Non-Surgical Periodontal Procedures

Antimicrobials, antiseptics and antibiotics

What is an antimicrobial?

Antimicrobials are substances that will inhibit or eliminate the growth of a microorganism. They include antibiotics, antiseptics and other disinfectants.

What are antiseptics?

Antiseptics are chemical disinfectants that are applied at the gum surface, or under the gum line, to inhibit the growth of microorganisms. Mouthwash is an antiseptic.

What is an antibiotic?

An antibiotic is a substance that is taken orally, or injected, which passes through the body in order to get to a site of infection. An antibiotic prevents the infecting organism from growing, or destroys the current growth. An antibiotic can also be used to prevent infection.

Some studies suggest that scaling and root planing with antimicrobial support will eliminate the need for periodontal surgery, and that it is a more cost-effective, user-friendly means of periodontal treatment. However, other recent studies have concluded that surgery may provide a better long-term outcome with less need for additional treatments than non-surgical therapy. The American Academy of Periodontology is concerned that these studies have initiated debate that is confusing for practitioners and patients and may thwart thoughtful discussion and better understanding of the key issue: what is the most effective means to keep periodontal diseases at bay for each individual patient?

AAP treatment guidelines have always stressed that periodontal health should be achieved in the least invasive, most cost-effective manner. This is often accomplished through non-surgical periodontal treatment, including scaling and root planing, followed by adjunctive therapy such as systemic and/or local delivery antimicrobials. Most periodontists would agree that after scaling and root planing, many patients do not require further active treatment, including surgical therapy. However, the majority of patients will require ongoing maintenance therapy to sustain health. Non-surgical treatment does have its limitations, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices.

Some studies propose that all patients receive antibiotics at the time of scaling and root planing. This blanket use of antibiotics is not necessary for most patients because the majority of individuals respond well to non-surgical treatment without antibiotics. Blanket antibiotic use disregards the Centers for Disease Control recommendations for appropriate antibiotic use for healthcare providers. As healthcare providers, it is important for all dentists to consider antibiotic usage guidelines in treatment planning, so that the effectiveness of their use is preserved for patients who do not respond to traditional therapy, and to avoid contributing to one of the world's most pressing health problems -- antibiotic resistance.

The AAP continually monitors emerging research to identify therapies that further its members' understanding of cost-effective, minimally invasive procedures in the treatment of periodontal disease. Unfortunately, when the overly simplistic dispute over non-surgical versus surgical procedures arises, it often misleads patients and the dental community into thinking it's an "either-or" debate. In fact, the procedures are complementary, each having their place in treatment, and each having their limitations.