The use of systemic antimicrobials in the treatment of acute and chronic
periodontal diseases must be viewed as a dilemma. On the one hand, the approach is attractive because of the microbial nature of
periodontal diseases but, on the other hand, evidence of benefit of these agents is equivocal for the majority of
periodontal diseases and antimicrobials have the potential to cause harm. The disadvantages of systemic antimicrobials can be grouped under the headings of
allergic reactions,
superinfection,
toxicity, drug interactions, patient compliance and, perhaps of most widespread importance, bacterial resistance. Mechanical
debridement methods, including drainage of
pus for acute
periodontal abscesses, should be considered the first line treatment for most
periodontal diseases. Systemic antimicrobials should be considered as adjuncts to mechanical
debridement methods and, in
chronic disease, never used alone as they can predispose to
abscess formation. Adjunctive systemic antimicrobials may be considered in
acute disease where
debridement or drainage of
pus is difficult, where there is local spread or systemic upset. In chronic
periodontal diseases, adjunctive antimicrobials should be considered in early onset or rapidly progressive disease or in advanced chronic adult disease where mechanical
therapies have failed or surgery is not a preferred option. Inadequate
oral hygiene and tobacco smoking are
contraindications to the use of antimicrobials. The value of systemic antimicrobials, where other systemic risk factors co-exist, has still to be established. The role of microbial diagnosis and sensitivity testing for antimicrobial selection at this time must be questioned.