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).
What was the research?
A systematic 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.
Who conducted the research?
The research was conducted by a team led by Shivi Khattri from Subharti Dental College and Hospital, Meerut, India, on behalf of Cochrane Oral Health. Sumanth Kumbargere Nagraj, Ankita Arora, Prashanti Eachempati, Chandan Kumar Kusum, Kishore G Bhat, Trevor M Johnson and Giovanni Lodi were also on the team.
What evidence was included in the review?
Data were extracted from 45 randomised controlled trials involving a total of 2,664 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.
What did the evidence say?
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.
How good was the evidence?
There is very low‐certainty evidence (for long‐term follow‐up) to inform clinicians and patients if antibiotics are of any help for the non‐surgical treatment of gum disease. There is insufficient evidence to decide whether some antibiotics are better than others
What are the implications for dentists and the general public?
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.
What should researchers look at in the future?
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.
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.
This post is an extended version of the review’s plain language summary, compiled by Anne Littlewood at the Cochrane Oral Health Group Editorial Base.