Effective Ways to Manage Antimicrobials in Periodontics

The study titled, ‘Antimicrobials in Periodontics: Controlling Chronic Disease’ was originally published by Dentistry Today.

Treating periodontal disease successfully has been one of the major concerns for most dentists. This concern is due to the ramifications caused by the disease in India. It has been estimated that periodontal disease has affected 95% of the Indian population. Let us begin by gaining a brief understanding of the periodontal disease.

What is Periodontal Disease?

Periodontal disease is an infection that is caused by bacterial growth in the mouth. It can be chronic and persistent. It begins with the rapid spreading of bacteria throughout the periodontium. This, in turn, ends up affecting the gums, connective tissue, and alveolar bone. It is vital to diagnose and take prompt action to treat it using the latest technology and drugs.

Managing Periodontal Disease

With the help of research and new technology, we have a better understanding as to why periodontal disease is caused. This can aid us to successfully manage the disease. It is advisable to carry out complete recordings of periodontal probing readings. Furthermore, to allow a preliminary diagnosis, newer screening systems for the evaluation of disease with a scoring system and abbreviated probings could be used. This will also help the patient to gain a better understanding of the disease.

One such treatment is the Stat-Ck. It presents a system based on recordings. For each quadrant, the deepest pocket depth is selected and allocated a letter grade ranging from A through F. It is then noted on the Stat-Ck Periodontal Record sheet. Each grade category has a recommended treatment. It is based on the knowledge of how the antimicrobial drugs function and our capability to fuse this with traditional nonsurgical therapy. The grading system will help the patient create an awareness of the health factors and disease. Moreover, it will make it easier for the patient to accept the needful treatment for the condition.

Due to the persistent nature of the bacteria, all charting, probings, treatment with SRP and adjunctive therapy should be carried out to prevent the infection from spreading, loss of teeth and the need for surgery. Every 3 months, mechanical instrumentation must be carried out to extract the bacteria that creates destructive pathogens. Reason being, the bacteria can return to the baseline levels because the pocket bacteria undergo rapid multiplication. The parameters for treatment have been redefined by the baseline activity these pathogens return to. Adjunctive treatment and the antibiotic Arestin have proven to eradicate the bacteria and improve the effectiveness of SRP.

According to a study conducted in 2006, SRP, when combined with Arestin was responsible for achieving a reduction of 49% in red-complex bacteria under 30 days. Another study conducted in 2008 found that using low-dose of doxycycline hyclate 20 mg, twice a day, and topical antimicrobial therapy provided great clinical benefits to manage severe periodontitis. These studies highlight the importance of combined therapy when it comes to controlling the disease

Periodontol Disease and Cardiovascular Disease

A study published in Heart in 2007, evaluated the effect of tooth loss on cardiovascular mortality. The research was conducted on 12,631 subjects who were around 30 years of age. After following up with them to 57 years of age, researchers discovered that those with a higher number of missing teeth during age 9 or older, were more likely to suffer from heart diseases.

Recent studies are highlighting the role of periodontal disease in the development of cerebrovascular and cardiovascular diseases. According to Dr. Mark Reynolds (Chairman, Department of Periodontics, University of Maryland Dental School), there are growing cases of evidence that implicate chronic inflammation could lead to the development of cardiovascular disease. He feels that dentists have a vital responsibility to inform the patients about the impact, a chronic infection could have on the overall health.

A study conducted in 2007 analyzed the effects of SRP combined with a dose of doxycycline and systemic biomarkers of disease in patients with suffered from coronary artery disease and chronic periodontitis. The research showed that there was a significant improvement in blood levels.

Painless Treatment Measures

If the patient knows that the treatment can be pain-free, they will be more likely to accept the care that is necessary to control the disease. It is therefore vital to provide the patient with treatment that is painless. Dentists can carry out a conservative treatment without the need for anesthesia by using a thermogel known as Oraqix. It contains 2.5% prilocaine, 2.5% lidocaine and can be applied in the gingival sulcus easily using a cannula dispenser. It has been proved by 3 clinical studies to reduce pain during SRP. Another effective way to reduce the patient’s discomfort is to use nitrous oxide analgesia. It relieves anxiety and helps the patient relax.


The patient can be treated successfully with the above-mentioned information accompanied by preventive home measures. These measures include daily use of mouth rinse, power toothbrush, irrigator, and an antimicrobial toothpaste. By having frequent dental visits followed with standard care that is required for periodontal treatment, patients can reduce the risk of medical conditions and maintain good periodontal health of their mouth.


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