The majority of inflammatory periodontal diseases is caused by bacteria. Mechanical removal of bacterial deposits from the teeth by the patient (individual oral hygiene) and mechanical debridement by the dentist (professional tooth cleaning, antiinfective periodontal therapy, periodontal surgery) are effective in treatment of most cases of plaque-induced gingivitis and periodontitis. However, in particular risk patients (e.g. under elevated risk for bacterial endocarditis) periodontal procedures that cause transitory bacteremia require systemic antibiotic prophylaxis. Further, in severe cases of necrotising ulcerative gingivitis and periodontitis local therapy has to be supported by systemic antibiotics. In cases of aggressive and generalised severe chronic periodontitis that show subgingival infection with particular periodontal pathogens, especially by Actinobacillus actinomycetemcomitans, successful therapy requires systemic antibiotics adjunctively to mechanical antiinfective therapy. Therapy of persisting pockets during supportive periodontal therapy may additionally benefit from application of locally delivered antibiotic devices.
Keywords: adjunctive systemic and local antibiotic therapy, periodontitis therapy, prophylaxis of bacterial endocarditis, necrotising ulcerative gingivitis/periodontitis