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Periodontal disease is a condition that worsens over time and can cause severe inflammation and tooth loss if not treated. One way to treat it is by using antibiotics, which can reduce the bacteria that cause the disease. Antibiotics can be used in combination with deep cleanings (scaling and root planning), gum surgery, or by themselves to help reduce the amount of bacteria before or after periodontal procedures are performed.

oral plaque

Local and Systemic Antibiotics

According to the research, antibiotic use in periodontal disease can be beneficial in some cases, but it is not a substitute for mechanical debridement and oral hygiene. Antibiotics can help reduce the bacterial load and inflammation in periodontal pockets, especially in patients with aggressive or refractory forms of the disease. More specifically, the purpose of using antibiotics in periodontal disease treatment includes:

Local Antibiotics:

**1. Direct Action at the Site of Infection:

  • Local antibiotics are often delivered directly to the site of infection in the periodontal pockets, which are spaces between the teeth and gums where bacteria thrive. This allows for a targeted and concentrated effect at the source of the infection.

**2. Reduction of Bacterial Load:

  • Local antibiotics help reduce the bacterial load within the periodontal pockets. By directly targeting the bacteria causing the infection, these antibiotics contribute to the elimination or suppression of the pathogens responsible for periodontal disease.

**3. Adjunct to Scaling and Root Planning (SRP):

  • Local antibiotics are frequently used as an adjunct to professional dental cleaning procedures, such as scaling and root planning. This combination enhances the effectiveness of the treatment by providing sustained antimicrobial activity in the periodontal pockets.

**4. Control of Inflammation:

  • By controlling the bacterial infection, local antibiotics help in reducing inflammation in the gums. This is crucial for preventing the progression of periodontal disease and promoting the healing of the affected tissues.

**5. Minimized Systemic Side Effects:

  • Local antibiotics minimize systemic side effects compared to systemic antibiotics, as they are applied directly to the affected area. This targeted delivery reduces the risk of widespread antibiotic exposure throughout the body.


Systemic Antibiotics:

**1. Treatment of Widespread Infections:

  • Systemic antibiotics are prescribed for cases where the periodontal infection is more widespread or severe. They are taken orally, and their effects are distributed throughout the entire body via the bloodstream, reaching distant areas of infection.

**2. Adjunct to Non-Surgical and Surgical Periodontal Therapy:

  • Systemic antibiotics may be used as an adjunct to non-surgical and surgical periodontal therapies. They are often prescribed in conjunction with professional cleanings, scaling and root planning, or surgical procedures to enhance the overall effectiveness of treatment.

**3. Management of Aggressive Periodontitis:

  • In cases of aggressive periodontitis, where rapid progression of the disease is observed, systemic antibiotics may be recommended to control the aggressive bacterial activity and aid in the stabilization of the condition.

**4. Reduction of Systemic Inflammatory Responses:

  • Periodontal disease is associated with systemic inflammatory responses that can impact overall health. Systemic antibiotics can help reduce these inflammatory responses, potentially contributing to improvements in systemic health.

**5. Management of Refractory Cases:

  • In cases where periodontal disease does not respond adequately to non-surgical interventions, systemic antibiotics may be considered as part of a comprehensive treatment plan. This is often done under the guidance of a periodontist or oral health professional.

Oral Antibiotic

Antibiotic use in periodontal disease can be beneficial in some cases, but it is not a substitute for mechanical debridement and oral hygiene. Antibiotics can help reduce the bacterial load and inflammation in periodontal pockets, especially in patients with aggressive or refractory forms of the disease. However, antibiotics also have some drawbacks, such as side effects, resistance, and interactions with other drugs. Therefore, antibiotics should be used judiciously and only as an adjunct to other treatments.

Here are some specific details about several different types of oral antibiotics:

- Azithromycin, a macrolide antibiotic, has a long half-life and can accumulate in gum tissues, making it a suitable choice for periodontal therapy.

- Doxycycline, a tetracycline antibiotic, has anti-inflammatory and anti-collagenase properties that can inhibit the breakdown of connective tissue and bone in periodontitis.

- Metronidazole, an antiprotozoal antibiotic, is often combined with amoxicillin to target the anaerobic bacteria that cause periodontal infections in severe and chronic periodontitis.


Topical Gels and Strips

One of the main benefits of applying antibiotics directly to the gums is that they do not affect the whole body. Gels and other methods that deliver antibiotics to the gum surface are often preferred over pills and are very effective when used after cleaning the plaque and tartar from the teeth and roots. Based on the research, some of the topical gel antibiotics that are proven to work for periodontal disease are:

- Doxycycline gel (Atridox), which is a tetracycline antibiotic that reduces inflammation and blocks collagenase, a protein that destroys connective tissue and bone. This gel releases the antibiotic over several days.

- Metronidazole gel (Elyzol), which is an antiprotozoal antibiotic that eliminates both bacteria and parasites that cause periodontal infections. It comes in gel and strip form. It is unique because it is able to destroy parasites as well as oral bacteria.

- Minocycline gel (Dentomycin or Arestin), which is another tetracycline antibiotic that reduces bacteria and pocket depth.

These gels are applied directly into the gum pockets after scaling and root planning, a procedure that removes plaque and tartar from the tooth surfaces and roots. They are designed to release the antibiotic slowly and effectively into the infected area. They may be used alone or in combination with other treatments, such as oral antibiotics or surgery, depending on the severity and type of periodontal disease. We will use antibiotics as needed to help your gums heal.

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