Antibiotic treatments can be used either in combination with surgery and other therapies, or alone, to reduce or temporarily eliminate the bacteria associated with periodontal disease.
However, doctors, dentists and public health officials are becoming more concerned that overuse of these antibiotics can increase the risk of bacterial resistance to these drugs. When germs become resistant to antibiotics, the drugs lose the ability to fight infection.
“The resistance we’re worried about,” explains Robert Genco, D.D.S., Ph.D., chairman of the oral biology department at The State University of New York at Buffalo, “is in association with antibiotics in the traditional use; those at higher levels in the blood that kill bacteria.”
Jerry Gordon, D.M.D., of Bensalem, Pa., shares Genco’s concerns. “There is a role for antibiotics in periodontal disease,” Gordon says, “but you have to be very selective in your use.”
Each time a person takes penicillin or another antibiotic for a bacterial infection, the drug may kill most of the bacteria. But a few germs may survive by mutating or acquiring resistance genes from other bacteria. These surviving genes can multiply quickly, creating drug-resistant strains. The presence of these strains may mean that the person’s next infection will not respond to another dose of the same antibiotic. And this overuse would be detrimental to people if they develop a life-threatening illness for which antibiotics would no longer be helpful.
John V. Kelsey, D.D.S., dental team leader in the FDA’s dermatologic and dental drug products division, says, “The widespread use of systemic antibiotics is generating resistant organisms, and that’s a problem.” And that fact, he says, “has prompted the industry to develop new strategies that would reduce the risk of resistance developing.”
For example, three relatively new drugs — Atridox (doxycycline hyclate), PerioChip (chlorhexidine gluconate), and Arestin (minocycline) — are antibiotics that were approved in sustained-release doses to be applied into the periodontal pocket. Local application of antibiotics to the gum surface may not affect the entire body, as do oral antibiotics.