the gum, at the junction with the tooth, in the space between these two elements.
The supragingival flora differs from the subgingival flora because the former is exposed to the environment and the air, whereas the latter lives in oxygen-poor conditions.
Microbiologically, there are two types of bacterial flora:
Microbial flora compatible with oral health – we cannot achieve zero bacterial contamination of the oral cavity. There are always bacteria living in the oral environment without expressing their pathogenic potential because the body’s defence mechanisms cope with and outnumber and outperform the bacteria. Saliva is the fluid responsible for maintaining oral health. It contains antibacterial proteins. Saliva’s effectiveness in antimicrobial defence would not be so remarkable if it were not for the role of oral hygiene. Tooth brushing and cleaning of interdental surfaces and rinsing with mouthwash help to mechanically remove bacteria. Without this hygiene protocol the saliva’s protective capacity would be exceeded and carious lesions and periodontal disease would set in prematurely.
Microbial flora incompatible with oral health – there are bacteria that, present in high concentrations in the oral cavity, cause sometimes irreversible damage. If these bacteria reach the sulcus, which is between the gums and between the first few millimeters, hygiene is almost impossible and the bacteria grow uncorrected.
The mechanism of attack of the bacteria that cause periodontal disease is easy to understand because it often starts with poor hygiene.
In dental plaque and tartar formed over time, through lack of local hygiene, bacteria develop their pathogenic mechanisms.
The first visible signs are inflammation of the gums, which will heal through retraction.
If treatment is not instituted at this stage, the progression of the disease is irreversible, the gum will recede further and the underlying bone will resorb.
Antibiotics can be used successfully in the treatment of periodontal disease, but must be administered with caution and accompanied by a holistic therapeutic approach. The efficacy of antibiotics in controlling infection and reducing inflammation has been demonstrated in clinical trials, but associated risks and the need for appropriate antibiotic selection should be considered. Antibiotic therapy in periodontal disease should be personalized and tailored to the individual needs of the patient, and judicious use of these drugs can contribute to improving oral health and quality of life of patients affected by this condition.