Marsh, L. (2018). Adjunctive use of antibiotics and antimicrobials in periodontal therapy.

Dimensions of dental hygiene, 16(9), 18-20.

The article ‘Adjunctive use of antibiotics and antimicrobials in periodontal therapy’

explains how systemic and local antibiotics/antimicrobials helps to treat periodontal disease as an

adjunctive treatment with scaling and root planning. Doxycycline is the only systemic drug

approved by FDA. Another systemic antibiotic is metronidazole which can be used as adjunctive

therapy to scaling and root planning. Metronidazole can also be given with amoxicillin to help

treat periodontal disease. These systemic antibiotics helps to reduce pocket depth and to increase

clinical attachment loss. There are some drugs that can be used locally on periodontal pockets.

These medicines can be placed directly into the periodontal pockets without any systemic side

effects. Chlorhexidine gluconate can be used in pockets more than 5 mm. It comes as a chip which

resorbs so patient does not have to come back to get it removed. Doxycycline hyclate is another

antibiotic which comes in two syringes that mixed together and placed into the periodontal pocket.

It takes 7 to 14 days for doxycycline to be completely absorbed. Another option is minocycline

hydrochloride, a broad-spectrum tetracycline antibiotic and it is one of the most active antibiotics

against periodontal disease. These locally delivered antibiotics can be very effective when used as

an adjunctive treatment with scaling and root planning. It will reduce the pocket depth and increase

the clinical attachment levels more than doing scaling and root planning alone. Author has also

mentioned antimicrobial rinses such as chlorhexidine, essential oils and delmopinol. They help to

reduce plaque accumulation. Chlorhexidine and essential oil mouthrinses helps to reduce

gingivitis. There are some risks associated with the use of antimicrobials. It cannot penetrate

through the deeper pockets. Some studies suggest that it can increase the risk of type-2 diabetes or

prediabetes. Some studies also show that it can increase the risk of oral cancer although there was
no evidence found. Later, author explains that dental hygienist should educate patients with

periodontal disease about these antibiotics and antimicrobials. Also adding smoking cessation,

nutritional counseling, diabetes risk assessment and oral cancer screening can help determine if

patient will benefit from the antibiotics and antimicrobials.

As a dental hygiene student, this article gives me an insight on different treatment options

available for the patient with periodontal disease. I learned from this article that there are

adjunctive therapies such as chlorhexidine chip and tetracycline available for the patient with

periodontal disease which can be given along with scaling and root planning. I also learned that

giving this treatment along with scaling and root planning significantly helps to reduce the deeper

pocket depth and to increase the clinical attachment level. I am sure I will utilize the information

found in this article because I do see patients with periodontal disease and I have seen some

patients with deeper pocket depth. I can suggest one of the locally delivered drug such as

minocycline or chlorhexidine chip to help improve the severity of the periodontal disease. I have

learned in the class about all these antimicrobials including chlorhexidine chip, minocycline

hydrochloride and doxycycline hyclate. I don’t think that there was any information that was

lacking, inconclusive, contradictory or vague.