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Medical Forum / General / Dentistry / March 2005Antibiotics for Periodontal Disease?
A friend of mine has periodontal problems, and is facing surgery to rid himself of inflamed gums. I was talking to someone who mentioned good success in using local and systemic antibiotics. I did a searches on Pubmed and Google, and found a fair amount of information that is generally positive on this topic. The only downsides that I'm seeing is that it might not work (in which case surgery could be tried), or that it contributes to the general worldwide problem of creating antibiotic-resistant bacteria (a problem, but perhaps it would be better to start by not prescribing antibiotics where they have no use, such as for the common cold). Based I'm what I'm seeing, I'm thinking that it might be reasonable for my friend to try local antibiotics first, give systemic antibiotics a shot if the systemics don't work, and try surgery as a last resort. I'm curious if this group has any thoughts about the effectiveness, cost-effectiveness, and downsides of this approach. Richard >A friend of mine has periodontal problems, and is facing surgery to rid >himself of inflamed gums. I seriously doubt it. The overuse of the word "surgery" causes patients to pony up bigger bucks than they otherwise would. It has cocktail-conversation value. >I was talking to someone who mentioned good success in using local and >systemic antibiotics. I did a searches on Pubmed and Google, and found >a fair amount of information that is generally positive on this topic. Maybe. >The only downsides that I'm seeing is that it might not work (in which >case surgery could be tried), or that it contributes to the general >worldwide problem of creating antibiotic-resistant bacteria (a problem, >but perhaps it would be better to start by not prescribing antibiotics >where they have no use, such as for the common cold). This is often marketing hype. If it were a viable alternative, it would be in conventional treatment. >Based I'm what I'm seeing, I'm thinking that it might be reasonable for >my friend to try local antibiotics first, give systemic antibiotics a >shot if the systemics don't work, and try surgery as a last resort. Sure, but I bet that the "health care provider" as Jan would say, isn't about to donate his script writing services or even accept twenty bucks for it. Tell us more ........ And post x-rays! Joel >I'm curious if this group has any thoughts about the effectiveness, >cost-effectiveness, and downsides of this approach. > >Richard STEP ONE: What exactly is the problem? This is always the first rule in TREATING any disease that people seem to gloss over. >>>A friend of mine has periodontal problems, and is facing surgery to rid >>>himself of inflamed gums. Sorry. Please define "surgery" for me so that I can be more precise in the future. >> This is often marketing hype. If it were a viable alternative, it >> would be in conventional treatment. This is often the case, but not always the case. I can cite examples, if you'd like. Richard >>A friend of mine has periodontal problems, and is facing surgery to rid >>himself of inflamed gums. [quoted text clipped - 42 lines] > This is always the first rule in TREATING any disease that people seem > to gloss over. >>>>A friend of mine has periodontal problems, and is facing surgery to rid >>>>himself of inflamed gums. [quoted text clipped - 7 lines] >This is often the case, but not always the case. I can cite examples, >if you'd like. Yes, I have read the literature as well. But strictly speaking, periodontitis is a localized disease with local etiology, not something like peritonitis. >Richard > [quoted text clipped - 44 lines] >> This is always the first rule in TREATING any disease that people seem >> to gloss over. A patient who opted for the PerioChip therapy noticed that each pocket was adjacent to a crown! These were not my crowns, but I am sure that this happened to my patients too. The crown is sometimes of beautiful interproximal contour, and other times not. Joel >>>>>A friend of mine has periodontal problems, and is facing surgery to rid >>>>>himself of inflamed gums. [quoted text clipped - 61 lines] >>> This is always the first rule in TREATING any disease that people seem >>> to gloss over. > Yes, I have read the literature as well. > > But strictly speaking, periodontitis is a localized disease with local > etiology, not something like peritonitis. Strictly speaking yes. But as you know, there are some pretty global systemic manifestations that are being associated with periodontitis these days. That would seem to leave the door open to the possibility of more effective systemic treatments in the future. I agree that systemic treatment is very limited right now. But considering how frustrating local approaches can be, investigating these systemic approaches seems like a good idea. Steve >>Richard >> [quoted text clipped - 44 lines] >>>This is always the first rule in TREATING any disease that people seem >>>to gloss over.  SignatureCut the nonsense to reply >> Yes, I have read the literature as well. >> [quoted text clipped - 10 lines] > >Steve I agree 100% THANKS. Well said. Joel >>>Richard >>> [quoted text clipped - 44 lines] >>>>This is always the first rule in TREATING any disease that people seem >>>>to gloss over. >> Yes, I have read the literature as well. >> [quoted text clipped - 10 lines] > >Steve Most of those systemic diseases are conditions which typically afflict the same demographics. I am not ready to embrace that line of thought without better research. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. >>Steve > [quoted text clipped - 4 lines] >Stephen Mancuso, D.D.S. >Troy, Michigan, USA That's my thinking too. I want to see something like, "Oh these six hundred patients had terrible periodontal disease, I gave them antibiotics, and lo and behold! Five hundred now have the periodontium of a 21-year old! Joel I like using "Lo and Behold!" where pure magic is invoked. >>>Steve >> [quoted text clipped - 16 lines] > >I like using "Lo and Behold!" where pure magic is invoked. Too many hygienists are trying to say that periodontal disease causes heart problems. you must first rule out things like smoking & poor physical health which causes both problems. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. >Too many hygienists are trying to say that periodontal disease causes >heart problems. you must first rule out things like smoking & poor >physical health which causes both problems. That is why I lose patience with the girls. They forget the patients are the doctor's patients, not their's. >.. >Stephen Mancuso, D.D.S. >Troy, Michigan, USA >>>Yes, I have read the literature as well. >>> [quoted text clipped - 14 lines] > the same demographics. I am not ready to embrace that line of thought > without better research. In general I agree. I don't necessarily think you can lump all of these associations together as far as how much they are associated with the literature. For example, there seems to be a pretty strong association between periodontal disease and low birth weight. I don't think the association between periodontal disease and cardiovascular and cerebrovascular disease is anywhere near as clear. Steve > .. > Stephen Mancuso, D.D.S. > Troy, Michigan, USA > > I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. SignatureCut the nonsense to reply Mightn't it be case that all of these things have the same underlying cause? Research seems to be uncovering a link between chronic inflammation (e.g. CRP) and a whole host of things. >>>> Yes, I have read the literature as well. >>>> [quoted text clipped - 29 lines] >> I am writing on a Tablet-PC,so forgive me if the PC misreads my >> handwriting. > Mightn't it be case that all of these things have the same underlying > cause? Research seems to be uncovering a link between chronic > inflammation (e.g. CRP) and a whole host of things. That's the big issue. Some of the studies (I don't have the references at my fingertips) said that they had adjusted for so-called confounding factors such as smoking and bad diet. The devil is (as it always is) in the details, and just how you do this. Like Joel, I'm not totally sold on the actual causation. The way the association is being used to rationalize therapy--well, that's something else again. Steve >>>>> Yes, I have read the literature as well. >>>>> [quoted text clipped - 29 lines] >>> I am writing on a Tablet-PC,so forgive me if the PC misreads my >>> handwriting. SignatureCut the nonsense to reply Call ten periodontists who are specailists in treating gums. Ask them for the prescription over the phone. "Are you coming in so I can look at it?" NOPE, just give me the prescription. Do you think that would work? Of course not. Joel >A friend of mine has periodontal problems, and is facing surgery to rid >himself of inflamed gums. [quoted text clipped - 16 lines] > >Richard I don't think that I suggested to do this. > Call ten periodontists who are specailists in treating gums. > [quoted text clipped - 30 lines] >> >>Richard No, that's my words. I am saying that taking a pill for periodontitis is not an accepted therapy. Its an exaggerated response to your question to point out the principle that there are many causes for periodontal disease. Catching the bug is not one, in general. Therefore, antibiotics alone are not the cure. Joel >I don't think that I suggested to do this. > [quoted text clipped - 32 lines] >>> >>>Richard Simiarly, Antibiotics alone for diabetic wound care ignores the etiology! Joel >No, that's my words. > [quoted text clipped - 5 lines] >the bug is not one, in general. Therefore, antibiotics alone are not >the cure. >A friend of mine has periodontal problems, and is facing surgery to rid >himself of inflamed gums. [quoted text clipped - 16 lines] > >Richard Depends on a hundred variables which require a real life exam to evaluate. Maybe yes and maybe no. .. Stephen Mancuso, D.D.S. Troy, Michigan, USA I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. Is there a "ferinstance" where it would be unwise to try antibiotics before the knife? >>A friend of mine has periodontal problems, and is facing surgery to rid >>himself of inflamed gums. [quoted text clipped - 24 lines] > > I am writing on a Tablet-PC,so forgive me if the PC misreads my handwriting. > Is there a "ferinstance" where it would be unwise to try antibiotics > before the knife? IMO, this has more to do with the stated intent than it does with the actual usage itself. There are some areas which may be judged borderline as far as need for surgery is concerned. I have no problem with use of something like Atridox in selected pockets like this. It may change a questionable surgery into a wait and see situation. I also have no problem with use of antibiotics perioperatively to decrease the chance of postop infection and speed healing. What I object to is putting a patient on long-term antibiotics and telling them this has a realistic chance of controlling a significant periodontitis in lieu of surgery. Steve SignatureCut the nonsense to reply |
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