Reviewer: Ge Shaohua (Shandong University Hospital of Stomatology)
Author: Zhang Leiqing (Affiliated Stomatological Hospital of Zhejiang University School of Medicine)
Periodontitis is an inflammation of periodontal tissue, including our common gingiva, periodontal ligament, alveolar bone, etc. (as shown below).
When you have periodontitis, you should seek treatment. The use of mechanical methods to remove plaque is currently the most widely used and effective method for the treatment of periodontal disease. However, in special cases, antibiotics are also required as a supplementary treatment for periodontal treatment, mainly including topical and systemic drugs.
1. Periodontitis suitable for drug treatment
So, when can periodontitis be treated with medication?
A brief summary follows:
Mechanical treatment (including scaling and scaling) is difficult to completely remove periodontal pathogens, so drugs can be used as adjuvant treatment. These sites include deep periodontal pockets (pathologically deepened gingival sulcus due to periodontitis), areas of posterior furcations, depressions in root profile, etc.;
Periodontal pathogens exist in other parts of the mouth, such as the back of the tongue, buccal mucosa, and tonsils;
People who cannot control and implement long-term effective control of the growth of pathogenic bacteria in the oral cavity by themselves, such as disabled people, Parkinson’s patients, long-term bedridden patients, patients with intraoral surgery, etc., can use drug-assisted treatment . However, dental plaque is constantly formed, and the use of chemical drugs to control plaque can only play an auxiliary role, or it can only be used under certain conditions, and it is not suitable for long-term use;
People who cannot practice oral hygiene temporarily after intraoral surgery;
Acute periodontal infection can be treated with systemic or local adjuvant drugs after periodontal mechanical treatment;
Patients with systemic diseases, such as rheumatic heart disease, diabetes, AIDS infection, need to use antibiotics before or at the same time as periodontal examination and mechanical treatment;
Prophylactic systemic antibiotics are required before and after periodontal surgery.
Since periodontal drug treatment has so much significance, what drugs are available on the market for periodontal disease treatment? What is their effect? Let us reveal them one by one.
Image source: Zhanku Hailuo
2. Topical medication for periodontitis
Let’s first look at topical medications for periodontitis. There are many types of topical medication for periodontitis, and there are many ways of medication, mainly gargling, rinsing, coating, slow release and controlled release in the periodontal pocket.
Rinse medicine
It is mainly used for the recurrence of gingival inflammation. It has no obvious stimulating effect on bacterial microorganisms on the surface of the teeth, the back of the tongue, and the buccal mucosa. The commonly used chlorhexidine solution is 0.12%~0.2% , 0.1% cibic ammonium chloride solution, 0.1% hydrogen peroxide solution, essential oil gargle, etc.
Rinse class
Commonly used after mechanical treatment, it can clean the mouth, stop bleeding and slow down the reattachment of pathogenic bacteria. Commonly used flushing drugs are 3% hydrogen peroxide solution, 0.12%~2% chlorhexidine solution, 0.5% povidone-iodine solution, etc.
Coated drugs
It is often used for more serious local periodontal inflammation, such as acute periodontal abscess, and has the functions of sterilization and pain relief. Commonly used coating drugs are compound iodine solution and so on.
Slow release drugs
That is, the drug can be slowly released locally until it is no longer released. It is mainly used for inflammatory sites with deep periodontal pockets after mechanical treatment and prone to bleeding after doctor’s probing, teeth after acute periodontal abscess drainage, teeth with periodontal fistula formation, and early peri-implantitis. Commonly used sustained-release preparations in periodontal pockets include 2% minocycline ointment, 5% minocycline flakes, and 25% metronidazole gel.
Controlled-Release Drugs
It means that the speed of local release of the drug can be controlled to achieve the purpose of achieving curative effect at a fixed point in time. At present, controlled-release drugs are still in the research stage, mainly as adjuvant therapy after mechanical therapy. Drugs that fall into the controlled-release class are currently available in non-degradable tetracycline controlled-release systems and absorbable 10% doxycycline gels.
3. Systemic medication for periodontitis
After talking about topical medicine for periodontitis, let’s look at periodontitisSystemic medication for inflammation.
Nitroimidazoles
Mainly includes metronidazole, tinidazole and ornidazole. Among them, metronidazole has a good therapeutic effect on periodontitis and necrotizing ulcerative gingivitis. In clinical practice, metronidazole is often used in combination with amoxicillin. It is worth noting that alcohol should be avoided during the taking of nidazole drugs, which can easily cause adverse reactions such as palpitation, guilty conscience, chest tightness and even shock.
Image source: Zhanku Hailuo
Amoxicillin
Often used in combination with metronidazole, it can be used to treat both localized and extensive aggressive periodontitis (a fast-progressing, widespread periodontitis), but Disabled.
Tetracyclines
Mainly includes tetracycline, minocycline and doxycycline. Tetracyclines are very effective in the treatment of localized aggressive periodontitis, but are contraindicated in pregnant women and children under 6 to 7 years old.
Macrolide antibiotics
Including spiramycin, roxithromycin, azithromycin, etc., effective for acute infections such as invasive periodontitis and periodontal abscess. Those allergic to macrolide antibiotics are contraindicated.
Although the drug treatment of periodontitis has the above effects, for most patients with periodontitis, mechanical treatment alone can achieve good results, and drug treatment is only used as mechanical treatment exist as auxiliary means. Patients must not blindly take medicines themselves, and must take medicines under the guidance of a doctor.
In addition, the long-term effects of periodontal treatment still depend on the patient’s self-control of bacteria and good regular maintenance therapy.
Image source: Zhanku Hailuo
*The content of this article is for the popularization of health knowledge and cannot be used as a specific diagnosis and treatment suggestion, nor can it replace the face-to-face consultation of a licensed physician, and is for reference only.
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