Reader Questions on Periodontics

Here are some questions from readers and my answers

1. How about antibiotics?  When do you use them?

For most periodontitis, antibiotics are not used.  Some clinicians and researchers advocate the use of antibiotics in treating periodontal disease.  Researches, however, shown little evidence for the routine use of antibiotics in treating periodontal disease.  Some periodontal diseases, such as localized or generalized aggressive periodontitis may benefit from the systemic use of antibiotics.  If you decide to use antibiotics in treating periodontal disease, please be sure that you have a sound rationale behind your choice.  Local application of antibiotics may be useful in some cases, but the routine use of it is not warranted.  Many research papers show significant improvement in clinical attachment gain and probing depth reduction over scaling and root planing alone when antibiotics are used locally with scaling and root planing.  Whether the improvement is clinically significant should be carefully considered.

2.  What kind of improvement can I expect after scaling and root planing moderately deep pockets (5 – 6 mm deep)?

The improvement you can expect after scaling root planing 5- 6 mm pockets is about 1 mm reduction in probing depth.  You can expect more reduction in probing depth if the pockets are edematous and severely inflamed since more shrinkage of soft tissue will occur after healing.  In areas where the soft tissues are usually thick, such as the distal of the second molars, the reduction of probing depth will be negligible.  The soft tissues are usually fibrous and do not shrink much after scaling and root planing.