Systemic antibiotics are increasingly used in the treatment of periodontal infections. Whilst these drugs are used mostly on an empirical basis, some physicians contend that rational use of antibiotics should be the norm due to their wide abuse and global emergence of antibiotic-resistant organisms. This is a review of the principles and rational antimicrobial therapy, treatment goals, drug delivery routes and various antibiotics used in the management of periodontal diseases. The available data indicate, in general, that mechanical periodontal treatment alone is adequate to ameliorate or resolve the clinical condition in most cases, but adjunctive antimicrobial agents, delivered systemically, can enhance the effect of therapy in specific situations. This is particularly true for aggressive periodontitis in patients with generalised systemic disease that may affect host resistance, and in case of poor response to conventional mechanical therapy. This article provides an update on systemic antibiotic therapy for the treatment of periodontitis.
Jenkins WMM, MacFarlane TW, Gilmour WH. Systemic metronidazole in the treatment of periodon titis. J Clin Periodontol. 1989;16:443–50.
2.
Pascale D, Gordon J, Lamster I. Concentration of doxycycline in human crevicular fluid. J Clin Perio dontol. 1986;13:841–4.
3.
Heijl L, Dahlen G, Sundin Y. A 4-quadrant com parative study of periodontal treatment using tetra cycline-containing drug delivery fibers and scaling. J Clin Periodontol. 1991;18:111–6.
4.
Goodson JM, Holborow D, Dunn RL. monolithic tetracycline-containing fibres for controlled delivery to periodontal pockets. J Periodontol. 1983;54:575–9.
5.
Okuda K, Wolff L, Oliver R. Minocycline slow release formulation effect on subgingival bacteria. J Periodontol. 1992;63:73–9.
6.
Polson AM, Garrett S, Stoller N. Multicenter study of doxycycline in treatment of periodontitis (abstract. J Dent Res. 1995;74(Spec Iss).
7.
Sapadin AN, Fleischmajer R. Tetracyclines: nonantibi otic properties and their clinical implications. J Am Acad Dermatol. 2006;54(2):258–65.
8.
Guerrero A, Griffiths GS, Nibali L. Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive peri odontitis: a randomized placebo-controlled clinical trial. J Clin Periodontol. 2005;32(10):1096–107.
9.
Winkelhoff AJ, JP R, RJ G. Metronidazole plus amoxycillin in the treatment of Actinobacillus actinomycetemcomitans associated periodontitis. J Clin Periodontol. 1989;16:128–31.
10.
Matarazzo F, Figueiredo LC, Cruz SEB. Clinical and microbiological benefits of systemic metronidazole and amoxicillin in the treatment of smokers with chronic periodontitis: a randomized placebo-controlled study. J Clin Periodontol. 2008;35(10):885–96.
11.
Sakellari D, Goodson JM, Kolokotronis A. Concentration of 3 tetracyclines in plasma, gingival crevice fluid and saliva. J Clin Periodontol. 2000;27.
12.
Lundstrom A, Johanson LA, Hamp SE. Effect of com bined systemic antimicrobial therapy and mechanical plaque control in patients with recurrent periodontal disease J Clin Periodontol 1984;11:321-30.
13.
Lindhe J, Liljenberg B, Adielsson B, Borjesson J. Use of metronidazole as a probe in the study of human periodontal disease. J Clin Periodontol. 1983;10(100):112.
14.
Lindhe J, Liljenberg B, Adielsson B. Effect of long-term tetracycline therapy on human periodontal disease. J Clin Periodontol. 1983;10:590–601.
15.
Loeshe WJ, Syed SA, Morison EC. Metronida zole in periodontitis. I. Clinical and bacteriological results after 15 to 30 weeks. J Periodontol. 1984;55:325–55.
16.
Heimdahl A, Nord CE, Okuda K. Effect of tinidazole on the oral, throat and colon microflora of man. Med Microbiol Immunol. 1980;168(1):1–10.
17.
Mitchell DA. Metronidazole: its use in clinical dentistry. J Clin Periodontol. 1984;11:145–58.
18.
Giedrys-Lepeper E, Selipsky H, Williams BL. Effects of short-term administration of metronidazole on the subgingival microflora. J Clin Periodontol. 1985;12(797):814.
19.
Altman EG. Rational use of metronidazole. Austral Dent J. 1980;25:135–8.
20.
Ohta Y. microbiological study on the periodontal lesi ons in advanced periodontitis. Changes in the regio nal flora and clinical features caused by short-term treatment with clindamycin. Skikwa Gakuho. 1984;8:1209–23.
21.
Caton JG, Ciancio SG, Blieden TM. Treatment with subantimicrobial dose doxycycline improves the efficacy of scaling and root planing in patients with adult periodontitis. J Periodontol. 2000;71(4):521–32.
22.
Golub LM, McNamara TF, Ryan ME. Adjunctive treatment with subantimicrobial doses of doxycycline: effects on gingival fluid collagenase activity and attachment loss in adult periodontitis. J Clin Perio dontol. 2001;28(2):146–56.
23.
Howell TH, Fiorellini J, Weber HP. Effect of the NSAID piroxicam, topically administered, on the development of gingivitis in beagle dogs. J Perio Res. 1991;26(3 Pt 1):180–3.
24.
Williams RC, Jeffcoat MK, Howell TH. Altering the progression of human alveolar bone loss with the non-steroidal anti-inflammatory drug flurbiprofen. J Periodontol. 1989;60:485–90.
25.
Kunihira DM, Caine FA, Palcains KG. A clinical trial of phenoxymethyl penicillin for adjunctive treat ment of juvenile periodontitis. J Periodontol. 1985;56:352–8.
26.
Hoge HW, Kirkham DB. Periodontosis: treatment results in a 15-year old girl. JADA. 1980;101:795–7.
27.
Slots J, Feik D, Rams TE. In vitro antimicrobial sensi tivity of enteric rods and pseudomonads from advan ced adult periodontitis. Oral Microbiol Immunol. 1990;5(5):298–301.
28.
Roberts MC. Antibiotic toxicity, interactions and resis tance development. Periodontol. 2000;28(280):97.
29.
Luthiger U. Clindamycin and penicillin V in the treat ment of periodontal infections. A randomised study. Swiss Dent. 1983;4:41–3.
30.
Rood JP. The value of metronidazole in dental and oral surgery.Dental Update 1980;7:293-300.
31.
Walker C, Gordon J. The effect of clindamycin on the microbiota associated with refractory periodontitis. J Periodontol. 1990;61(11):692–8.
32.
Golub LM, McNamara TF, D’Angelo G. A non antibacterial, chemically-modified tetracycline inhibits mammalian cillagenase activity. J Dent Res. 1987;66:1310–4.
33.
Golub LM, Goodson JM, Lee HM. Further evidence that tetracyclines inhibit collagenase activity in human crevicular fluid and from other mammalian sourcesa. J Perio Res. 1985;20:12–23.
34.
C X, D S, T S. Clinical and microbiological effects of different antimicrobials on generalized aggressive periodontitis. Jl Clin Perio dontol. 2006;33(4):254–64.
35.
Novak MJ, Polson AM, Adair SM. Tetracycline therapy in patients with early juvenile periodontitis. J Perio dontol. 1988;59:366–72.
Christersson LA, Slots J, Rosling BG. Microbio logical and clinical effects of surgical treatment of localised juvenile periodontitis. J Clin Periodontol. 1985;12:465–76.
38.
Slots J, Rosling BG. Suppression of the periodonto pathogenic microflora in localised juvenile periodon titis by systemic tetracycline. J Clin Periodontol. 1983;10:465–86.
39.
Madianos PN, Bobetsis YA, Kinane DF. Generation of inflammatory stimuli: how bacteria set up inflamma tory responses in the gingiva. J Clin Periodontol. 2005;32(Suppl 6):57–71.
40.
Gillett R, Johnson NW. Bacterial invasion of the perio dontium in an case of juvenile periodontitis. J Clin Periodontol. 1982;9:93–100.
41.
Palenstein Heldermann WH. Is antibiotic therapy justified in the treatment of human chronic inflamma tory periodontal disease? J Clin Periodontol. 13:932–8.
42.
Wolff LF, Liljemark WF, Bloomqvist CG. The distribution of Actinobacillus actinomycetemcomitans in human plaque. J Perio Res. 1985;20:237–50.
43.
Zambon JJ, Christersson LA, Slots J. Actinobacillus actinomycetemcomitans in human periodontal dise ase. Prevalence in patients groups and distribution of biotypes and serotypes whitin families. J Periodontol. 1983;54:707–11.
44.
Theilade E. The non-specific theory in microbialv aetiology of inflammatory periodontal diseases. J Clin Periodontol. 1986;13:905–11.
45.
Kaldahl WB, Kalkwarf KL, Patil KD. Long-term evaluation of periodontal therapy: I. Response to 4 therapeutic modalities. J Periodontol. 1996;67(2):93–102.
46.
Kaldahl WB, KL K, KD P. A review of longi tudinal studies that compared periodontal therapies. J Periodontol. 1993;64(4):243–53.
47.
Reynolds JJ, Meikle MC. Mechanisms of connective tissue matrix destruction in periodontitis. Periodontol. 2000;14:144–57.
48.
Sorsa T, Tjaderhane L, Salo T. Matrix metallopro teinases (MMPs) in oral diseases. Oral Dis. 2004;10(6):311–8.
49.
Saglie R, Newman MG, Carranza FA, Pattison GL. Bacterial invasion of gingiva in advanced periodontitis in humans. J Periodontol. 1982;53:217–22.
50.
Kinane DF, Lappin DF. Clinical, pathological and immunological aspects of periodontal disease. Acta Odontol Scand. 2001;59(3):154–60.
51.
Schenkein HA. Host responses in maintaining perio dontal health and determining periodontal disease. Periodontol. 2000;40:77–93.
52.
Slots J, Ting M. Actinobacillus actinomycetemcomi tans and Porphyromonas gingivalis in human perio dontal disease: occurrence and treatment. Perio dontol. 2000;20:82–121.
53.
Feng Z, Weinberg A. Role of bacteria in health and disease of periodontal tissues. Periodontol. 2000;40:50–76.
54.
Nishihara T, Koseki T. Microbial etiology of periodon titis. Periodontol. 2000;36:14–26.
55.
Paster BJ, Boches SK, J G. Bacterial diversity in human subgingival plaque. J Bacteriol. 2001;183(12):3770–83.
56.
Dyke TE, D S. Risk factors for periodontitis. J Int Acad Periodontol. 2005;7(1):3–7.
57.
Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Perio dontol. 1999;4(1):1–6.
58.
Haffajee AD, Socransky SS, Gunsolley JC. Systemic anti-infective periodontal therapy. A systematic review. Ann Periodontol. 2003;8(1):115–81.
59.
Loesche WJ, Giordano H, P. Metronida zole in periodontitis: reduced need for surgery. J Clin Periodontol. 1992;19(2):103–12.
60.
Roberts MC. Antibiotic toxicity, interactions and resis tance development. Periodontol. 2000;28:280–97.
61.
Stoltze K, Stellfeld M. Systemic absorption of metro nidazole after application of a metronidazole 25% dental gel. J Clin Periodontol. 1992;19:693–7.
62.
Walker CB, Karpinia K, Baehni P. Chemotherapeutics: antibiotics and other antimicrobials. Periodontol. 2000;36(1):146–65.
63.
Winkelhoff AJ, CJ T, Graaff J. Microbio logical and clinical results of metronidazole plus amoxicillin therapy in Actinobacillus actinomycetem comitans-associated periodontitis. J Periodontol. 1992;63(1):52–7.
64.
Meyer DH, Lippmann JE, Fives-Taylor PM. Invasion of epithelial cells by Actinobacillus actinomycetemco mitans: a dynamic, multistep process. Infect Immun. 1996;64(8):2988–97.
65.
Mombelli A, Gmur R, Gobbi C. Actinobacillus actinomycetemcomitans in adult periodontitis. I Topographic distribution before and after treatment J Periodontol. 1994;65(9):820–6.
66.
Slots J, Research. Science and Therapy Committee. Systemic antibiotics in periodontics. J Periodontol. 2004;75(11):1553–65.
67.
Winkelhoff AJ, TE R, J S. Systemic antibio tic therapy in periodontitics. Periodontol. 2000;10:45–78.
68.
Pejčić A, Peševska S, Grigorov I. Periodontitis as a Risk Factor for General Disorders. Acta Facult Med Naiss. 2006;23(1):59–65.
69.
Herrera D, Sanz M, Jepsen S. A systematic re view on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients. J Clin Periodontol. 2002;29(Suppl 3):160–2.
70.
Haffajee AD. Systemic antibiotics: to use or not to use in the treatment of periodontal infections. That is the question J Clin Periodontol. 2006;33(5):359–61.
71.
Walker CB. The acquisition of antibiotic resistance in the periodontal microflora. Periodontol. 2000;10:79–88.
72.
Drisko CH. Non-surgical pocket therapy: pharmaco therapeutics. Ann Periodontol. 1996;1(1):491–566.
73.
Slots J, Ting M. Systemic antibiotics in the treatment of periodontal disease. Periodontol. 2000;28:106–76.
74.
Baker PJ, Evans RT, Coburn RA. Tetracycline and its derivatives strongly bind to and are released from the tooth surface in active form. J Periodontol. 1983;54:580–5.
75.
Baker PJ, Evans RT, Slots J, Genco RJ. Susceptibility of human oral anaerobic bacteria to antibiotics siutable for topical use. J Clin Periodontol. 1985;12:201–8.
76.
Herrera D, Alonso B, León R, Roldán S, Sanz M. Anti microbial therapy in periodontitis: the use of systemic antimicrobials against the subgingival biofilm. J Clin Periodontol. 2008;35:45–66.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
