antibiotics, which include tetracycline hydrochloride, doxycycline, and
minocycline, not only have anti-bacterial actions but also, even in low
doses, help block collagenase -- the protein that destroys
connective tissue and bone.
A number of methods have been
developed to apply antibiotics to the
gum areas. Actisite is a thin thread similar to dental floss, which is
treated with tetracycline hydrochloride. The treated thread, is
temporarily inserted between the tooth and gum, where it releases
a steady concentration of tetracycline to the diseased gum tissue thus
there are rarely any side effects. After 10 days
the thread is removed. One study showed that scaling and root planing
plus short-term antibiotic-thread therapy reduced the need for gum
surgery and tooth extractions by 88%.
Other treatments employ
metronidazole as a gel (Elyzol) or a strip applied to the gum
pocket. Similar procedures employ minocycline loaded into tiny
Atridox is a method for
delivering doxycycline; it is applied as a gel that conforms to the gum
and then solidifies. Over the next few days, it releases the
PerioChip is a chip that is placed into
the gum pocket after scaling. Overtime, it slowly releases
chlorhexidine, a powerful bacteria-killing antiseptic.
The first oral antibiotic (Periostat)
specifically developed for periodontal disease has been approved and
some research suggests that it may improve tooth attachment by 50%. The
drug uses doses of the antibiotic doxycycline that are too low to fight
bacteria but sufficient to block the actions of collagenase. Doses are
also too low to pose a risk for the development of antibiotic-resistant
"Periostat is a subclinical dosage of doxycycline,
to suppress the destructive enzyme, collagenase which destroys
gingival tissue and alveolar bone. As a subclinical dosage, 20 mg., it
has NO antibiotic activity and will not create any microbial
20 mg = Periostat. (take
100mg Doxy Hyclate and dilute it in 60cc syringe with 50cc of water
and use 10cc BID or 1oz cap and dilutes the capsule in that then in
5 more and take one of the caps BID and tosses the 4 not used
for psoriasis because PD is the same disease different
end cursor chemical) IDF 10/05
In addition, it is totally
safe, with no major side effects other than allergy to the drug. It
can be taken long term, with continued benefit, and helps to
predictably stabilize a patient's perio condition. It can be used in
the high risk patients, and used with all patients who have
active bleeding in multiple sites. It is useful for management of all
cases of periodontitis in order too successfully manage perio disease
Neil R. Gottehrer
Taking a common nonsteroidal anti-inflammatory drug, such as
aspirin or ibuprofen (Advil), along with the doxycycline may even
enhance the effectiveness of this treatment.
Long-term use of antibiotics
is generally advised for the control of juvenile periodontitis,
refractory periodontitis, rapidly progressing periodontitis, and
prepubertal periodontitis. Recently, a study showed that patients with
standard periodontitis required fewer surgical treatments when they were
given antibiotics for two weeks and then maintenance cleaning for
three months. The most widely used drugs are the tetracyclines and
metronidazole (Flagyl). Amoxicillin is also useful. These
medications can also be an effective short-term adjunct to periodontal
treatment. One study found that metronidazole was particularly effective
in reducing the need for
periodontal surgery when it was given for a week after scaling and
root planing. Common side effects include allergic reactions, stomach
upset, yeast overgrowth, and sensitivity to sunlight (with
0.05% to 0.10% may be used for oral irrigation as part of a therapeutic
regimen for gum disease.
A fresh solution
should be prepared for each use. Mix:
Antabuse effect of metronidazole
hence the recommendation of no drinking.
metalloproteinases chew up collagen which holds it together
This solution can be used for wound
irrigation and as an antiseptic mouthrinse.
CDA Journal Vol 30, No. 4, April 2002
Dentistry Today pg 42, September 2002
- 10% carbamide peroxide
to follow when you should use place Arestin-Pockets 5mm or greater
with bleeding on probing.
How much does one dose of Arestin cost-one box $16 per dose.
Fee per pocket- $25-30 per pocket
Retreat a pocket with Arestin-usage was placement at time of scaling and
root planing followed by placement at 3 months and 6 months.
Reimbursement from insurance companies. Every company has
its own protocol, most of which
seem to make little sense. .. bottom line is if you are going to use it
the patient needs to expect to pay for it.
Tea Tree Oil
Tea Tree Oil
is an excellent oxidizer of
bacterial antigens that cause PD.
antibiotics enhance healing for aggressive periodontitis
Aggressive periodontitis is a rare form of gum disease
characterized by early onset and severe bone loss that can lead to
edentulism at an early age. Researchers at the Eastman Dental Institute
in London compared full-mouth instrumentation within 24 hours with and
without systemic antibiotics to determine differences in healing.
All subjects received oral hygiene instructions and supragingival
instrumentation prior to the start of the study in an attempt to
bring each individual's plaque level to 20% or less. The placebo or
control group began the study with an average plaque score of 20%, and
the test group's average plaque score was higher, at 25.5%. The
test group also started out with higher full-mouth bleeding scores:
61.5% compared to 55% for the control group.
Patients were instructed to rinse twice daily with 0.2% chlorhexidine
for two weeks. No subgingival instrumentation was provided during the
six-month test period.
All patients were given two bottles of pills and instructed to take one
of each, three times daily for seven days. Only the research coordinator
knew who received the antibiotics (500 mg of amoxicillin and 500 mg
of metronidazole), and who received placebo pills.
Both groups demonstrated good healing at two and six months, with
the test group showing a greater average pocket depth reduction, 3 mm in
the test group compared to 2 mm in the control group and more deep
pockets being resolved. At two months, 49% of pockets in the test group
and 42% of pockets in the placebo group converted from 4 mm or deeper to
3 mm or less. At six months, the figures were 55% for the test group and
37% for the placebo group.
Systemic antibiotics may enhance healing for those with aggressive
periodontitis when combined with full-mouth instrumentation.
Guerrero, A., Griffiths, G., Nibali, L., Suvan, J., Moles, D., Laurell,
L., Tonetti, M.: Adjunctive Benefits of Systemic Amoxicillin
and Metro-nidazole in Non-Surgical Treatment of Gener-alized Aggressive
Perio-dontitis: A Randomized Placebo-Controlled Clinical
Trial. J Clin Perio 32: 1096-1107, 2005. cited PerioReports V17, #11