some microbial species within the bacterial plaque are responsible for development and progression of periodontitis. however, root planing and curettage/Modified Widman flap are involved in elimination of majority of microbial plaque that contain both periodontal pathogens and non pathogenic organisms as a non specific therapy, so is it necessary to prescribe systemic antibiotics in all cases as adjunct to mechanical procedures?
I have had very detailed debates with clinicians and periodontists and have come to a conclusion listening to all the experts I have come across. The conclusion is that its not mandatory to prescribe systemic antibiotics in every case. It all depends on how severe the case is and a dozen other issues related like systemic health, oral health, patient factors as well. This is a really good question and answers from other clinicians would give us an insight as to what they think or there opinion is about this
Oral surgical wounds considered as clean contaminated wound, which have 5-15 % chance of developing infections. Literature review shows the lack of convincing evidence about prescribing antibiotics for the most of surgical procedures (including periodontal surgical procedures), even for dental implant surgery and mandibular fractures.
There are, however, guidelines for antibiotic prescription in oral surgical procedures in general. Surgical procedures last not more than 2 hours, do not need antibiotic prescription provided the patient is healthy.
No. The mechanical removal of the biofilm is still the corner stone of each anti-infective therapy. There are no pills against periodontitis.
The prescription of antibiotics is limited (as you said) as adjunctive and just for severe cases, e.g. severe chronic periodontitis and aggressive periodontitis cases. If periodontitis is associated with systemic diseases, this may be an other reason.
However, for phase one therapy (non-surgical) the latest systemic reviews (see JADA) shows no superior effect of antibiotics as adjunctive to mechanical biofilm removal in comparison to SRP alone. All depends on the individual case and there is no generalizable recommendation.
· Powell et al. J Periodontol 2005;76:329-33. suggested that there may be no benefit in prescribing antibiotics for the sole purpose of preventing postoperative infections.
· Abu-Ta’a et al. J Clin Periodontol 2008;35:58-63. have speculated that antibiotic use may not be effective in preventing postoperative infections in aseptic conditions, but they significantly reduce the postoperative discomfort.
· An antibiotic regimen regarding correct choice of antibiotic and the duration of the prescription is the need of the hour to prevent misuse and drug resistance.
In certin cases of localized and generalised aggressive periodontitis the causal pathogens have the capability of tissue penetration and invasion. Mechanical debridement, eliminates the biofilm on the root surfaces, however surgical excision of the pocket walls eliminates part of the invaded microorganisms but not entirely. Therefore, entire elimination of the causal organisms might require a full course of antibiotics as an adjunct to the surgical precedure.
i dont think it is recommended in every non surgical or surgical case. But yes it depends on the severity of the disease and other systemic factors. However studies using antibiotics with surgical and non surgical therapies in severe chronic patients have found better results than without antibiotics.
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