Sub-antimicrobial doses of doxycycline will prevent the recurrence of periodontal disease and has been recommended for at least twenty years. However, this is a specific treatment and antibiotics belonging to other classes are not effective. The mechanism is inhibition of inducible  MMPs and pro-inflammatory cytokines and has nothing to do with the antibiotic properties of doxycycline    Go into the literature and look for the name Lorne M. Golub. He has been the lead investigator in this area for more than 30 years. This is still an important area of research because periodontal disease puts one at risk for cardiac failure. The same MMP enzymes that  are at raised levels in the jaw tissue are also at raised levels in the circulation and lead to heart muscle deterioration.

For a recent article see M.S. Elburki et al. in "Mediators of Inflammation"(http://doi.org/10.1155/2014/9594710.

                                             Francis Johnson.

                                                                      . 

The combination of conventional treatment with systemic antimicrobial therapy and close follow-up care seems to be the best for aggressive periodontitis.

If everyone who has Pperiodontitis used Periostat there would likely be no need to plane or scale the teeth. This is NOT antimicrobial therapy!!! It relies principally on the intrinsic property of doxycycline (and other tetracyclines) to inhibit a number of tissue degrading enzymes known as MMPs The enzymes involved degrade the collagen in both the soft and hard tissue but are of the inducible variety and not the constitutive type. The latter (MMP1 for example, in humans) are essential and continuously-operating enzymes but are non-targets of this class of drug substance unlike the earlier MMP inhibitors such as Marimasts or Batimastat which knocked down all of these enzymes.

                                            Francis Johnson

yes, for patients who have cardiac disease because they could have emdocarditis

It is speculation that patients with periodontitis may have endocarditis but the real problem is heart failure due to heart muscle deterioration and in the case of  periodontitis this relationship is now well-established in the dental/medical litwrature.

Thanks to all for their valuable suggestions regarding the prescription of systemic antibiotics after periodontal therapy.

Still I have a dilemma about prescription of antibiotics after scaling and root planing, periodontal surgery in systemic healthy person ( no diabetic, cardiac diseases etc.) 

I think it is fully dependent on the patient. All the aptient do not need sysemic therapy, but only for special patient such as those with immune defiencies, or other probelms it is a requirment

Antimicrobials need to be sparingly used, even when the thumb of rule makes you go against it. If the immune system can take control of the situation, we can avoid the use of antimicrobials. 

I think it is fully dependent on the patient. All the patients  do not need sysemic therapy, but only for special patient such as those with immune defiencies, or other probelms it is a requirment

Francis, I cannot locate the article you cited by M.S. Elburki et al., "Mediators of Inflammation"(http://doi.org/10.1155/2014/9594710). Is there a PMID, or if it is in a book, it is essential that you provide the name of the book, book editors, and publisher so that we can get a copy through Interlibrary loan. Thanks  Martin

Dear Dr. Martin,

Pleas provide me with your Email address and I will forward copies of two pertinent articles that we published recently.. My address is [email protected]

                            Francis J.

[email protected]

Thanks

Can you send the article to me.

My e mail is [email protected]

Thanks for your answer dr Francis

Regards

Abhay

I have suggested to Francis that he post the copies on Researchgate. It is his work and I don't feel that it is appropriate for me to post them.

Martin

Dear Abhay Das

Francis asked me to post his two publications as attached files. Please let me know if you can download them successfully

Martin Levine

Dear Dr. Levine,

                             Thanks so much.

                                                    Francis J.

Thanks a lot to dr Levine and dr Francis.

I down loaded the both article that you have provided.

Best regards

Abhay

There is a huge body of evidence to support the fact that periodontal disease can be managed successfully with non-surgical therapy in conjunction with periodontal maintenance care (Hill et al. 1981, Pihlstrom et al. 1983, 1984, Lindhe & Nyman 1984, Lindhe et al. 1984, Ramfjord et al. 1987, Kaldahl et al. 1996). Antibiotics will help in the short term, and this is supported by systematic reviews on the topic (see Herrera et al. 2008) . However the clinical benefit is questionable. Periodontal disease at the end of the day is a bacterial mediated disease, and whilst antibiotics will reduce the bacterial load in the short term, if adequate plaque control and professional maintenance care is not present the bacteria will just regrow and the disease will be re-established. An increased use of antibiotics will eventually lead to more drug-resistant bacteria in society, and so for a disease which for most people can be managed effectively without it (I very rarely prescribe antibiotics in my practice), I think the answer to your question should be NO.

The present consensus for the use of antibiotic therapy to control chronic periodontitis is based on a publication in which Haffajee et al. [1] report on antibiotic therapy to control attachment loss in patients who are otherwise refractory (unresponsive) to therapy. This problem was investigated extensively by the late Drs Socransky and Haffajee [1-4], and their colleagues and successors, Drs Teles, Colombo, and Van Dyke [5-7], and also by my group originally in collaboration with Dr. Socransky [8]. Dr. Socransky sent us serum and records from 59 of his patients after therapy, i.e. Widman flap surgery as necessary to complement deep scaling and root planning (SRP). The patients were instructed to brush and floss their teeth twice daily and to return every 3 months. We designated the refractory responders as those who had lost mean attachment 3 months after all therapy was completed. We measured antibodies to E. corrodens lysine decarboxylase (LDC) in their serum and found increased levels compared with good responders [8], but too small to inhibit LDC enzymatic activity compared with LDC immunization, which we performed in beagle dogs [9]. Although we have reported that LDC immunization inhibits gingivitis development in beagle dogs [9], translating this into immunization against gingivitis in humans will take time. Currently, it seems that refractory responders should be treated with antibiotics, 500 mg amoxicillin and 250 mg metronidazole three times daily for 14 days [1]. Unfortunately, this may have evolved into treating ALL chronic periodontitis patients with antibiotics [6] and I strongly agree with Dr. Ngo that this is potentially dangerous. There is an urgent need to re-emphasize that at least 75 – 80% of chronic periodontitis patients can be treated successfully by SRP with Widman flap surgery as necessary and NO antibiotics. The problem is to identify the refractory patients, i.e. those who lose mean periodontal attachment within 3, 6, 9 or 12 months after completing therapy. I and many others are investigating faster and cheaper ways of diagnosing and treating such patients, but none exists at present.

Reference List

  [1]    Haffajee AD, Uzel NG, Arguello EI, Torresyap G, Guerrero DM, Socransky SS. Clinical and microbiological changes associated with the use of combined antimicrobial therapies to treat "refractory" periodontitis. J Clin Periodontol 2004 Oct;31(10):869-77.

  [2]    Haffajee AD, Cugini MA, Dibart S, Smith C, Kent RL, Jr., Socransky SS. Clinical and microbiological features of subjects with adult periodontitis who responded poorly to scaling and root planing. J Clin Periodontol 1997 Oct;24(10):767-76.

  [3]    Haffajee AD, Teles RP, Socransky SS. The effect of periodontal therapy on the composition of the subgingival microbiota. Periodontol 2000 2006;42:219-58.

  [4]    Haffajee AD, Torresyap G, Socransky SS. Clinical changes following four different periodontal therapies for the treatment of chronic periodontitis: 1-year results. J Clin Periodontol 2007 Mar;34(3):243-53.

  [5]    Colombo AP, Boches SK, Cotton SL, et al. Comparisons of subgingival microbial profiles of refractory periodontitis, severe periodontitis, and periodontal health using the human oral microbe identification microarray. J Periodontol 2009 Sep;80(9):1421-32.

  [6]    Colombo AP, Bennet S, Cotton SL, et al. Impact of periodontal therapy on the subgingival microbiota of severe periodontitis: comparison between good responders and individuals with refractory periodontitis using the human oral microbe identification microarray. J Periodontol 2012 Oct;83(10):1279-87.

  [7]    Teles FR, Teles RP, Uzel NG, et al. Early microbial succession in redeveloping dental biofilms in periodontal health and disease. J Periodontal Res 2012 Feb;47(1):95-104.

  [8]    Levine M, LaPolla S, Owen WL, Socransky SS. Antibody-based diagnostic for 'refractory' periodontitis. J Clin Periodontol 2002 Oct;29(10):935-43.

  [9]    Peters JL, Demars PL, Collins LM, et al. Effects of immunization with natural and recombinant lysine decarboxylase on canine gingivitis development. Vaccine 2012 Oct 19;30(47):6706-12.

Thank you Dr Levine and Dr Ngo for your highly impacted answer to my question. Special thanks to Dr Levine..

Best Regards 

Dr Abhaya

Answer to your question, should be No. But, in patients where is compromited sistemic health (patient with risk for endocarditis), patients with uncontroled diabetes, there are indication to prescribe systemic antibiotics.

At this time, this is not a straightforward question because, as Kir indicates, there are patients who present with various susceptibility factors. So when you get a new patient, it is important to do as thorough a prophylaxis as possible. I attach 2 papers that may be relevant about who and when you should prescribe antibiotics (Haffajee 2004), and what some of the most serious and easily detected susceptibility factors are (Giannobile 2013). You cannot keep using antibiotics to treat chronic periodontitis without a risk of eventually incurring antibiotic resistance that can spread to the local population. Hope this helps - Martin