Periodontal disease is a chronic inflammatory condition affecting the supporting structures of the teeth. It is a leading cause of tooth loss in adults in the United States. Proper management involves mechanical plaque removal along with adjunctive therapies like systemic antibiotics and antiseptic mouthwashes.
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✅ Signs and Symptoms of Periodontal Disease
° Red, swollen, or bleeding gums
° Persistent bad breath (halitosis)
° Gum recession and loose teeth
° Deep periodontal pockets
° Pain or discomfort when chewing
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° Scaling and root planing (SRP): The cornerstone of non-surgical periodontal therapy
° Oral hygiene education: Proper brushing and flossing techniques
° Antimicrobial therapy: Selective use of systemic antibiotics and antiseptic rinses
° Surgical therapy: For advanced or refractory cases
✅ Common Antibiotics in Periodontal Therapy
Note: Pediatric doses must be weight-adjusted and prescribed by a qualified healthcare professional.
✅ Most Used Antiseptic Mouthwashes in Periodontal Care
Caution: Chlorhexidine is highly effective but should not be used continuously for more than 2–3 weeks due to risk of staining and altered taste.
💬 Discussion
Recent studies confirm that systemic antibiotics, particularly the combination of amoxicillin and metronidazole, enhance periodontal healing when used adjunctively in patients with advanced periodontitis. However, routine use is not recommended to avoid antimicrobial resistance.
Chlorhexidine remains the gold standard among antiseptic rinses in post-operative care or during active periodontal therapy. Yet, due to aesthetic side effects like tooth staining, essential oils and CPC-based rinses are better tolerated for long-term daily use.
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The use of antibiotics and antimicrobial mouthwashes in periodontics should be selective and evidence-based. While they do not replace mechanical debridement, they play a valuable role in enhancing treatment outcomes in severe or high-risk cases. Rational and limited use helps reduce bacterial resistance while improving oral and systemic health.
📚 References
✔ Albandar, J. M. (2014). Global risk factors and risk indicators for periodontal diseases. Periodontology 2000, 65(1), 29–51. https://doi.org/10.1111/prd.12061
✔ Herrera, D., Sanz, M., Jepsen, S., Needleman, I., & Roldán, S. (2020). A systematic review on the effect of systemic antimicrobials in periodontitis treatment. Journal of Clinical Periodontology, 47(S22), 164–175. https://doi.org/10.1111/jcpe.13235
✔ Sanz, M., Herrera, D., Kebschull, M., & Chapple, I. L. C. (2020). EFP S3 Level Clinical Practice Guideline for the treatment of periodontitis. Journal of Clinical Periodontology. https://doi.org/10.1111/jcpe.13290
✔ van Winkelhoff, A. J., & Herrera, D. (2022). Antimicrobials in the treatment of periodontitis: A review of clinical efficacy and resistance. Periodontology 2000, 89(1), 131–148. https://doi.org/10.1111/prd.12410
✔ Slots, J. (2019). Systemic antibiotics in periodontics. Journal of Periodontology, 90(12), 1458–1466. https://doi.org/10.1002/JPER.18-0718
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