Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis

Shivi Khattri, Sumanth Kumbargere Nagraj, Ankita Arora, Prashanti Eachempati, Chandan Kumar Kusum, Kishore G Bhat, Trevor M Johnson, Giovanni Lodi

What are the benefits and risks of using antibiotics as well as cleaning by a dental care professional to treat gum disease?

Why is this question important?

Gum disease is a common condition in which the gums become swollen, sore or infected. It is caused by bacteria that accumulate on gums and teeth. Diseased gums may bleed when people brush their teeth, and may cause bad breath. If gum disease is not treated, teeth can become loose and eventually fall out. This can affect a person’s ability to chew and speak. It can also make people feel self‐conscious about their appearance.

Dental‐care professionals can clean teeth and gums to remove excess bacteria from the mouth. They use special instruments – typically, an ultrasound scraper followed by specialised hand‐held instruments – to scrape bacteria from the teeth, and stop these from affecting the gums.

Antibiotics (medicines that kill bacteria) taken by mouth (orally) can be used alongside professional cleaning, to remove bacteria from the area between the teeth and gums. However, there are potential risks associated with antibiotics, such as allergic reactions and antibiotic resistance (changes in bacteria after exposure to antibiotics, that allow the bacteria to survive future antibiotic treatment).

We conducted a review of the evidence from research studies to find out about the benefits and risks of using antibiotics alongside professional dental cleaning to treat gum disease. We also wanted to know if some antibiotics work better than others in this situation.

How did we identify and evaluate the evidence?

First, we searched for randomized controlled studies (clinical studies where people are randomly put into one of two or more treatment groups), because these studies provide the most robust evidence about the effects of a treatment. We then compared the results, and summarized the evidence from all the studies. Finally, we rated our confidence in the evidence, based on factors such as study methods and sizes, and the consistency of findings across studies.

What did we find?

We found 45 studies that involved a total of 2664 people over the age of 18 who had gum disease. The studies compared professional cleaning plus antibiotics against professional cleaning alone, or compared different antibiotics used alongside professional cleaning against one another.

We cannot tell whether antibiotics reduce gum disease in the long term (one year or more after treatment), or whether some antibiotics are better than others. This is because we have very little confidence in the evidence we found.

We cannot tell whether antibiotics are associated with unwanted effects, because we have too little confidence in the evidence. The most commonly reported unwanted effects were temporary, mild gastrointestinal disturbances, such as nausea, vomiting, diarrhoea, or a metallic taste in the mouth. No serious unwanted effects were reported.

No studies reported on antimicrobial resistance or changes in people’s quality of life.

What does this mean?

We do not know whether:

‐ using antibiotics alongside professional cleaning is beneficial for treating gum disease in the long term (more than one year after treatment);
‐ using antibiotics alongside professional cleaning is associated with unwanted effects; or
‐ some antibiotics are better than others for treating gum disease alongside professional cleaning.

Our confidence in the available evidence is very low. The results of our review are likely to change if more evidence becomes available. Future studies should clearly define what qualifies as a minimally important improvement in gum disease.

How‐up‐to date is this review?

The evidence in this Cochrane Review is current to March 2020.

Read the full review.

Khattri  S, Kumbargere Nagraj  S, Arora  A, Eachempati  P, Kusum  CK, Bhat  KG, Johnson  TM, Lodi  G. Adjunctive systemic antimicrobials for the non‐surgical treatment of periodontitis. Cochrane Database of Systematic Reviews 2020, Issue 11. Art. No.: CD012568. DOI: 10.1002/14651858.CD012568.pub2.