Procedures

Localized antibiotic administration

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What type of locally applied antibiotic would you recommend for my condition? The effectiveness of each is similar. The material cost to the dentist of treating three affected sites on one tooth with Arestin® is about the same as treating two sites with PerioChip®, or the entire tooth with Actisite®. If many sites require treatment, Atridox® becomes cost competitive; however if only one or two teeth require treatment, a significant portion of the Atridox® may be wasted and the cost will be greater than that of the other three.

The time required to place Actisite® and Atridox® is significantly greater than for Arestin® or PerioChip®, which may translate into greater cost as well.

What kind of adverse reactions to locally applied antibiotics might I expect?

What do you expect the long term success of treatment to be, and do you think the treatment will need to be repeated for the best treatment outcome? The answer will frequently be "yes", and if you are committed to saving your teeth, you should be prepared to undergo multiple rounds of treatment if you proceed with any.

Locally applied antibiotic treatment has not been studied in the following situations, and its effectiveness has not been established:

• Diabetic patients
• Patients with acute abscesses
• Rapidly progressive periodontitis
• Acute Necrotizing Ulcerative Gingivitis (ANUG, or "Vincent's Disease")
• Localized juvenile periodontitis
• As an adjunctive treatment, administered at the time of periodontal surgery
• Patients with peri-implantitis (the same disease as periodontitis, only occurring around dental implants

Locally applied antibiotics may be placed by Dentists, Registered Dental Hygienists, and in some States, by Expanded Duties Dental Assistants (EDDAs). Only a dentist may diagnose the need for them, however.

Although they may delay or eliminate the need for periodontal surgery, locally applied antibiotics are not a guarantee that periodontal surgery will be avoided.

There are treatments currently being studied that, combined with conventional treatments for periodontal disease (scaling & root planing), may help to improve a patient's response to periodontal disease. Among these are treatment with Non-Steroidal Anti-inflammatory Drugs (NSAIDs); and treatment with bisphosphonate drugs, which greatly reduce the rate at which the skeleton remodels (particularly the head and neck bones). These medications are collectively referred to as "Host Modulation Factors".

Another treatment of this sort which has already been shown in clinical trials to improve periodontal health more than scaling & root planing alone is treatment with low doses of doxicycline taken in pill form. When given in 20 milligram doses twice a day for six to twelve months, statistically measurable improvements have been demonstrated. Taken at that dose, doxicycline does not kill periodontal bacteria or even reduce their numbers. It merely prevents their ability to manufacture enzymes which destroy the periodontal tissues.

Ask your dentist if he or she is aware of any new developments in the area of host modulation. There are also studies being done on the use of metronidazole in treating periodontal disease, which may be of interest.

If you have a prescription plan under your health insurance, it may pay for low dose doxicycline treatment. If you have dental benefits, check to see if your plan covers locally applied antibiotics, and whether it covers repeat treatment or not. Although periodontal treatment can be costly, it may be less expensive than losing the teeth and having to replace them with prosthetic ones (e.g. dentures, implants).

Some patients may have particularly aggressive species of bacteria present. The dentist can sample the bacteria and send them to a laboratory to determine exactly which ones they are. This may help to determine the most appropriate antibiotic or other course of treatment.

Most cases of periodontal disease can be controlled by motivation and active involvement of a patient who understands the condition, and wants to avoid its negative consequences.