What is the typical treatment for periodontitis?

Treatment for Periodontitis

The primary treatment for periodontitis consists of scaling and root planing (SRP), with adjunctive sub-antimicrobial dose doxycycline (20 mg twice daily for 3-9 months) recommended by the American Dental Association to improve clinical outcomes. 1

Non-Surgical Treatment Approach

• Scaling and root planing (SRP) is the cornerstone of initial non-surgical periodontal therapy, involving the mechanical removal of dental biofilm and calculus from tooth surfaces 2
• Home care review and oral hygiene instruction are essential components of successful periodontitis treatment 2
• The American Dental Association recommends systemic sub-antimicrobial dose doxycycline (20 mg twice daily for 3-9 months) as an adjunct to SRP for chronic periodontitis 1
• SRP combined with sub-antimicrobial dose doxycycline (SDD) shows significant improvements in clinical outcomes, including reduction of probing depth (0.9 mm), clinical attachment level gain (0.88 mm), and improvements in plaque index and gingival index 1
• The Scottish Dental Clinical Effectiveness Programme recommends against using antimicrobials for chronic periodontitis or peri-implantitis 1

Surgical Treatment Options

• For residual sites with active periodontitis after initial non-surgical therapy, contemporary regenerative or traditional resective surgical therapy may be utilized 2
• Surgical intervention aims to gain access to root surfaces for thorough debridement and to reshape gingival and osseous tissues to create a more cleansable environment 3
• Periodontal regenerative procedures may be considered to restore lost periodontal tissues in specific defects 2

Adjunctive Antibiotic Therapy

• The combination of amoxicillin and metronidazole as an adjunct to SRP shows greater reduction in probing depth (0.58 mm) and clinical attachment level gain (0.42 mm) compared to SRP alone 1
• Metronidazole alone or in combination with amoxicillin has demonstrated significant improvements in clinical parameters when used as an adjunct to SRP 1
• Systemic azithromycin has shown modest improvements in probing depth reduction (0.21 mm) and clinical attachment level gain (0.23 mm) 1
• There is insufficient and inconclusive evidence supporting the benefit of adjunctive antibiotic therapy in smokers with chronic periodontitis 1

Maintenance Therapy

• Regular periodontal maintenance therapy at appropriate intervals is crucial for long-term success and tooth retention 2
• For adults, twice-yearly visits are recommended to perform conventional supportive periodontal therapy, including periodontal risk assessment and supragingival and subgingival debridement as necessary 1
• Continued monitoring and reinforcement of oral hygiene practices are essential components of maintenance therapy 2

Special Considerations

• Rapidly progressive periodontitis may require more aggressive treatment approaches, including antibiotics in standard doses for conventional time periods 4
• Advanced periodontitis with multiple abscesses may be treated with antibiotics such as amoxicillin, tetracycline, doxycycline, minocycline, clindamycin, or combined therapy of amoxicillin with metronidazole 3
• The timing of antibiotic administration may impact outcomes, with greater improvements observed when antibiotics are administered during the initial phase of treatment rather than after healing 1

Common Pitfalls to Avoid

• Relying solely on antibiotic therapy without addressing the primary cause through mechanical debridement 5
• Neglecting regular maintenance therapy after initial treatment, which can lead to disease recurrence 2
• Failing to address modifiable risk factors such as smoking, diabetes control, and oral hygiene practices 2
• Using antimicrobials for chronic periodontitis when not indicated according to guidelines 1