What is that?

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 aren't antibiotics always the solution?

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, they do not permanently solve the underlying problem.

Furthermore, systemic antibiotics do not only affect the disease-causing bacteria in the gum pockets, but also the entire microbiome in the mouth and gut. Beneficial bacteria are damaged, the balance is disrupted – and resistant germs can develop.

Guidelines therefore recommend using antibiotics only in precisely defined exceptional situations and not routinely for every case of periodontitis.

Science explained briefly

Studies show that the most important component of periodontal therapy is subgingival instrumentation – that is, the thorough cleaning of the root surfaces and periodontal pockets. Systemic antibiotics offer additional benefit only in a few, very severe cases and should be carefully considered in these instances.

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.

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 the risk of resistance decreases.

What can you do?

• Don't rely on "pill instead of cleaning" – good mechanical cleaning is the basis of any therapy.
• Go for professional teeth cleaning regularly and for periodontal treatment if necessary.
• Discuss with your dentist whether you really need an antibiotic in your case – and what alternatives are available.
• Focus on microbiome-friendly products that specifically block disease-causing mechanisms instead of killing all bacteria.
• Addressing risk factors such as smoking, poorly controlled diabetes, or chronic stress worsens the prognosis of periodontitis.

In summary

• 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.

Did you know?

A significant proportion of antibiotics prescribed in outpatient settings originate from dentistry – although periodontitis can be successfully treated without systemic antibiotics in most cases.

Sources

• Current guidelines for periodontal therapy (stage III/IV)
• Eick S. et al. – Alternatives to antibiotics in periodontology
• Antimicrobial Resistance Collaborators – Global burden of bacterial antimicrobial resistance
• PerioTrap research documents on virulence-blocking agents