From the Guidelines
The most effective treatment for periodontitis involves a comprehensive approach combining professional dental care and home maintenance, with scaling and root planing as the initial treatment, and adjunctive antibiotics such as amoxicillin/metronidazole or azithromycin for moderate to severe cases, as supported by the most recent study 1.
Treatment Overview
The treatment for periodontitis typically includes:
- Scaling and root planing, a deep cleaning procedure where dental professionals remove plaque and tartar from below the gumline and smooth rough spots on tooth roots
- Adjunctive antibiotics, such as amoxicillin/metronidazole or azithromycin, for moderate to severe cases, which have been shown to significantly reduce probing depth and clinical attachment level gain 1
- Daily home care, including thorough brushing twice daily with a soft-bristled toothbrush, daily flossing, and possibly using an antimicrobial mouthwash containing chlorhexidine
Antibiotic Therapy
The use of antibiotics, such as amoxicillin/metronidazole or azithromycin, has been shown to be effective in reducing probing depth and clinical attachment level gain, with significant beneficial effects observed in patients taking these antibiotics adjunctive to scaling and root planing 1
Home Maintenance
Daily home care is essential, including:
- Thorough brushing twice daily with a soft-bristled toothbrush
- Daily flossing
- Possibly using an antimicrobial mouthwash containing chlorhexidine
Lifestyle Modifications
Lifestyle modifications, including smoking cessation and managing conditions like diabetes, are important as they significantly impact treatment success, and regular follow-up appointments every 3-4 months are crucial for maintenance.
Additional Therapies
Additional therapies, such as surgical interventions, including flap surgery, bone and tissue grafts, or guided tissue regeneration, may be necessary for advanced cases, and the use of natural products, such as aloe vera or green tea, may also be beneficial in reducing plaque and gingivitis levels, as shown in studies 1
From the Research
Periodontitis Treatment
The treatment for periodontitis typically involves a combination of non-surgical and surgical approaches.
- Initial non-surgical periodontal therapy primarily consists of home care review and scaling and root planing 2.
- For residual sites with active periodontitis at periodontal re-evaluation, a contemporary regenerative or traditional resective surgical therapy can be utilized 2.
- Periodontal maintenance therapy at a regular interval and long-term follow-ups are also crucial to the success of the treatment and long-term retention of teeth 2.
Antibiotic Therapy
The use of antibiotics as an adjunct to scaling and root planing has been studied in several trials.
- A study found that the administration of amoxicillin and metronidazole immediately after completion of full-mouth periodontal debridement significantly improved the 6-month clinical outcomes of full-mouth non-surgical periodontal debridement 3.
- A systematic review found that the concomitant administration of systemic amoxicillin and metronidazole adjunctive to scaling and root planing provided significantly better effects overall and more pronounced probing pocket depth reduction in periodontal pockets initially measuring ≥6 mm 4.
- However, another study found no statistically significant difference between the effects of amoxicillin and/or metronidazole and scaling and root planning in the treatment of chronic periodontitis 5.
Evidence-Based Guidelines
The American Dental Association has developed an evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts.
- The guideline recommends scaling and root planing as the initial nonsurgical treatment for chronic periodontitis, with a moderate benefit and the benefits outweighing potential adverse effects 6.
- The guideline also recommends systemic subantimicrobial-dose doxycycline and systemic antimicrobials as adjunctive therapies to scaling and root planing, but with different strengths of recommendation due to the potential for adverse effects 6.