Gum Disease : Antibiotic Treatments, Oral Health and Overall Health

by Food and Drug Administration (FDA)

(Page 3 of 3)

Antibiotic Treatments

Antibiotic treatments can be used either in combination with surgery and other therapies, or alone, to reduce or temporarily eliminate the bacteria associated with periodontal disease.

However, doctors, dentists and public health officials are becoming more concerned that overuse of these antibiotics can increase the risk of bacterial resistance to these drugs. When germs become resistant to antibiotics, the drugs lose the ability to fight infection.

"The resistance we're worried about," explains Robert Genco, D.D.S., Ph.D., chairman of the oral biology department at The State University of New York at Buffalo, "is in association with antibiotics in the traditional use; those at higher levels in the blood that kill bacteria."

Jerry Gordon, D.M.D., of Bensalem, Pa., shares Genco's concerns. "There is a role for antibiotics in periodontal disease," Gordon says, "but you have to be very selective in your use."

Each time a person takes penicillin or another antibiotic for a bacterial infection, the drug may kill most of the bacteria. But a few germs may survive by mutating or acquiring resistance genes from other bacteria. These surviving genes can multiply quickly, creating drug-resistant strains. The presence of these strains may mean that the person's next infection will not respond to another dose of the same antibiotic. And this overuse would be detrimental to people if they develop a life-threatening illness for which antibiotics would no longer be helpful.

John V. Kelsey, D.D.S., dental team leader in the FDA's dermatologic and dental drug products division, says, "The widespread use of systemic antibiotics is generating resistant organisms, and that's a problem." And that fact, he says, "has prompted the industry to develop new strategies that would reduce the risk of resistance developing."

For example, three relatively new drugs — Atridox (doxycycline hyclate), PerioChip (chlorhexidine gluconate), and Arestin (minocycline) — are antibiotics that were approved in sustained-release doses to be applied into the periodontal pocket. Local application of antibiotics to the gum surface may not affect the entire body, as do oral antibiotics.

Oral Health and Overall Health

According to the Centers for Disease Control and Prevention (CDC), researchers have uncovered potential links between periodontal disease and other serious health conditions. In people with healthy immune systems, the influx of oral bacteria into the bloodstream is usually harmless. But under certain circumstances, the CDC says, the microorganisms that live in the human mouth can cause problems elsewhere in the body "if normal protective barriers in the mouth are breached."

If you have diabetes, for example, you are at higher risk of developing infections such as periodontal disease. These infections can impair the body's ability to process or use insulin, which may cause your diabetes to be more difficult to manage. Diabetes is not only a risk factor for periodontal disease, but periodontal disease may make diabetes worse.

However, the CDC cautions that there is not enough evidence to conclude that oral infections actually cause or contribute to cardiovascular disease, diabetes and other serious health problems. More research is underway to determine whether the associations are causal or coincidental.

Other Common Measures for Treating Gum Disease

Curettage — a scraping away of the diseased gum tissue in the infected pocket, which permits the infected area to heal.

Flap surgery--involves lifting back the gums and removing the tartar. The gums are then sewn back in place so that the tissue fits snugly around the tooth. This method also reduces the pocket and areas where bacteria grow.

Bone grafts — used to replace bone destroyed by periodontitis. Tiny fragments of your own bone, synthetic bone, or donated bone are placed where bone was lost. These grafts serve as a platform for the regrowth of bone, which restores stability to teeth.

Soft tissue grafts — reinforce thin gums or fill in places where gums have receded. Grafted tissue, most often taken from the roof of the mouth, is stitched in place over the affected area.

Guided tissue regeneration — stimulates bone and gum tissue growth. Done in combination with flap surgery, a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow to better support the teeth.

Bone (osseous) surgery — smoothes shallow craters in the bone due to moderate and advanced bone loss. Following flap surgery, the bone around the tooth is reshaped to decrease the craters. This makes it harder for bacteria to collect and grow.

Medications — in pill form are used to help kill the germs that cause periodontitis or suppress the destruction of the tooth's attachment to the bone. There are also antibiotic gels, fibers or chips applied directly to the infected pocket. In some cases, a dentist will prescribe a special anti-germ mouth rinse containing a chemical called chlorhexidine to help control plaque and gingivitis. These are the only mouth rinses approved for treating periodontal disease.

Other Potential Factors That Contribute to Gum Disease

While plaque is the primary cause of periodontal disease, the American Academy of Periodontology (AAP) says that other factors are thought to increase the risk, severity, and speed of gum disease development. These can include:

Tobacco use — one of the most significant risk factors associated with the development of periodontitis. People who smoke are seven times more likely to get periodontitis than nonsmokers, and smoking can lower the chances of success of some treatments.

Hormonal changes — may make gums more sensitive and make it easier for gingivitis to develop.

Stress — may make it difficult for the body's immune system to fight off infection.

Medications — can affect oral health because they lessen the flow of saliva, which has a protective effect on teeth and gums. Some drugs, such as the anticonvulsant medication diphenylhydantoin and the anti-angina drug nifedipine, can cause abnormal growth of gum tissue.

Poor nutrition — may make it difficult for the immune system to fight off infection, especially if the diet is low in important nutrients. Additionally, the bacteria that cause periodontal disease thrive in acidic environments. Eating sugars and other foods that increase the acidity in the mouth increases bacterial counts.

Illnesses — may affect the condition of your gums. This includes diseases such as cancer or AIDS that interfere with the immune system.

Clenching and grinding teeth — may put excess force on the supporting tissues of the teeth and could speed up the rate at which these tissues are destroyed.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.