Antibiotics for Periodontal Disease (Gingivitis)

Author: V. Dimov, M.D.
Reviewer: S. Randhawa, M.D.

A 37-year-old male with moderate periodontal disease asks his physician about antibiotic treatment.

Past medical history (PMH)

Pre-hypertension (Pre-HTN), hyperlipidemia (HLP).

Medications

None.

Physical examination

Stable vital signs (VSS).
Oral: moderate periodontal disease.
The rest of the examination is normal.

Laboratory results

No evidence of diabetes.
LDL 131 mg/dL
HDL 35 mg/dL
Ultra-sensitive CRP 2.6

What is the best treatment approach to this patient's periodontal disease (gingivitis)?

Refer to a dentist for plaque removal with scaling and root planing (SRP) q 3-6 mo. This approach is usually sufficient for most patients. Prevention involves meticulous hygiene with brushing, flossing and regular dental visits.

What other treatment options are available?

Local therapy

Chlorhexidine (PerioGard) 0.12% oral rinse 15 cc bid between dental visits reduces bacterial flora/prevents plaque advancement.

Local delivery antibiotics are adjunct to SRP (applied once): minocycline 1mg microsphere (Arestin)/tetracycline 12.7mg fiber (Actisite)/doxycycline 10% gel (Atridox)/chlorhexidine 2.5mg chip (PerioChip).

Atridox is a doxycycline gel that conforms to the gum surface and then solidifies.

Elyzol is a gel or strip applied to the gum that is composed of metronidazole.

Systemic therapy

Submicrobial dose doxycycline hyclate (Periostat) 20mg PO q12h x 90d (up to 9mo) reduces periodontitis by inhibiting collagenase. Effect is small but significant.

Strong evidence exists for use of oral antibiotics as adjunct to SRP in severe/refractory/aggressive cases.

Culture is advised prior to initiation of treatment.

If sites of disease few, SRP + local-delivery antibiotics (PerioChip).

If extensive disease, SRP + systemic antibiotics. If culture is unavailable and no prior antibiotic history, tetracycline 250mg PO q6h OR doxy/minocycline 200mg PO x 1 then 100mg PO qd x 14d. Alternative: amoxicillin/clav 250-500mg PO q8h x 10d. For more aggressive disease: amoxicillin 500mg+metronidazole 250mg PO q8h x 7d.

What happened?

The patient was given a prescription for Periogard and Periostat and he was referred to a dentist for plaque removal and evaluation for local therapy.

A diet modification and exercise regimen were recommended. A follow-up visit was arranged in 3 months for repeat FLP and ultra-sensitive CRP.

References

Gingivitis/periodontitis. Spyridon Marinopoulos, M.D. Hopkins ABx Guide.
Periodontal disease. University of Maryland Medical Center.
Image source: Cross-section of a tooth with visible gums, or gingiva, Wikipedia, GNU Free Documentation License.

Related reading

People who consume a lot of omega-3 fatty acids (in oily fish) have a 22% lower risk of developing gum disease http://goo.gl/hsD0B
C reactive protein concentration itself is unlikely to be even a modest causal factor in coronary heart disease - BMJ, 2011. http://goo.gl/d5lCH

Published: 06/22/2008
Updated: 11/10/2010

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