Introduction
In the case of pure gingivitis, i.e. gingivitis, no antibiotics are usually prescribed. Antibiotics are useful in all cases of periodontitis, i.e. inflammation of the entire periodontium. But not every periodontitis is supported by antibiotics.
It is important to weigh up the benefits and risks of antibiotic therapy and whether it is worthwhile. The goal of antibiotic treatment is to stop the receding gums from receding due to the bacteria in the oral cavity and gum pockets. However, if this can be removed purely by mechanical removal of plaque, the risky and cost-intensive therapy is not required additionally.
When do I need antibiotics?
Whether and when to take antibiotics in case of periodontitis (= inflammation of the periodontium, i.e. the gums, the surrounding bone and the fibrous apparatus that holds the tooth) is decided by the dentist. He carefully weighs the relation between cost-benefit and risk-benefit. Patients with gingivitis or with mild periodontitis do not need antibiotics as long as they are systemically healthy (in terms of their overall body image).
The indication for systemic antibiotic administration is indicated in aggressive periodontitis, which also occurs in adolescents. In the case of severe chronic periodontitis, antibiotics are also used, as the chronically consolidated disease cannot be treated otherwise. If, despite good mechanical cleaning, there is no improvement but even more receding gums, the antibiotic helps. In the case of abscesses, which spread around the periodontium and can lead to symptoms such as fever and swollen lymph nodes, antibiotics should help to heal as quickly as possible. If the general condition is reduced by systemic diseases and the immune system is not strong enough to fight periodontitis, only an antibiotic can support the healing process.
Which antibiotics are used?
There are basically two different mechanisms of action. One type of antibiotic has a bacteriostatic effect, the other bactericidal. Chemically speaking, the antibiotic types differ in their structure.
An important group are the antibiotics of the so-called ß-lactams. These are contained for example in penicillin. They dissolve the bacteria directly, which is useful for gum inflammations.
Especially in case of periodontitis, which should be supported by antibiotic therapy, the bacteria should be killed immediately. If only their growth is stopped, the remaining bacteria can continue to cause damage. The inflammation cannot simply be treated in this way.
Amoxicillin is most often used in combination with metronidazole. In patients with penicillin allergy, the active ingredient amoxicillin is replaced by ciproflaxacin. The antibiotics described above are administered systemically, mostly in the form of tablets.
In addition, local antibiotics are useful, which are only applied to the hard and soft tissues in the mouth. – Bacteriostatic means that the bacteria are not killed directly, but only prevented from multiplying. – Bactericidal antibiotics dissolve the bacteria by dissolving the cell wall or preventing their production.
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