Antibiotics: When and in which cases?

Taking antibiotics tablet

According to the recommendations of the professional societies, the adjunctive use of antibiotics in the context of periodontal therapy should be limited to the following indications:

  • aggressive, rapidly progressive forms of periodontitis
  • therapy-resistant periodontitis
  • severe chronic periodontitis
  • moderate-to-severe cases of periodontitis in patients with systemic diseases or conditions that interfere with immune function
  • peri-implant infections

It should be noted that the occurrence of periodontopathogenic bacteria differs depending on the individual patient and the efficacy of antibiotics is limited to specific groups of bacteria. For this reason, according to the German Society of Dental and Oral Medicine (DGZMK), for the selection of a suitable antibiotic, the existing periodontal infection should be determined by microbiological analysis of the subgingival plaque.

Effect of antibiotics on biofilm is limited

Oral bacteria are organized inside a biofilm that provides them with protection. On the one hand, the biofilm matrix represents a physical barrier that is difficult for the antibiotic to penetrate. On the other hand, bacteria in the biofilm are often in a “resting state”. This greatly reduces the effect of antibiotics on the cells. Administering antibiotics without performing subgingival scaling at the same time is therefore unhelpful.

Optimum timing of antibiotic therapy

In order to maximize medication efficacy, the German Society of Dental and Oral Medicine (DGZMK) recommends that antibiotics be administered after biofilm disintegration, i.e. immediately after completion of supra- and subgingival debridement. It should be noted that cleaning of supragingival areas as part of a professional tooth cleaning is not sufficient by itself.

Preventing recolonization

Bacteria have a short generation time, which means that they proliferate rapidly. In order to prevent recolonization of areas that have already been cleaned, instrumentation should be performed in a single session if possible, or alternatively on 2 consecutive days.