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Is There A Place For Antibiotics In Periodontal Therapy?

The answer is yes but not early in treatment. What I mean is that antibiotics are not a solution for incomplete or inappropriate treatment. Antibiotics are more of, for lack of a better term, a last resort.

There are no short cuts to an appropriate treatment protocol. Thorough scaling and root planing, along with plaque control instructions, should be the foundation of our treatment approach. When I say thorough, I’m referring to comprehensive scaling and root planing, not a prophy. Scaling and root planing is a definitive procedure, almost always requiring anesthesia. When this doesn’t result in success, surgery must be considered. The primary purpose of surgery is to gain visual access into the pocket to better and more completely scale and root plane.

The vast majority of patients will respond favorably to the above resulting in periodontal stability. For the few that still remain unstable, antibiotics are a step that can now be considered.

In years past low dose tetracycline was a popular treatment. In using this, there were concerns about the long term use of an antibiotic not the least being the development of resistance. Also, If you proceed with this approach, when do you stop?

Local delivery of antibiotics is popular but the effectiveness is questionable. Local delivery of antibiotics is impractical when there are multiple refractory areas.

A therapeutic dose of antibiotics over a defined period of time, say two weeks, has worked best for me. I have used several combinations of antibiotics and almost always had positive results, at times, remarkable results. One of the most interesting findings is that the positive effects can last for months or even years after a single two week course of antibiotics. This can be explained by the antibiotics disrupting the delicate relationship between the organisms in the plaque. A relationship may not redevelop!

I have purposely avoided a one size fits all approach to spell out antibiotics combinations and doses. I invite your comments on specific treatments you have found effective.

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