While systemic antibiotics have a very limited use in treating typical periodontal disease, there has been much interest in local antibiotic delivery. If an antibiotic can be delivered directly to the pocket, without the patient having to take systemic doses, there are far fewer side effects, and fewer chances of resistant bacteria forming. In addition, with direct local delivery, the concentration of the antibiotic at the diseased site can be 100 times greater than taking the medication orally. However, it is important to note that all local delivery antibiotics are recommended as adjuncts to scaling and root debridement, and not as stand-alone treatments.
The most recent local antibiotic therapy introduced consists of small spheres of minocycline, a derivative of tetracycline. This drug, similar to the ingredients in Actisite and Atridox, is very effective in killing the bacteria that are thought to cause periodontal disease. The primary advantage of this new product is the ease of use. The spheres, which look like a fine powder, are contained in a small blunt plastic needle, and are injected into the pocket. This requires no anesthesia. The spheres are bioadhesive, and stick to the pocket wall where they slowly release minocycline over a 14-21 day period. Because the spheres are also biodegradable they do not require removal.
Generally speaking local delivery antibiotics are used in the Periodontal Maintenance phase of therapy, when isolated areas of the mouth seems to be worsening. Their use is generally not recommended during the active phase of treatment. The effectiveness of these products is somewhat controversial, and while there is usually some improvement, whether these results are long-term has yet to be demonstrated. Certain cases seems to respond better than others, and your periodontist will help advise you whether these treatments may be beneficial in your particular case.
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