[The use of antibiotics]

Antibiotic therapy should be oriented towards sensitive pathogenic strains. The problem in most periodontal infections is that the latter are not clearly identified and that culturing techniques to document sensitivity are time-consuming (at least 5 days for anaerobes) and cumbersome. Thus for chronic periodontal infections, the choice is based on the clinical diagnosis: juvenile, post-juvenile, chronic adult, periodontitis.... It is known from longitudinal studies that mechanical plaque control can cope with nearly all periodontal infections. Antibiotic therapy should thus be limited to refractory or very aggressive cases, acute complications, immunologically compromised patients and patients with a need for antibiotic coverage during surgical procedures. If needed tetracyclines, metronidazole, clindamycin, bacampicillins are the appropriate adjuvants in different types of infections. Considering the side-effects and the increasing resistance of bacterial species, dentists should never use antibiotics without the appropriate local treatment and without a clear-cut indication. Postoperative swelling certainly is not one.