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Topical and Systemic Antibiotics in the Management of Periodontal Diseases

Adopted by the FDI General Assembly: 18 September 2003


The realisation, over the past three decades or so, of the microbial specificity of periodontal disease has led to an increasing use of antimicrobial agents in the management of periodontal infections. These include systemic antibiotics, topical antibiotics and topical antiseptics. Despite such frequent use of antibiotics in the management of periodontal diseases, the literature indicates only a few good controlled trials that compare the efficacy of adjunctive antibiotic use to mechanical therapy alone. Currently there is much ongoing research and interest in this topic amongst the dental profession, especially in view of the global problem of the emergence of antibiotic resistant organisms. Hence, the knowledge base on the subject is increasing rapidly and, at the time of writing FDI takes the following position:

Present Position:

  • Scientific evidence indicates that mechanical periodontal treatment alone is
    adequate to ameliorate or resolve the clinical condition in a vast majority of
    patients with periodontal diseases.
  • Adjunctive antibiotics should only be used after careful clinical evaluation of the
    condition, being cognisant that unwarranted use may be of negligible benefit to
    the patient whilst, in the longer term, may promote the emergence of antibiotic
    resistant organisms in the community.
  • However, adjunctive antimicrobial agents delivered either locally or systemically,
    may enhance the effect of therapy in specific situations.
  • Systemically delivered antibiotics may be considered for aggressive (early onset
    and refractory) periodontitis and in patients with generalised systemic disease
    that may affect host resistance.
  • Locally delivered antibiotics or antiseptics together with mechanical debridement
    may be indicated for non-responding sites of local infection or in localised
    recurrent disease.
  • The dentist should place the patient on an individually tailored post-treatment
    maintenance care programme, after resolution of the particular periodontal

Optimal plaque control by the patient is of paramount importance for a favourable clinical and microbiological response to any form of periodontal therapy.

Main authors:
Prof L P Samaranayake, Prof A Mombelli, Prof N Johnson

Submitted by:
FDI Science Commission

FDI Science Commission Project 2-99: Indications and Contraindications for Topical and Systemic Antibiotics in the Management of Periodontal Disease Samaranayake LP and Johnson N Guidelines for the use of antimicrobial agents to minimise the development of resistance FDI Commission Project 2-96. International Dental Journal 1999; 49: 189-195
Mombelli A and Samaranayake LP Topical and systemic antibiotics in the management of periodontal diseases: FDI Commission Project 2-99, International Dental Journal (in preparation)