There are some cases where the typical cleaning and treatment methods may not completely get rid of certain bacteria that cause gum disease, especially in hard-to-reach areas like the spaces between teeth or deeper gum pockets.
Some bacteria can even find hideouts in other places like the tongue or tonsils.
This is where antibiotics come into play, as they can help target these persistent germs that can contribute to the progression of the disease.
The use of systemic antibiotics has been found to be necessary to eliminate these bacteria from the tissues in the management of gum disease. In fact, it has been observed that the incorporation of antibiotic treatment often results in better management of gum disease compared to mechanical removal of plaque and calculus from root surfaces alone.
Antibiotics are like reinforcements, enhancing the effects of regular treatment and helping to eliminate the remaining harmful bacteria that conventional methods might not reach effectively.
Different Ways to use Medication for Gum Disease
a. Systemic Administration of Antibiotics
Ideally, an antibiotic used to treat advancing gum disease should specifically target the bacteria causing the condition, be safe, stick around in the tissues, not usually be used for other illnesses, and be affordable.
But as of now, there isn’t one antibiotic that fits all these criteria perfectly.
There are different types of antibiotics that can be used in the treatment of gum disease, most of which are administered in combination. This option is considered to be more cost effective than testing and targeted selection of antibiotics for the specific microorganisms.
Tip:
Start taking the antibiotics a day before the cleaning. And the cleaning should be done within the time frame of the antibiotic prescription.
They can be delivered in different ways:
b. Targeted Delivery – Inside the Gum Pockets
One approach involves using a special method to send antibiotics right inside the gum pockets. By doing this, we can use smaller amounts of antibiotics directly where they’re needed, avoiding any potential side effects that can come with taking antibiotics through the whole body. This way, we’re giving the bad bacteria a taste of their own medicine.
c. Full Mouth Disinfection
This approach involves thorough cleaning of the whole mouth in two sessions within a day. Alongside cleaning the teeth, the tongue gets a special brushing with a gel, the mouth gets rinsed with a solution, and the infected pockets are flushed with another solution. This all-out attack has shown promising results, reducing the infection and helping the mouth heal.
d. Modifying the Body’s Response
Instead of just targeting the bacteria, we’re changing how the body responds to the infection. This can be done by using special medications that control the body’s reactions. Think of it like calming down the battle scene to minimize the damage.
Types of Antibiotics for Periodontal Disease
The most effective antibiotics for managing gum disease include:
1. Tetracyclines
Cleaning away plaque and tartar from the roots of teeth might not completely get rid of bacteria in the gum tissues. Hence, the need for systemic tetracycline to help eliminate these bacteria from the gum tissues.
These antibiotics have been used quite a bit in treating periodontitis, especially the localized form. They’re able to concentrate in the gum tissues and inhibit the growth of specific bacteria like Aggregatibacter actinomycetemcomitans.
Studies have shown that tetracyclines can stop the loss of bone around the teeth and reduce the levels of harmful microbes when used along with cleaning and root planing.
Dental professionals recommend taking a dosage of 250 milligrams, four times a day.
2. Doxycycline
Doxycycline is considered as one of the best antibiotics for periodontal disease because it is much more present in the spaces between gums and teeth compared to other medications—about 7 to 20 times more available.
Another significant aspect is that it works in two different ways. As an antibiotic, it’s particularly effective against A. actinomycetemcomitans, which makes it a good choice for treating periodontitis.
But that’s not all. Doxycycline doesn’t just fight against microbes. It also has some other helpful effects on the body’s response:
- It counteracts collagenase, an enzyme that breaks down collagen in tissues (collagen is necessary for tissue regeneration)
- It reduces inflammation.
- It stops the loss of bone tissue.
- It encourages reattachment of the gums to the teeth.
Your dentist may recommend “low dose doxycycline” (LDD), which means taking a small amount of the medication, which makes it easier for the body to absorb from the digestive tract.
For using it as an infection-fighting treatment, the recommended dose is 100 milligrams two times on the first day, followed by 100 milligrams once daily for 21 days.
3. Metronidazole (Flagyl)
Metronidazole, also known as Flagyl, isn’t the first choice for treating infections from a bacterium called A. actinomycetemcomitans. It is preferred for fighting against certain types of bacteria that don’t need oxygen, like P. gingivalis and Prevotella intermedia.
That said, it can still be useful for people with periodontitis when used alongside other antibiotics like amoxicillin or tetracycline.
4. Amoxicillin
Unlike other antibiotics, Amoxicillin doesn’t directly kill bacteria. Rather, it disrupts their ability to build protective walls around themselves, which they need to multiply and survive.
Regardless of its mode of action, Amoxicillin has proven to be quite effective in managing periodontitis, whether it’s concentrated in specific areas or affects the entire mouth. This is because it is a broad-spectrum antibiotic that can target a wide array of bacteria responsible for oral infections. The recommended dosage is 500 mg three times a day for 8 days.
5. Amoxicillin–Clavulanate Potassium
When amoxicillin is combined with clavulanate potassium, it becomes resistant to specific enzymes that certain bacteria produce to evade antibiotics. This combination is particularly useful in managing localized periodontitis and preventing the loss of bone in the jaw.
6. Ciprofloxacin
Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic that works against many gram-negative periodontal bacteria. It is effective against all strains of the periodontal pathogen A. actinomycetemcomitans, including some resistant to other antibiotics like tetracycline or amoxicillin.
Ciprofloxacin may be prescribed as a pill or in gel form applied directly into infected periodontal pockets during deep cleanings. It shows minimal disruption of beneficial bacteria species associated with promoting gum health. This helps facilitate reestablishment of healthy oral environment.
Ciprofloxacin can be used together with metronidazole for broad coverage against both gram-negative and anaerobic bacteria.
7. Macrilodes
Macrolides are a group of antibiotics that work by inhibiting bacterial protein synthesis, which prevents growth and replication of bacteria. Macrolides have both antimicrobial effects to directly kill bacteria as well as anti-inflammatory effects to reduce swelling and infection in the gums.
Common macrolides used in dentistry include erythromycin and azithromycin (Zithromax). Azithromycin in particular accumulates well in dental plaque and gum tissues. It has been shown effective against P. gingivalis, a major periodontal pathogen.
Macrolides can help reduce pocket depth, gum bleeding, and improve clinical attachment levels, which helps periodontal pockets heal. They may be prescribed as a pill or applied directly as a gel into infected gum pockets.
8. Clindamycin (lincosamide)
Clindamycin is a lincosamide antibiotic that also inhibits bacterial protein synthesis. It is effective against common gram-positive periodontal bacteria like Fusobacterium nucleatum.
Clindamycin helps halt the progression of periodontitis and shows good penetration into gingival crevicular fluid. It may be used for acute infections or anaerobic flora not responsive to tetracyclines or metronidazole.
Targeting Infections Directly with Topical Antibiotics
When dealing with gum infections, topical antibiotics offer a targeted solution by delivering treatment straight to the affected gum tissue. Unlike oral antibiotics that circulate throughout the body, topical treatments focus their efforts exactly where the problem is.
These topical treatments work especially well after intensive cleaning procedures like root planing and scaling. These cleanings help remove the buildup of plaque and bacteria beneath the gumline, but sometimes a little extra help is needed to tackle the remaining infection.
There are several forms of topical antibiotics available:
- Atridox® Gel – This gel adapts to the shape of your gums and solidifies over time, releasing doxycycline antibiotic to combat the infection gradually.
- PerioChip – This small chip is placed into the pockets between your teeth and gum tissue, where bacteria gather. It releases chlorhexidine, a strong antibacterial and antiseptic agent, which slowly fights the infection and can reduce the depth of the pockets in your gums.
- Actisite® Strip – Resembling dental floss, this thin strip carries tetracycline hydrochloride. Placed between your teeth and infected gum tissue for about 10 days, it helps reduce bacteria and pocket depth. In some cases, multiple strips are used throughout the mouth.
- Elyzol® – Available in both gel and strip forms, this unique antibiotic treatment contains metronidazole. It’s effective against both bacteria and parasites, providing a comprehensive solution.
- Arestin® Mini-Capsules – After deep cleaning, these mini-capsules containing minocycline antibiotic are placed into your gums. They continue to release the medication over time, targeting the infection specifically.
Topical antibiotics are a powerful tool in the fight against gum infections, as they deliver treatment right where it’s needed most. They can play a crucial role in your periodontal health journey, aiding your mouth’s recovery and promoting better oral wellness.
Best use of Antibiotics for gum disease treatment
When it comes to battling the bacteria causing periodontal infections, it’s not a one-size-fits-all situation. These infections are like a mix of different types of bacteria – some that thrive with oxygen, some with very little, some that are gram-negative, and some that are gram-positive.
These antibiotics can be powerful allies in the fight against gum disease, enhancing the effects of regular treatments and helping patients regain healthier gums and teeth. However, using them isn’t a straightforward decision.
It’s based on careful consideration of the patient’s condition and the bacteria involved, and you often need to use more than one antibiotic to effectively fight them off. That said, pairing antibiotics needs good judgment based on their strength: some antibiotics slow down the growth of bacteria (bacteriostatic), while others go all out to kill them (bactericidal).
For instance:
- The metronidazole and ciprofloxacin duo is a powerhouse against mixed infections. Metronidazole goes after the anaerobic bacteria, the ones that don’t like oxygen, while ciprofloxacin targets the facultative anaerobes, those that can handle some oxygen. Together, they’re like the perfect team to tackle these mixed oral infections.
- In the case of serial therapy, you may need to use one antibiotic at a time. For example, if we use tetracycline, which slows down bacterial growth, alongside amoxicillin, which goes for the kill, they might get in each other’s way. As such, they should be used one after the other as directed by your doctor or dentist.
Final Thoughts
Dealing with the diverse bacteria causing periodontal infections requires a strategic approach. Serial and combination therapy bring together different antibiotics to effectively tackle these mixed infections. It’s all about using the right medication at the right time to manage bacteria and restore oral health.
