Dr. James Belcher, December 14, 2025

Antibiotics – helpful, but not harmless

Antibiotics have saved countless lives – but they are not a panacea. Their use comes with side effects, and more and more bacteria are developing resistance. In this article, you'll learn why we need more sophisticated approaches to infections and what alternatives exist.

Antibiotika – hilfreich, aber nicht harmlos

What's behind it?

Antibiotics have been used in dentistry for many years as a supportive therapy for severe forms of periodontitis . They are intended to suppress bacteria in the oral cavity and thus reduce inflammation. These are usually broad-spectrum antibiotics that act not only in the mouth but throughout the entire body . What was long considered a "safe additional weapon" is now viewed much more critically – primarily because of side effects, strain on the microbiome and increasing antibiotic resistance .

Why is it relevant?

Periodontitis is primarily a localized disease of the tooth-supporting structures . The main treatment consists of mechanical cleaning of the periodontal pockets and consistent oral hygiene – not medication. While antibiotics can temporarily reduce the bacterial load , and can, if used correctly, also lead to a positive shift of the microbiome lead. She However, this does not permanently solve the actual problem. and clinically relevant as long as there is no optimal Follow-up care is provided over the years (Harks et al., 2015) .

Furthermore, systemic antibiotics do not only affect the pathogenic bacteria in the periodontal pockets, but also the entire microbiome, not only in the mouth but also in the gut. Beneficial bacteria are damaged, the balance is disrupted there as well – and resistant germs can develop with repeated administration (Reissier et al., 2023). Guidelines therefore recommend that antibiotics should only be used in precisely defined exceptional situations and not routinely in every case of periodontitis (Sanz et al., 2023).  


Infobox
A significant Portion The antibiotics prescribed in outpatient settings originate from dentistry (Albrecht et al., 2024) – periodontitis can be successfully treated in most cases without systemic antibiotics , as it is diagnosed at an early stage through regular dental check-ups. and the administration of antibiotics only after careful consideration by the dentist. in stages II and IV should (Benz et al., 2023).

Scientific background

Studies show: The most important building block of Periodontal therapy Subgingival instrumentation —that is, thorough cleaning of the root surfaces and periodontal pockets—is essential. Systemic antibiotics offer additional benefit only in severe and very severe cases (stages III and IV) and should be carefully considered in these cases (Benz et al., 2023).  

At the same time, the number of resistant bacteria is increasing worldwide . Every unnecessary use of broad-spectrum antibiotics increases the selective pressure: bacteria that survive the drug can spread. This is particularly critical because periodontitis is not an acutely life-threatening disease – the benefit of antibiotic therapy must therefore always be considered in relation to this global risk (Bartsch et al., 2025).  

Modern approaches therefore rely on targeted strategies such as blocking bacterial virulence factors . Instead of completely destroying bacteria, their "weapons" are deactivated. This leaves the microbiome largely intact and reduces the risk of resistance (Calvert et al., 2018).  

Practical tips for everyday life

  • ✓ Don't rely on "pill instead of cleaning" – good mechanical cleaning is the basis of any therapy (Chapple et al., 2015).  
  • ✓ Regular professional teeth cleaning and, if necessary, further treatment Periodontal treatment go (Ibid.).  
  • ✓ Discuss with your dentist whether you need an antibiotic – and what alternatives are available.  
  • ✓ On Use microbiome -friendly products that specifically block disease-causing mechanisms instead of killing all bacteria.  
  • ✓ Address risk factors such as smoking, poorly controlled diabetes or chronic stress – they worsen the prognosis of periodontitis (Sabine Elisabeth et al., 2025).  

At a glance

ⓘ Periodontitis is primarily treated mechanically, not with tablets .

ⓘ Antibiotics are only useful in selected, severe cases.

ⓘ Every unnecessary use promotes resistance and damages the microbiome.  

ⓘ Targeted microbiome modulation is a modern, gentler approach.

Sources

  • Albrecht H, Schiegnitz E, Halling F. Facts and Trends in Dental Antibiotic and Analgesic Prescriptions in Germany, 2012–2021. Clinical Oral Investigations. 2024.

  • Bartsch S, Scholz KJ, Al-Ahmad A, Cieplik F. Effects of Antimicrobial Agents Used for Dental Treatments: Impacts on the Human Oral Ecosystem and the Resistome. Advances in Experimental Medicine and Biology. 2025.

  • Benz L, Winkler P, Dannewitz B, et al. Additional Benefit of Systemic Antibiotics in Subgingival Instrumentation of Stage III and IV Periodontitis With Aggregatibacter Actinomycetemcomitans: A Retrospective Analysis. Journal of Clinical Periodontology. 2023.

  • Calvert MB, Jumde VR, Titz A. Pathoblockers or antivirulence drugs as a new option for the treatment of bacterial infections. Beilstein Journal of Organic Chemistry. 2018;14:2607–2617. doi:10.3762/bjoc.14.239.

  • Chapple IL, Van der Weijden F, Doerfer C, et al. Primary Prevention of Periodontitis: Managing Gingivitis. Journal of Clinical Periodontology. 2015;42 Suppl 16:S71–S76. doi:10.1111/jcpe.12366.

  • Cruz DFD, Duarte PM, Figueiredo LC, et al. Metronidazole and Amoxicillin for Patients With Periodontitis and Diabetes Mellitus: 5-Year Secondary Analysis of a Randomized Controlled Trial. Journal of Periodontology. 2021.

  • Haque MM, Yerex K, Kelekis-Cholakis A, Duan K. Advances in novel therapeutic approaches for periodontal diseases. BMC Oral Health. 2022;22:492. doi:10.1186/s12903-022-02530-6.

  • Harks I, Koch R, Eickholz P, et al. Is Progression of Periodontitis Relevantly Influenced by Systemic Antibiotics? A Clinical Randomized Trial. Journal of Clinical Periodontology. 2015.

  • Nong L, Jonker M, de Leeuw W, Wortel MT, Ter Kuile B. Progression of ampC amplification during de novo amoxicillin resistance development in E. coli. mBio. 2025.

  • Reissier S, Penven M, Guérin F, Cattoir V. Recent Trends in Antimicrobial Resistance Among Anaerobic Clinical Isolates. Microorganisms. 2023.

  • Sabine Elisabeth G, Yuxi Z, Jiawen Y, et al. Systemic, lifestyle and environmental modifying factors in the pathogenesis of periodontitis. Journal of Periodontal Research. 2025.

  • Benz L, Winkler P, Dannewitz B, et al. Additional Benefit of Systemic Antibiotics in Subgingival Instrumentation of Stage III and IV Periodontitis With Aggregatibacter Actinomycetemcomitans: A Retrospective Analysis. DZZ 2/2025, 80th year, April 2025; 80. 

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