Antibiotics in dentistry - can I take them?

Indications for the use of antibiotics in dentistry

The need for treatment with antibiotics depends on the nature of the infection and the body's ability to withstand the course. The main reasons for prescribing antibiotics include:

1. When advanced caries threatens pulpitis, the dentist may prescribe antibiotics to limit the spread of the pathological process. The patient is prescribed antihistamines to complement the effectiveness of antibiotics.
2. With the development of an inflammatory process of periodontal tissue (periodontitis), antibiotic therapy allows the destruction of protozoa, gram-negative anaerobes in the oral cavity. Various dosage forms of drugs are used for treatment: gels, ointments, intramuscular and intravenous injections, tablets.
3. The proliferation of pathogens, poor immunity, caries and dense plaque can lead to the development of gingivitis. After laboratory detection of the sensitivity of microbes to the antibiotic, a course of treatment is prescribed. Antibiotic drugs are mainly used for catarrhal gingivitis.
4. The appearance of purulent accumulations inside the oral mucosa provokes the appearance of a fistula. The process occurs due to the proliferation of anaerobic gram-negative bacteria, streptococci, staphylococci, Pseudomonas aeruginosa or Escherichia coli. A doctor-prescribed course of antibiotics, which are also used for dental implantation, will help cope with the infection.
5. Inflammation of the connective tissue around the root of the tooth is called periodontitis. The occurrence of the disease is a consequence of dental trauma, a complication of pulpitis, caries, or an error in dental treatment. If the process is not stopped, pus may appear. The effectiveness of antibiotics for periodontal disease is felt after preliminary cleaning of the periodontal tissue.
6. The result of inflammation of various origins can be a granuloma - a cavity of granulation tissue filled with fluid. Location: on the gum near the root of the tooth. It is important to start treating granuloma in the early stages. The use of antibiotics facilitates the opening of the granulosa vesicle and suppresses the infection accumulated in it, and serves to prevent infection. Self-medication with antibacterial drugs is unacceptable.

When is antibiotic treatment necessary in dentistry?

Most often, antibiotic therapy is prescribed in maxillofacial surgery - as a prophylaxis before surgery and to minimize the risk of complications after it. In dental clinics in Moscow it is indicated for patients:

• with catarrhal gingivitis;
• with periodontitis, in which there is a need for treatment of a dental cyst;
• with advanced periodontitis and periodontal disease;
• with periostitis and osteomyelitis;
• after a complex tooth extraction.

Since the bacterial microflora of the oral cavity is mixed, antibiotics with a wide spectrum of action are prescribed to treat inflammation.

Types of antibiotics for toothache

Doctors use antibiotics in dentistry, which have a wide range of applications, to stop the growth and reproduction of mixed bacterial infections in the oral cavity. Drugs are divided into the following types:

Should I take an antibiotic for dental inflammation?

What to do if the gums become inflamed after the removal of a wisdom tooth, due to trauma, or with advanced caries? How to treat a complicated form of periostitis and periodontitis? The effectiveness of therapy largely depends on the selection of the optimal type of antibacterial drug to suppress the pathological process. It is useful to know when an antibiotic is prescribed for dental inflammation, which groups of drugs are most often used in dental practice.

Gingivitis - symptoms and treatment

The development of gingivitis begins with the formation of plaques from dental plaque. They form after lack of proper oral hygiene for 1-2 days. The most common places for plaque formation are interdental spaces and the cervical area.

A film called pellicle is formed from saliva and fluid secreted by the gums. Normally, it performs a protective function, but in the initial stages of gingivitis it promotes the adhesion (sticking) of bacteria that are present in the oral cavity even in a healthy person. Usually these are aerobic cocci and rods.

Microorganisms actively reproduce, and an anaerobic (oxygen-free) environment is formed in the depths of their colony. This creates optimal conditions for the proliferation of aggressive gram-negative microflora. These bacteria produce toxins that can penetrate tissue and destroy the mucous membrane, which leads to erosive changes in the epithelium.

The body tries to resist the damaging effects and in response launches an inflammatory reaction to destroy pathogenic factors. In some cases, the immune system copes with the microflora on its own, but more often the inflammation progresses or becomes chronic.

The destructive effect of microorganisms and the inflammatory process lead to deterioration of microcirculation in the gums and a decrease in the activity of antioxidant defense mechanisms. This leads to an aggressive effect on the epithelium of complement system factors (protective proteins circulating in the blood), which causes progressive destruction of the mucosa. In patients with immune defects, hormonal disorders, blood diseases, traumatic damage to the gums and thinned mucous membranes, soft tissues are more vulnerable, and the process of their destruction is more active.

If the pathological process is actively developing, the number of immune system cells (lymphocytes and macrophages) increases in the soft tissues. They destroy cells and fibrillar structures of the cytoplasm (rigid, parallel fibers that determine the shape of the cell). This leads to expansion of the space between the gum and tooth, thinning of the epithelial layer.

Inflammation can go away completely with the onset of recovery, or become chronic. In the second case, the regeneration processes are disrupted, the epithelium is replaced by granulation tissue (connective tissue that is formed during the healing of tissue defects), which can grow greatly, covering the tooth crown [4].

How to use an antibiotic for tooth inflammation with pus

At the first stage, while the pathological process is less active, rinses with an antibacterial effect are carried out as prescribed by the dentist.

Local medications act directly on the affected area and are less absorbed into the systemic circulation, which reduces the risk of side effects.

You need to crush the tablets of Lincomycin, Azithromycin or Tetracycline, combine them with lukewarm (not hot) boiled water, and rinse your mouth with the solution. The proportions of the components are selected by the dentist.

Active inflammatory process in the periosteum and gums after removal of the problem unit, with infection from the outside or hematogenously, flux is an indication for the prescription of antimicrobial compounds. It is important to prevent complications that develop when purulent masses accumulate or exudate exits into the oral cavity through the fistula. With the flow of blood and lymph, infectious agents penetrate into other parts of the body.

Periodontitis and periostitis in acute or chronic form are dangerous diseases. To heal the wound, the dental surgeon first cleans the affected area, removes a thick mass containing pathogens, particles of blood and mucus. The second stage is the prescription of antibacterial drugs. For purulent inflammation, penicillins show high effectiveness: Amoxicillin, Amoxiclav. Depending on the severity of the pathological process, antibiotics are taken orally or given injections.

If an odontogenic infection is detected, against which the gums fester, the use of the drugs Gentamicin, Grammidin C, Ciprofloxacin, Cifran is indicated.

Names of antibiotics used for inflammation of the dental nerve and root

The dentist prescribes medications to suppress infection based on the results of an examination of the problem area. When the nerve is inflamed, it is difficult to eat and drink; throbbing or aching pain accompanies a person throughout the day and intensifies at night.

Before starting therapy, the doctor conducts an allergy test and interviews the patient to identify contraindications.

Antibiotics help eliminate inflammation of the root and dental nerve:

1. Ciprofloxacin.
2. Azithromycin.
3. Amoxiclav.
4. Azithromycin.
5. Ampiox.
6. Doxycycline.
7. Digital

List of effective antibacterial agents for dental infections under the crown

After endoprosthetics and implant installation, some patients complain of discomfort. Pain and inflammation are a consequence of a violation of the technology for fixing artificial teeth and crowns: the dentist did not completely fill the cavity inside the problem unit or mechanical damage to the canal walls occurred. If the implantologist is poorly qualified, the pin may be installed incorrectly. Perhaps the smallest parts from dental instruments remain inside the canal.

There are several causes of the pathological process and pain syndrome:

• swollen gums or gumboil (acute inflammation);
• cyst - a cavity with fluid near the root of a problematic unit of the dentition;
• inflammation of the submandibular salivary glands;
• dental granuloma;
• a fistula on the gum is a hole through which purulent masses are released.

With the development of inflammation in periodontal tissues, an abscess forms at the root apex. Painful sensations are a consequence of the active accumulation of exudate and pressure on neighboring areas.

The main condition for eliminating discomfort is a timely visit to the dentist to remove the crown, clean the root canals, and eliminate the cause of the inflammatory process. Uncontrolled use of antibiotics can harm the body.

Before treating the canals, the doctor makes an injection into the gum, removes the prosthesis, and examines the affected area.

Effective antibiotics are prescribed to suppress the infection:

After the removal of a wisdom tooth, there is an increased risk of not only inflammation, but also bleeding from the socket.

If the patient takes the drug Warfarin to prevent thrombosis, then you need to warn the dentist: the doctor temporarily stops taking the medication for several days before and after the extraction of the “eight”, be sure to coordinate this action with the cardiologist.

It is important to know how to combine an antithrombotic agent with antimicrobial compounds.

Inflammation of the gums: causes, symptoms, treatment and prevention

Traditional methods of combating gum inflammation

To combat inflammation and pain at home, there is a wide range of medicinal plants.
The effectiveness of recipes has been tested for centuries. However, as is the case with the use of products sold in pharmacies, to achieve the desired result and to avoid side effects, it is recommended to first consult a dentist. Most folk remedies are decoctions, tinctures and compresses. Among the most popular plants it is worth highlighting the following:

• Oak bark, St. John's wort - produce a general strengthening effect.
• Chamomile, calendula - produce a pronounced antibacterial effect.
• Sage, aloe leaves, yarrow herb - relieve inflammation and relieve pain.

In most cases, plants and herbs are used at first, when gingivitis has not yet caused complications. If they occur, then it is more advisable to use medications. It is better to prepare products in small portions (several times), as they quickly deteriorate. Below we present to your attention several simple and proven recipes.

Recipe No. 1: aloe compress

Aloe leaves have disinfectant and antiseptic properties. The compress is prepared as follows:

• Take a fresh leaf of the plant.
• Remove the spines and outer shell from it.
• Cut lengthwise.
• Apply to the place where the gum is inflamed.
• Hold for 10 – 15 minutes.

The compress is recommended to be used in the morning and evening. To achieve a more effective elimination of inflammation, you can make a concentrated infusion of the juice in boiling water and use it for rinsing.

Recipe No. 2: oak bark decoction

Oak bark perfectly fights bacteria and eliminates inflammation. To make a decoction, you will need 2 tbsp. l. crushed raw materials and 0.5 liters of water. Boil over low heat for 10 - 15 minutes and use daily as a rinse until the condition of the gums returns to normal.

Recipe No. 3: sea buckthorn oil compress

Sea buckthorn oil is commercially available, but it can also be prepared at home:

• Take 1 kg of sea buckthorn berries.
• Extract the juice using a juicer.
• Place in a dark place for several days.
• Use a spoon to remove any floating oil from the surface.

Sea buckthorn oil compresses are effective in treating any inflammatory processes. It’s easy to use: soak gauze in the raw material and apply to the site of inflammation for 15 – 20 minutes.

Recipe No. 4: decoction of pine buds

A good remedy for bleeding gums. All you need is 2 tbsp. l. young kidneys and 500 grams of water. Simmer for 10 minutes, then cool and filter. Rinse your mouth for 5 – 10 minutes.

Recipe No. 5: propolis infusion

Propolis is excellent for restoring tissue joints and has antibacterial properties. To prepare, you need to place the raw material in a dark bottle and fill it with a 70% alcohol solution so that it covers the propolis by about 1 cm. After a day, you need to strain and mix 20 drops of the tincture with 200 grams of water (for 1 procedure). Rinse three times a day.

The use of antibiotic therapy during pregnancy and lactation

Most antimicrobial agents are prohibited for use by expectant mothers and during breastfeeding. When prescribing antibiotics to suppress the purulent-inflammatory process in the gums and periosteum, the doctor takes into account the benefits for the woman and the possible risk for the developing fetus.

With the active spread of infection, suppuration, development of sepsis, severe complications against the background of the pathological process, it is possible to take certain groups of antibacterial agents. The new generation of antibiotics is less toxic to the fetus.

Under strict medical supervision, in the minimum effective dose, the following is prescribed:

• Ornidazole;
• Metronidazole;
• Josamycin;
• Azithromycin;
• Clarithromycin;
• Clindamycin;
• Cefepime;
• Ceftaroline.

The list of approved drugs is indicated by the dentist. The best option is to additionally consult with a gynecologist managing the pregnancy.

Anti-tuberculosis antibiotics are allowed to be used by pregnant women in combination with other drugs according to a specific regimen for a long period.

Contraindications to treatment with antibacterial drugs

Compositions for suppressing the inflammatory process in gingival and bone tissue during toothache are not suitable for all patients. Restrictions for use are related to age, body reactions, and special conditions. Most antibacterial drugs should not be used by nursing mothers or pregnant women.

Main contraindications for antibiotic therapy:

• allergic reactions;
• liver and kidney failure;
• intolerance to the active substance: you need to choose a substitute with another active ingredient;
• myasthenia gravis;
• damage to the optic nerve;
• severe diseases of the gastrointestinal tract;
• the patient is taking medications that are incompatible with a certain group of antibiotics;
• tendinitis;
• epilepsy;
• children's age (restrictions are indicated in the instructions for the drug).

A limited range of antibacterial compounds are used in pediatric practice.

It is important to clarify in the instructions the age of the child for safe antibiotic therapy for acute inflammation of tissues in the oral cavity.

In case of purulent inflammation, the development of periostitis and periodontitis, when the gums are swollen, the dentist selects effective antibacterial compounds. Many inexpensive antibiotics work well for dental inflammation and quickly suppress the pathological process. New generation drugs with a minimal list of contraindications and side effects are safer.

Antibiotics for toothache.

Many people consider antibiotics a panacea for all ills and, at the first problem with their teeth, begin to take them intensively. However, such self-medication can cause irreparable harm to other organs and systems of the body, without improving the condition of the teeth. Prescribing antibiotics is the exclusive prerogative of the doctor. In what cases are these medications prescribed?

Non-surgical adjuvant therapy for the treatment of periodontal diseases

Periodontal disease is an umbrella term used to describe an infectious inflammatory process that can affect one structural element or a complex of periodontal elements. The structures that support the tooth are alveolar bone, periodontal ligament and root cementum. Periodontal diseases are mainly provoked by the action of dental plaque or microbial biofilm, which is a heterogeneous structure of pathogenic microorganisms. More than 500 species of microorganisms are considered potential etiological agents that provoke damage to periodontal tissues. In addition to them, viruses and fungi also play an important role in the pathogenetic process. As the disease occurs and progresses, pathogenic microorganisms colonize the gum area surrounding the tooth, and as a result of their impact on the tissue, a periodontal pocket begins to form. Up to 109 species of bacteria can be found in deep periodontal pockets, but despite the potential of many pathogens that are associated with periodontal disease, only a small number are associated with active disease.

Socransky et al divided pathogens involved in disease progression into two main groups: the “red” and “orange” complexes. The red complex includes the following Gram-negative anaerobic bacteria: Porphyromonas gingivalis, Treponema denticola and Tanneralla forsythia, while the orange complex consists of Prevotella nigrescens, Peptostreptococcus micros, Campylobacter rectus, Centruroides gracilis, Campylobacter showae, Eubacterium nodatum and Streptococcus constellatus. In addition, Aggregatibacter actinomycetemcomitans and Eikenella corrodens are closely associated with periodontal diseases. As a result of numerous studies, it has been established that in order to achieve a successful treatment result, one aspect of therapy must be aimed specifically at neutralizing these bacteria, the activity of which is directly related to the course of the disease.

Antibiotics

Systemic antibiotic therapy should be considered as an acceptable treatment option for patients with periodontitis. This approach is relevant for patients who are resistant to conventional disease therapy or who have the following health problems: the presence of an abscess, a compromised or weakened immune state, uncontrolled diabetes mellitus, the presence of signs and symptoms of systemic lesions, fever and lymphadenopathy. The choice of the most appropriate systemic antibiotic should be based on the results of culturing microorganisms and testing their sensitivity to a particular drug. Thus, it is possible to find out, firstly, what microorganisms are present in the affected area, and, secondly, to select the most effective and active agent. But it should be remembered that systemic antibiotic therapy should not be the only method of treatment, but only represent a segment of an integrated approach to examination, diagnosis and development of adequate systemic therapy. Antibiotic therapy, like any other treatment method, has its advantages and disadvantages. Since taking these drugs is a fairly well-known method of treatment, patients, as a rule, understand the main key points of this treatment, and without any problems agree to the proposed algorithm for the course of medications. But at the same time, patients can often confuse the official main names of medications, forget the dose, time, or even the very fact of taking them, thereby disrupting the effect of their action. Systemic antibiotics may cause side effects and gastrointestinal disturbances in the form of diarrhea or abdominal cramps. Other possible negative effects of drugs are associated with allergic reactions and the emergence of bacterial resistance to antibiotics during prolonged and uncontrolled use. Bacterial resistance is a major concern in medicine because it creates a number of other scientific and clinical dilemmas regarding the therapeutic trade-off between the risk of treatment and the potential benefit of antibiotics.

Systemic antibiotics reach periodontal tissues by extravasation from the blood serum, after which they pass through the junctional epithelium and lining of the gingival pocket to enter the gingival sulcus area. The effective concentration of the antibiotic when it reaches the gingival sulcus during a course of treatment differs from that in any other tissue system or organ with signs of infection, which is associated with the specific structure of the periodontium. There are a number of well-tested antibiotic regimens for the treatment of periodontal diseases, which are usually used in combination with mechanical removal of supra- and subgingival deposits and bacterial plaque. This approach, combined with effective home oral hygiene, is aimed at reducing the bacterial load in the area of ​​the gum tissue above and below the marginal border. Some physicians commonly prescribe antibiotic regimens for the treatment and management of periodontal disease based on amoxicillin (375 mg) and metronidazole (500 mg) taken 3 times a day for 7 days in combination with oral scaling and complete root planing for the first time. 48 hours. This approach helps to achieve a reduction in pocket depth and reduce bleeding, which was found when comparing treatment results in the study and control groups. An alternative treatment regimen is to take azithromycin (500 mg) for 3 days prior to scaling and root planing to reduce red complex bacteria and reduce gingival scores. In the absence of the ability to culture bacteria and determine their sensitivity to antibiotics, you can use the empirical principle of prescribing drugs for the treatment of periodontitis. Evidence-based treatment options include a combination of amoxicillin and metronidazole (250 mg - 500 mg each) taken 3 times a day for 8 days, or a combination of metronidazole and ciprofloxacin (500 mg) for 8 days, 2 times a day.

Topical antibiotic therapy is an alternative adjuvant treatment option that can also be used during the treatment of periodontal lesions. The essence of the procedure is to deliver the antibiotic directly to the periodontal pocket - that is, directly to the site of colonization of pathogenic bacteria, while the concentration of the antibiotic in the affected area increases markedly compared to systemic administration. Another advantage is the absence of potential gastrointestinal disorders and allergic reactions. The first antibiotic used for topical treatment was Actisite (periodontal tetracycline). It consisted of non-resorbable, tetracycline-impregnated fibers that were placed directly into the periodontal pocket and remained there for 10 days until the next visit to the dentist. Over time, drugs and methods of their delivery to the area of ​​periodontal lesions have been improved. Thus, Atridox (Denmat) was developed, which is the first resorbable topical antibiotic consisting of a gel form of doxycycline. This drug is injected into the pocket using a syringe, and upon contact with saliva, it hardens, acquiring a waxy consistency. Thus, the antibiotic can be released from the solidified phase within 21 days. Arestin (Orapharma) is also a topical absorbable antibacterial that consists of minocycline granules in powder form. It is supplied in the form of ampoules charged into a syringe. The powder is injected directly into the periodontal pocket, the high level of its therapeutic effect continues for 14 days, and the drug itself remains in the pocket for 28 days. Studies have proven that the use of topical antibiotics together with the procedure of complete removal of tartar and root surface cleaning allows to achieve clinically effective results: a decrease in the depth of the pockets and partial restoration of the damaged biological attachment are observed.

Antimicrobial mouth rinses

Antimicrobial rinses are well-known and acceptable procedures that effectively complement the comprehensive treatment of gum tissue inflammation. Examples of their justified use are situations where the patient is unable to provide optimal oral care using conventional hygiene products at home, for example, in the postoperative period. To choose the right mouth rinse that will effectively cope with gum inflammation and at the same time prevent plaque, you need to find out whether it has a Certificate of Approval from the American Dental Association. If yes, then this product has gone through a series of clinical, biological and laboratory tests that have proven its anti-inflammatory and antibacterial effectiveness. However, it should be understood that this assessment is advisory, but not prescriptive regarding the drug. The only rinses available on the market with the appropriate rating of the Association are representatives with phenolic components, such as Listerine and other similar versions. Chlorhexidine gluconate (0.12%) is also considered the gold standard among antimicrobial rinses, which is available only by prescription in the United States and is known under the commercial names Peridex and PerioGuard (Colgate-Palmolive). Chlorhexidine is the most effective antimicrobial rinse, reducing bacteria and providing effective treatment for gingivitis. The drug is more effective against gram-positive bacteria and yeast, and less effective against gram-negative pathogens. It is usually prescribed postoperatively to reduce the bacterial load during the healing period. Chlorhexidine has a high substance content, which ensures its prolonged action. Some side effects associated with the use of chlorhexidine include potential staining of the teeth and dorsum of the tongue; change in taste perception; the risk of possible formation of supragingival stone, the formation of signs of mucositis and desquamation of the epithelium. Other antimicrobial rinses available to the general public, but less often recommended by specialists, are quaternary ammonium derivatives such as Cepacol (Reckitt Benckiser). Sanguinarine-based products, like Viadent, are no longer widely available on the market. Oxygenate-based products, such as hydrogen peroxide, are recommended to be used more often in paste form. They have anti-inflammatory properties, which reduce signs of bleeding. The latter is an important critical indicator for assessing periodontal inflammation. However, these representatives have only a small effect on the level of bacterial contamination, and recently opinions have increasingly been expressed about their possible carcinogenic potential. Triclosan is another antimicrobial agent available in the form of toothpastes and rinses. However, according to research, it also shows minimal effects on the microbial flora of the oral cavity, and the safety of its use is still in question.

Anti-inflammatory agents

We must remember that periodontal diseases are infectious in nature, and inflammatory phenomena are the body's immune response to microbial contamination. In inflamed tissues, the process of proliferation of pathogenic bacteria occurs faster, which leads to the progression of pathological and destructive effects of the inflammatory process, through the activation of cells of the body's immune system (macrophages and their precursors, monocytes, lymphocytes, and polymorphonuclear leukocytes, such as neutrophils). Components of the microbial structure, such as lipopolysaccharide, which is found in the cell walls of gram-negative anaerobic microorganisms, activate macrophages to produce and secrete proinflammatory cytokines such as interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-alpha). Interleukin-1 stimulates bone resorption and also promotes the release of PGE2 by fibroblast cells, which are the main and most abundant types of connective tissue cells. Fibroblasts synthesize collagen, the main structural protein of connective tissue, which is also the main component of gum and bone fibers. These cells and inflammatory response cells (neutrophils and macrophages) synthesize matrix metalloproteinases (MMPs), which are enzymes or proteins involved in a number of biological reactions. For example, MMP-1 and MMP-8 are enzymes that are involved in the degradation of collagen, which significantly weakens the periodontal structure. Activation of the immune system is inherently a protective reaction of the body - a response to bacterial invasion, however, during the mechanism of implementation of the immune response, tissues of the host organism itself are destroyed. This phenomenon is associated with the release of cytokines, pro-inflammatory mediators and MMPs, since these agents act not only locally on periodontal tissue, but when entering the bloodstream they can also cause undesirable systemic effects.

MMPs are a group of proteolytic enzymes found in periodontal tissues, which contain collagenase and gelatinase. The function of these enzymes is to remodel the extracellular matrix. Since doxycycline was found by researchers to have anticollagenlytic properties, they proposed its use as a modulatory agent for the treatment of periodontitis. Subantimicrobial doses of doxycycline (20 mg twice daily) are effective in inhibiting collagenase activity while having no effect on antimicrobial resistance when used in combination with complete scaling and root planing. This approach provides the maximum effect for restoring biological tissue attachment and reducing the depth of periodontal pockets.

Oral medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) have also been studied as inhibitors of the host response in the treatment of periodontal disease. Their mechanism of action is to prevent the production of prostaglandins. Prostaglandin E2 (PGE2) is directly associated with the processes of inflammation and bone resorption, which is confirmed by its verification in affected periodontal areas. In the course of studying various NSAIDs (flurbiprofen, ibuprofen, ketorolac, naproxen, aspirin), which were administered systemically or locally, it was found that when they were combined with the procedure for complete removal of plaque and root surface cleaning, it was possible to maintain the existing height of the alveolar ridge, preventing it resorption. Bisphosphonates are a class of drugs that inhibit alveolar bone resorption that have also been used as host-modulating agents in the treatment of periodontal disease. Studies have shown that bisphosphonates, when used in conjunction with full mouth cleaning, reduce periodontal pocket depths and levels of bleeding during probing, as well as improve restoration of biological attachment and maintain ridge height. However, despite the potential benefits of bisphosphonates, studies have shown that long-term use and high doses of the drugs initiate osteonecrosis of the jaw. Obviously, for reasoned conclusions, it is necessary to conduct further more detailed studies that will help determine the ratio of the potential benefits of drugs and the relative risk of complications in the treatment of periodontitis.

Host modulation therapy

Local application of host-modulating agents, such as enamel matrix proteins, bone morphogenetic proteins and platelet-derived growth factors, can be quite effective in the complex treatment of periodontitis. Enamel matrix proteins are available in the form of Emdogain (Straumann) and have been successfully used in the restoration of periodontal defects. These proteins play the role of healing modulators, stimulating the regeneration of all periodontal components of the supporting apparatus of the tooth. Bone morphogenetic proteins promote the modulation and differentiation of mesenchymal cells into bone progenitor cells. They act as a scaffold onto which new bone tissue can grow and are often used in guided bone regeneration during alveolar ridge augmentation. Finally, platelet-derived growth factors enhance the chemotaxis of neutrophils and monocytes, stimulate the proliferation of fibroblasts and, accordingly, the synthesis of the extracellular matrix, and also increase the level of differentiation of mesenchymal progenitor cells, fibroblasts and endothelial cells. It is platelet-derived growth factors that are most often used during surgical interventions on periodontal tissues in order to accelerate their regeneration.

conclusions

New knowledge regarding host-bacterial interactions and host immune responses that provoke periodontal tissue damage will be useful for the development of newer and more effective concepts for the treatment of periodontitis using systemic and local antibiotics, antimicrobial rinses and principles of host-modulating therapy. The results of further studies may shed light on auxiliary adjuvant therapy, which can be used to correct treatment algorithms in order to achieve the most successful effect of complex therapy for lesions of the supporting apparatus of the tooth.

Posted by Alison Glascoe, DDS, MS

Are antibiotics effective?

Before starting a course of antibiotics, you should determine the cause of your toothache. There are two main factors that provoke it:

1. Caries that has developed to pulpitis. When the carious process affects the nerve, the tooth begins to react to various irritants: sour, sweet, cold, hot. Since in this case the pain is provoked by an intradental inflammatory process, antibiotics will be completely useless. For such pain, anti-inflammatory drugs, for example, Ibuprofen, are relevant. In addition to drug treatment, it is also planned to remove the affected tissue and fill the dental canals.
2. An infection localized in a “dead” tooth. In such a situation, after removal of the nerve, the tooth does not react to sour, sweet and other irritants, but at the same time it hurts - and more and more every day. It's all about microbes that multiply either in an unfilled canal or in some tiny crack in the root. As a result, a purulent abscess or gumboil develops near the root of the tooth. The latter, by the way, is deadly. If such inflammation of the tooth root occurs, antibiotics are prescribed, but before taking them the patient will have to undergo the procedure of opening the abscess.

Before pinning any hopes on antibiotics, you should understand a few facts about this group of drugs:

• antibiotics help in treating the disease that provokes toothache, and do not relieve the pain itself (there are analgesics for this purpose);
• different antibiotics have different effects on pathogens, so it is almost impossible to successfully select such a medicine on your own;
• the effectiveness of taking antibiotics without concomitant dental treatment tends to zero.

The course of antibiotic treatment should not be interrupted prematurely: incomplete therapy will not lead to the desired result.

What are the dangers of taking medications on your own?

The need for antibiotic therapy is determined by the nature of the disease and the body’s response to it. Selectivity in its appointment is explained by two reasons.

1. Antibiotics affect all types of microflora, both harmful and beneficial, which in some cases can lead to problems with the mucous membranes of other organs and exacerbation of chronic diseases.
2. When exposed to them, bacteria begin to mutate, forming resistance to drugs of a certain type. For this reason, first-generation drugs, such as penicillin, have already ceased to act on pathogens. Scientists have proposed new developments, but if used thoughtlessly, without following the rules of therapy, history may repeat itself.

In addition, each of the drugs has its own side effects - from nausea and itching to anaphylactic shock. Their manifestations may require immediate medical attention.

Therefore, dentists prescribe a course of antibiotics only in cases where the likelihood of complications of the disease exceeds the risks of taking the drug. At the same time, they consciously approach the choice of medication and its dosage, as well as the duration of the course. Let's look at what can lead to self-prescription of an antibiotic for tooth root inflammation.