Mechanical periodontal therapy is usually sufficient to treat the majority of periodontal diseases. But, in the case of certain aggressive periodontitis, antimicrobial medication must be combined with conventional non-surgical therapy.

Reasons:

-Certain microorganisms attach to periodontal tissues and invade them.

-Certain microbes are hard to eliminate because of their location (hard-to-reach areas). 

-Certain pathogens are resistant to mechanical periodontal therapy.

Choice of antibiotic:

It depends on the bacteria responsible and the extent of the infection. After determining the nature of the microorganism in question with a bacterial culture, an effective antibiotic is selected.

 Methods of administration:

  1. Systemic administration

For some patients, systemic antibiotics may be prescribed to be taken orally, to help treat their periodontal disease.

Indications:

  • Aggressive periodontitis.
  • Nonresponse to the mechanical treatment.
  • Patients with a history of endocarditis or prosthetic valve (prophylactic antibiotherapy is necessary).
  • In case of suppuration, during the initial treatment.

2. Local administration

Definition:

It consists in the insertion of the syringe or water jet to disinfect the pockets using an antibiotic or nonsteroidal anti-inflammatory drug. 

Objectives:

  • Perturbation of the subgingival flora.
  • Sanitization and oxygenation the pocket.
  • Stabilization of the bone lysis.
  • Prevention of reinfection.

Indications:

  • As a complement to the mechanical treatment for pockets < 5mm.
  • After drainage of a periodontal abscess.
  • Disinfection of pocket before surgery.
  • Interradicular lesion.

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