Treatment Overview

Periodontitis, commonly known as gum disease, is a serious infection that damages the soft tissue and, without treatment, can destroy the bone that supports your teeth. For many, the symptoms of bleeding gums, persistent bad breath, or loose teeth cause significant anxiety and self-consciousness. It is a condition that affects not just oral health but overall well-being, often making eating or smiling uncomfortable. While the diagnosis can be alarming, periodontitis is highly treatable, especially when caught early.

Treatment is essential to stop the infection, prevent tooth loss, and reduce the risk of systemic health issues like heart disease and diabetes, which are linked to gum inflammation. The primary goal is to thoroughly clean the pockets around teeth and prevent further damage to the surrounding bone. Because gum disease progresses differently in everyone, treatment plans vary. A dentist or periodontitis specialist will recommend a regimen based on how deep the gum pockets are and the specific bacteria involved (National Institute of Dental and Craniofacial Research, 2023).

Overview of treatment options for Periodontitis

The treatment of periodontitis typically involves a tiered approach. The foundation of care is non-surgical mechanical cleaning, known as scaling and root planing, which physically removes plaque and tartar from below the gumline. Medications are generally used as an adjunct to this procedure, not as a replacement for it.

Pharmacological treatments are used to reduce the bacterial load that mechanical cleaning cannot reach or to modulate the body’s immune response to prevent tissue destruction. In advanced cases where deep pockets remain after cleaning and medication, surgical procedures such as flap surgery or bone grafting may be necessary to restore health. However, medication plays a crucial role in stabilizing the condition before surgery is considered.

Medications used for Periodontitis

Medications for gum disease can be delivered directly to the site of infection (local) or taken as pills (systemic).

Prescription Mouthrinses: The most common first-line antimicrobial is a prescription mouth rinse containing chlorhexidine. It is used to control bacteria when treating gingivitis and after gum procedures. Clinical experience suggests that consistent use can significantly reduce inflammation and bleeding.

Antiseptic Chips or Gels: For persistent deep pockets, dentists may insert tiny gelatin chips or gels directly into the gum pocket after a deep cleaning. These contain slow-release antibiotics such as doxycycline or antimicrobial agents like chlorhexidine. Over the course of a week or so, the medication dissolves, delivering a high concentration of the drug directly to the infected area.

Oral Antibiotics: In cases of aggressive periodontitis or acute infections (like a gum abscess), systemic antibiotics may be prescribed. Common options include amoxicillin or metronidazole. These are intended to eliminate bacteria that have invaded the gum tissue itself.

Enzyme Suppressants: A unique approach involves low-dose doxycycline. Unlike high doses used to kill bacteria, this low dose works by inhibiting enzymes (collagenase) that break down gum tissue. It is used to protect the gums from the body’s own overactive immune response (American Academy of Periodontology, 2022).

How these medications work

Antiseptics and antibiotics work by targeting the bacterial colonies responsible for the infection. By reducing the number of harmful bacteria in the periodontal pockets, the inflammation subsides, allowing the gums to heal and reattach more firmly to the teeth.

Enzyme suppressants work differently. In periodontitis, the body’s immune system releases enzymes to fight bacteria, but these enzymes can inadvertently destroy collagen, the connective tissue holding the gums together. Enzyme suppressants block this destructive activity, effectively slowing down the progression of bone and tissue loss without acting as an antibiotic.

Side effects and safety considerations

While generally safe, periodontal medications have specific side effects. Chlorhexidine mouthwash often causes brown teeth staining and altered taste with prolonged use. Oral antibiotics can cause stomach upset and, if misused, contribute to antibiotic resistance.

Doxycycline is contraindicated for patients with tetracycline allergies. Pregnant women must consult their dentist, as some antibiotics affect fetal tooth development. Immediate care is needed for face or throat swelling, a sign of severe allergic reaction.

Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.

References

  1. National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov
  2. American Academy of Periodontology. https://www.perio.org
  3. Mayo Clinic. https://www.mayoclinic.org
  4. American Dental Association. https://www.ada.org

Medications for Periodontitis

These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Periodontitis.

Found 1 Approved Drug for Periodontitis

Minocycline

Brand Names
ZILXI, Emrosi, Amzeeq, Arestin, Minocin

Minocycline

Brand Names
ZILXI, Emrosi, Amzeeq, Arestin, Minocin
Form: Injection, Aerosol, Tablet, Powder, Capsule
Method of administration: Oral, Intravenous, Topical
FDA approval date: December 30, 1991
Classification: Tetracycline-class Drug
Minocycline hydrochloride tablets, USP are indicated in the treatment of the following infections due to susceptible strains of the designated microorganisms: Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox and tick fevers caused by rickettsiae. Respiratory tract infections caused by Mycoplasma pneumoniae. Lymphogranuloma venereum caused by Chlamydia trachomatis. Psittacosis (Ornithosis) due to Chlamydophila psittaci. Trachoma caused by Chlamydia trachomatis, although the infectious agent is not always eliminated, as judged by immunofluorescence. Inclusion conjunctivitis caused by Chlamydia trachomatis. Nongonococcal urethritis, endocervical, or rectal infections in adults caused by Ureaplasma urealyticum or Chlamydia trachomatis. Relapsing fever due to Borrelia recurrentis. Chancroid caused by Haemophilus ducreyi. Plague due to Yersinia pestis. Tularemia due to Francisella tularensis. Cholera caused by Vibrio cholerae. Campylobacter fetus infections caused by Campylobacter fetus. Brucellosis due to Brucella species (in conjunction with streptomycin). Bartonellosis due to Bartonella bacilliformis. Granuloma inguinale caused by Klebsiella granulomatis. Minocycline is indicated for the treatment of infections caused by the following gram-negative microorganisms when bacteriologic testing indicates appropriate susceptibility to the drug: Escherichia coli. Klebsiella aerogenes Shigella species. Acinetobacter species. Respiratory tract infections caused by Haemophilus influenzae. Respiratory tract and urinary tract infections caused by Klebsiella species. Minocycline hydrochloride tablets, USP are indicated for the treatment of infections caused by the following gram-positive microorganisms when bacteriologic testing indicates appropriate susceptibility to the drug: Upper respiratory tract infections caused by Streptococcus pneumoniae. Skin and skin structure infections caused by Staphylococcus aureus. (NOTE: Minocycline is not the drug of choice in the treatment of any type of staphylococcal infection.) When penicillin is contraindicated, minocycline is an alternative drug in the treatment of the following infections: Uncomplicated urethritis in men due to Neisseria gonorrhoeae and for the treatment of other gonococcal infections. Infections in women caused by Neisseria gonorrhoeae. Syphilis caused by Treponema pallidum subspecies pallidum. Yaws caused by Treponema pallidum subspecies pertenue. Listeriosis due to Listeria monocytogenes. Anthrax due to Bacillus anthraci s. Vincent’s infection caused by Fusobacterium fusiforme. Actinomycosis caused by Actinomyces israelii. Infections caused by Clostridium species. In acute intestinal amebiasis, minocycline may be a useful adjunct to amebicides. In severe acne, minocycline may be useful adjunctive therapy. Oral minocycline is indicated in the treatment of asymptomatic carriers of Neisseria meningitidis to eliminate meningococci from the nasopharynx. In order to preserve the usefulness of minocycline in the treatment of asymptomatic meningococcal carriers, diagnostic laboratory procedures, including serotyping and susceptibility testing, should be performed to establish the carrier state and the correct treatment. It is recommended that the prophylactic use of minocycline be reserved for situations in which the risk of meningococcal meningitis is high. Oral minocycline is not indicated for the treatment of meningococcal infection. Although no controlled clinical efficacy studies have been conducted, limited clinical data show that oral minocycline hydrochloride has been used successfully in the treatment of infections caused by Mycobacterium marinum. To reduce the development of drug-resistant bacteria and maintain the effectiveness of minocycline hydrochloride tablets, USP and other antibacterial drugs, minocycline hydrochloride tablets, USP should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
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