In dentistry, antibiotics are most often prescribed either for inflammation of the gums or for the development of purulent inflammation at the apex of the tooth root, which may be a symptom of swelling of the gums or face (flux). And the most important point here is the choice of antibiotic, because for different dental diseases, different antibiotics will be optimal.
Therefore, we have divided our article into 2 thematic parts. The first part will be devoted to - what antibiotics are needed for gum flux and the development of purulent inflammation at the root of the tooth, and the second - how to choose the best antibiotic for inflammation of the gums (chronic periodontitis).
Antibiotics for flux and inflammation of the roots of the teeth -
Let's consider what antibiotics for gum flux can be used for an adult. The choice here is quite large, ranging from inexpensive antibiotics such as lincomycin and amoxicillin, but the following medications will be optimal.
1) Amoxiclav -
contains the original amoxicillin in combination with clavulanic acid. Amoxicillin antibiotic is a synthetic penicillin, and if it is used without clavulanic acid, it may not be effective against many pathogenic bacteria. Therefore, the drug Amoxiclav will be the most effective option, unless, of course, you are not confused by the price of 400 rubles per pack. The regimen for an adult is 500 mg, 2 times a day (usually within 4-5 days, after which, if necessary, the doctor can extend it for another 2-3 days).
If this price is high for you, then you can buy inexpensive amoxicillin, which goes without clavulanic acid (only not produced in Russia), and take it already at 500 mg 3 times a day - only 5-7 days. Moreover, in case of severe inflammation, it is best to connect Metronidazole to it, which is also taken in case of purulent infections, 500 mg 3 times a day (only 5-7 days).
Important: if you have ever had diarrhea after taking antibiotics (this is due to the development of pseudomembranous colitis to take them) or have intestinal diseases / dysbacteriosis, and you do not want to increase the risk of developing diarrhea after taking the antibiotic - the best choice would not be amoxicillin, but still Azithromycin. Or in parallel with Amoksiklavom already on a mandatory basis to use the tab. Metronidazole - this antibiotic will be effective against the bacteria Clostridium difficile, which is responsible for the development of pseudomembranous colitis.
2) Azithromycin -
as well as clindamycin, this antibiotic can be used for allergies to β-lactam antibiotics, for example, the same amoxicillin. There are different application regimens, but according to studies with purulent odontogenic infections, the optimal treatment regimen is to take 1000 mg once a day, after which the drug is taken for another 2 or 3 days - 500 mg once a day. But the price of this antibiotic will be quite high, if not to take into account Russian manufacturers.
For example, the drug Azithromycin Azitral of a good Indian manufacturer Shrey will cost you 300 rubles per pack of 3 500 mg capsules (it turns out that you need to purchase 2 packs for the course). The short course of use is due to the fact that this antibiotic has a cumulative effect, and therefore, even after the end of its administration of the drug, its therapeutic concentrations remain in the body for several days.
3) Lincomycin and Clindamycin -
these are antibiotics of the group of lincosamides, and clindamycin is a more effective analogue of lincomycin (in terms of effectiveness for some types of pathogenic bacteria that cause purulent inflammation, clindamycin is more effective than lincomycin by 2-10 times). The peculiarity of these antibiotics is some tropism to the bone tissue, which is an advantage for purulent inflammation in the area of the teeth, as well as their low price. The disadvantages include a narrow spectrum of antimicrobial action, as well as the fact that they often cause pseudo-membranous colitis.
Lincomycin regimen - 2 capsules 3 times a day, just 5 days. Clindamycin dosage regimen - 1 capsule 150 mg 4 times a day, for 4 days. The latter is the drug of choice for allergies to β-lactam antibiotics, which include penicillins, amoxicillin, cephalosporins, etc. Reasonable price - packing 16 tab. on 150 mg (production of Serbia) costs about 160 rubles. For the prevention of pseudomembranous colitis, both antibiotics should also be combined with tab. Metronidazole.
Important: Remember that you should not take antibiotics yourself without a prescription. The choice of antibiotic is made by the doctor taking into account the specific situation in the oral cavity, the severity of purulent inflammation, as well as taking into account your chronic diseases. Antibiotics for gum flux are appointed by the dental surgeon immediately after a small incision of the gums, which allows for outflow of pus. But antibiotics cannot be a substitute for this procedure.
Antibiotic treatment of inflammation of the gums near the tooth (flux) is not the main treatment. Conducting a cut, although necessary, is also not the main treatment. The main treatment is the treatment of the causative tooth, because The cause of the flux is always only one - an infection in the root canals of one of the teeth. This may be a consequence of untreated caries or pulpitis of the tooth in time, or it may be a consequence of the previously poor quality root canal filling.
→ How to treat flux on the gums
Antibiotics for Toothache -
Pain in the tooth is a consequence of either inflammation of the nerve in the tooth (this disease is called pulpitis), or inflammation at the apex of the tooth root (periodontitis). Antibiotics will not help you reduce pain, and can only slow down, but not prevent the development of inflammation. They are usually prescribed after the opening of abscesses on the gums, or in the process of treatment of purulent inflammation at the apex of the tooth root.
An effective remedy for the relief of toothache are non-steroidal anti-inflammatory drugs (NSAIDs), which include Nurofen, as well as other much more powerful analgesics. The initiation of antibiotics before visiting the dentist may be reasonable only in one case - if you already have a gum or facial swelling in the evening or at night, and you are going to go to the dentist only the next day.
Antibiotics for inflammation of the gums -
In the treatment of inflammation of the gums (unlike the situation with the flux), several other antibiotics are used than those mentioned above. Below you will find a list of antibiotics relevant for 2019, which are considered the most effective for treating gums. An important point that you should take into account is that antibiotics can only be applied after prior removal of dental plaque.
It is pathogenic bacteria of dental deposits that cause the development of gingivitis and periodontitis, and taking antibiotics without removing the causative factor will only lead to a temporary slight decrease in the symptoms of inflammation. Therefore, if you do not want to achieve with the intake of antibiotics simply asymptomatic progression of the disease - first carry out an ultrasonic cleaning of dental plaque at the dentist.
1. Amoxiclav® -
This drug is a combination of the antibiotic Amoxicillin and clavulanic acid. The use of standard Amoxicillin is one of the indications for periodontal diseases (inflammation of the gums), but without combination with clavulanic acid, it no longer affects many types of pathogenic bacteria. Thanks to this acid, Amoxiclav is still effective even against bacteria that are insensitive to amoxicillin, as well as penicillins and cephalosporins.
Application Scheme -
The recommended dosage for adults is 500 mg 2 times a day (within 8 days). Like all other antibiotics used in the treatment of gingivitis, its use should be carried out only after the removal of supra-and subgingival dental deposits from the dentist, which cause the development of gingivitis. In case of aggressive periodontitis, in the presence of deep periodontal pockets, in the presence of dysbiosis or diarrhea after taking antibiotics in the past, it is best to use Amoxiclav in combination with Metronidazole.
2. Ciprofloxacin -
The antibiotic Ciprofloxacin belongs to the 2nd generation fluoroquinolone group. Currently, this drug is the only antibiotic in periodontal antibiotic therapy, which suppresses absolutely all strains of A. actinomycetemcomitans (at the same time, it has a minimal effect on the normal microflora of the oral cavity).
Application Scheme -
The recommended dosage for adults is 500 mg 2 times a day (for 10 days). And never, you hear - never buy Russian-made ciprofloxacin or other antibiotics, if you want to protect yourself from pseudomembranous colitis. Two packs of the drug "Tsiprolet" of Indian production (10 tab. 500 mg each) needed for a course of treatment will cost you about 250 rubles. We add that with diabetes it is best to immediately make a choice in favor of the antibiotics of the fluoroquinolone group.
When treating periodontitis, this antibiotic is best used in combination with metronidazole, since in this case, the entire possible spectrum of anaerobes is overlapped. Or take a combination drug like Ciprolet A, in which ciprofloxacin is combined with tinidazole.
3. Metronidazole -
Antibiotic Metronidazole cannot be used as monotherapy in the treatment of gum disease, but it increases the effectiveness of antibiotic therapy if used in combination with other antibiotics. Studies have shown that in combination with amoxicillin or ciprofloxacin, it can be particularly effective in the treatment of chronic periodontitis.
Application Scheme -
The recommended dosage for adults is 500 mg 3 times a day, for a total of 10 days. The advantage of this antibiotic is that it, like ciprofloxacin, has almost no effect on the normal microflora of the oral cavity. Packaging "Metronidazole Nycomed" of the Japanese pharmaceutical company Takeda (20 tab. 500 mg each) will cost you about 100 rubles. Polish drug "Trichopol" - about 120 rubles for a pack. 20 tablets.
4. Azithromycin -
The antibiotic Azithromycin belongs to the group of macrolides. Effective against anaerobes and gram-negative bacteria. Studies show that azithromycin at a dosage of 500 mg on the first day and 250 mg another 5 days can be an effective therapy in the treatment of gingivitis. Nevertheless, it is believed that such a treatment regimen will be somewhat less effective than combinations of antibiotics: 1) amoxiclav + metronidazole, 2) ciprofloxacin + metronidazole.
5. Tetracycline and Doxycycline -
The use of these antibiotics can be very effective in the treatment of aggressive periodontitis, because they have the ability to concentrate in the gingival fluid in the periodontal pockets, successfully suppress the bacterium A. actinomycetemitans (which is associated with severe inflammation in periodontitis). For example, the concentration of Tetracycline in the gingival fluid may be 2 to 10 times higher than its content in serum, while in Doxycycline this indicator is 7 to 20 times.
Another unique feature of these antibiotics is their anti-collagenase activity. The fact is that some pathogenic bacteria have a feature to produce the enzyme collagenase, which destroys the connective tissue, thereby contributing to the destruction of the bone around the teeth and the emergence of periodontal pockets. Tetracycline and doxycycline inhibit this enzyme, and may contribute to partial bone regeneration. Therefore, these antibiotics are considered # 1 if surgical treatment of periodontitis (ie, curettage or patchwork operations) is performed on the background of antibacterial therapy.
The recommended dosage of tetracycline is 250 mg 4 times a day (8-10 days). Doxycycline, which in turn is a semisynthetic tetracycline, can be used for a long course and at a low dosage that does not reduce the effectiveness of the treatment of gingivitis. Periodontists recommend using this drug 100 mg 1 time per day (for 21 days), while doxycycline almost does not irritate the gastrointestinal tract.
If we talk about drugs, then we can recommend the drug "Doxycycline Soluteb" pharmaceutical company Astellas (Netherlands). A feature of this drug are effervescent tablets, which must be dissolved in water before use. Due to this, the drug is rapidly and 100% absorbed in the gastrointestinal tract, practically without affecting the intestinal microflora. Cost of 1 pack 10 tab. on 100 mg - will make from 300 rubles (on the above described course of treatment 2 packings of drug are necessary).
Important: The anti-collagenase activity of tetracycline and doxycycline makes them the best choice in the surgical treatment of periodontitis, as a result of which it becomes possible to completely sanitize the periodontal tissues (ie, remove all inflammatory granulations from under the gums, as well as subgingival dental plaque). But we recommend their reception - only after sowing the contents of periodontal pockets on the microflora, which can be performed in any diagnostic laboratory.
This is necessary to eliminate resistance to these drugs, which is sometimes found. If in principle you do not want to spend time and money on conducting a microbiological study, it is better to choose combinations of antibiotics: either amoxiclav + metronidazole or ciprofloxacin + metronidazole.
Topical antibiotics -
In the complex treatment of gum inflammation, systemic antibiotic therapy is usually used only in the presence of medium and deep periodontal pockets, with a rapid aggressive periodontitis, and also the patient’s refusal to undergo surgical treatment (curettage of the gums) when indicated for this. In most cases, for non-severe forms of periodontitis, only antiseptic rinses are most often prescribed + special gels are applied to the gums.
→ Gels and ointments for gums with antibiotics
Antibiotics for implantation -
A separate issue of the use of antibiotics is their use in implantology - in preparation for surgery, its maintenance and use in the early postoperative period - for the prevention of infectious complications, as well as for the treatment of infectious complications (periimplantitis) that have already occurred. Read more about choosing antibiotics in these cases in the article:
→ The choice of antibiotics in implantology
Antibiotic injections in the gums -
I would like to say a few words about this method of treatment as the injection of antibiotics into the gums. Abroad, this method of treatment has never been used because of the enormous harm that is inflicted on the gums by such injections. In Russia, this method of treatment was previously very common due to its low cost and low qualification of dentists (in conditions when periodontal doctors are not specially trained for this purpose, and any ordinary dentist is engaged in the treatment of periodontal diseases).
Below we will explain why, if you were offered a course of antibiotics in your gums at the clinic, you should immediately run out of this clinic and look for another clinic / another doctor. The visible part of the treatment is mainly such that injections in the gums at first can actually lead to a decrease in the intensity of inflammation (decreases bleeding, pain, swelling and redness of the gums). Although some patients already at this stage may experience abscess formation of the gums - especially often this happens in the presence of deep periodontal pockets.
An injection of an antibiotic directly into the gum leads to the creation of a terrifyingly high concentration of antibiotic in the gums and bone around the tooth. The antibiotic lincomycin is usually prescribed. In low concentrations, it is bacteriostatic, but in high concentrations it begins to have a bactericidal effect, which leads to the simultaneous destruction of a very large number of pathogenic microorganisms (and not gradual, as it should be). The death of pathogenic bacteria is always accompanied by the release of a large number of toxins, various pathogens, as well as the so-called "cytokines" (inflammatory mediators).
When too many of them are thrown out at the same time, this leads to the appearance of multiple foci of necrosis in the periodontal periodontal - this is the ligamentous apparatus of the tooth, with the help of the fibers of which the tooth connects to bone tissue. Such areas of necrosis heal with the formation of scar tissue, the formation of which at first gives the appearance of strengthening the tooth, but, unfortunately, the joy does not last long. Normal periodontal teeth are adapted to bear a large mechanical (chewing) load, which cannot be said about scar tissue. And as soon as the area of attachment of the tooth to the bone is reduced due to the normal periodontium, a mechanical overload of the ligamentous apparatus of the tooth occurs.
As a result, the bone tissue around the tooth begins to dissolve, which leads to an even greater increase in its mobility.Moreover, in this case, the mobility will not be associated with inflammation, but with a decrease in the level of the bone, as well as a decrease in the area of the periodontal attachment of the tooth root to the bone. And this is irreversible mobility, which can not be corrected by any treatment. We hope that our article: Antibiotics for toothache and gum disease - turned out to be useful to you!
Author: dentist Kamensky K.V., 19 years experience.