What is the role of antimicrobial therapy in the management of periodontitis in primary care?

Antimicrobial therapy in the management of periodontitis in primary care has a limited and adjunctive role rather than being a primary treatment modality. The cornerstone of periodontitis management is mechanical debridement and oral hygiene measures rather than systemic antibiotics. Antimicrobial therapy is generally reserved for specific cases where there is evidence of acute infection or systemic involvement, or in patients at risk of infective endocarditis undergoing dental procedures, where appropriate prophylaxis is indicated to prevent systemic infection ¹.

Routine use of systemic antibiotics for periodontitis in primary care is not recommended due to concerns about antimicrobial resistance and the need for antimicrobial stewardship, which emphasises judicious use of antibiotics only when clearly indicated ². Instead, primary care management focuses on non-antibiotic interventions such as scaling and root planing, patient education on oral hygiene, and referral to dental specialists when necessary.

Recent literature, such as the systematic review by Akram et al. (2020), suggests that adjunctive therapies like photodynamic therapy and laser irradiation may enhance the outcomes of mechanical debridement in chronic periodontitis, potentially reducing the need for systemic antibiotics. This supports a trend towards minimizing antibiotic use and exploring alternative adjunctive treatments (Akram et al., 2020).

In summary, antimicrobial therapy in primary care for periodontitis should be reserved for specific clinical indications, with a strong emphasis on antimicrobial stewardship to prevent resistance. Mechanical and non-antibiotic adjunctive therapies remain the mainstay of treatment, with systemic antibiotics used cautiously and typically under specialist guidance or in the context of systemic risk factors ¹,²(Akram et al., 2020).