This issue will affect your office's perio program. In 1996, The American Academy of Periodontology puplished a "Position Paper" entitled "Systemic Antibiotics in Periodontics" It was published in the Journal of Periodontology and can be found in volume 67:831-838. The paper urges restraint when prescribing antibiotics for periodontitis.

 The article is full of supporting references and has dramatically affected some of our treatment protocols. In this newsletter, I will outline the major thrusts of the paper and then describe what we are doing in light of this information.

 The paper stresses the following 5 points:

 1. Periodontal pockets almost never have only one pathogen residing. Typical strains may include the following bacteria:

2. Because of the pathogen mix, it is highly unlikely that prescribing any one single antibiotic will be effective in eradicating the flora.

 3. The emerging resistance among oral and medical pathogens to common antibiotics dictates a restrictive and common sense conservative use of systemic antibiotic therapy.

 4. Patients with gingivitis or stable adult periodontitis usually respond well to mechanical periodontal therapy alone and derive little or no additional benefit from antibiotic therapy.

 5. Systemic antibiotic therapy for periodontal therapy should be reserved to the following:

Previously, we have used systemic antibiotics, most commonly Doxycycline, with patients in the maintenance phase of therapy if they showed signs of returning inflammation. Additionally, we have used Doxycycline in "pulsed dose deliveries" for our bone regenerative patients.

Wherever possible, we will avoid the use of systemic antibiotics in the control of routine adult periodontitis and rely instead upon stressing excellent oral hygiene and the use of topical agents contained in rinses and pastes. I urge your practice to adopt the same approach in your soft tissue and maintenance programs. [top]
 

Literally hundreds of journal references exist reporting the findings of studies which investigated the efficacies of topical agents with respect to reductions in plaque and gingivitis. Another position paper by The American Academy of Periodontology discusses the research data on chemical agents. Some of the more important ones are synopsed below.

Supragingival irrigation has long been recognised as clinically beneficial especially when medicaments (Chlorhexidine, Listerine or Oxyfresh) area diluted. Improvements are seen with microbiologic and gingivitis studies. Gingival inflammation has been reduced up to 62% in some studies. We are prescribing oral irrigators for any patient with difficulty in interproximal plaque control. Again, this shift in philosophy relates directly to our hesitancy in prescribing systemic antibiotics when inflammation is returning. Reports on subgingival irrigation are conflicting and thus it remains controversial, especially when done as a single, in office delivery. This is largely due to the fact that the gingival crevicular fluid washes the medicaments from the pockets too rapidly. Therefore "gels" may be of greater benefit due to the "substantivity" during office use. A chlorine dioxide gel (Oxyfresh) is being used in this manner. Other gels are in development.

For information on where to obtain any products contained in this page go to help on Selecting Oral Care Products.

 Hopefully this review of the current literature describing the philosphy shift will help you in your perio programs. [top]