The Wonderful World of Oral Microbiology
In the majority of periodontitis cases associated with A. actinomycetemcomitans mechanical periodontal treatment does not result in elimination of this pathogen. This phenomenon is associated with a reduced treatment response. A systemic therapy with metronidazole and amoxicilline has shown to be effective in eliminating this pathogen in the majority of the cases (Berglund et al. 1998, Pavicic et al. 1994, van Winkelhoff et al, 1989, 1992, Winkel et al. 2001).
Treatment of periodontitis associated with P. gingivalis can respond favorably after a systemic therapy with metronidazole. It has been shown that pocket depth reduction, gain of clinical periodontal attachment and the number of teeth in need of additional periodontal therapy is reduced after systemic metronidazole.
T. forsythia can be associated with refractory periodontitis, especially in smoker patients. It has been shown that systemic metronidazole in these cases can significantly improve clinical and microbial parameters (Winkel et al. 1997).
P. micros can be found in special patient categories in high numbers with or without major pathogens such as A. actinomycetemcomitans or P. gingivalis. High numbers of P. micros can be found in heavy smokers, immuno-compromised patients, diabetes mellitus patients, medically compromised patients and patients suffering from chronic stress. Systemic antimicrobial therapy may be unpredictable in these subjects. It has been suggested that systemic clindamycin may support periodontal treatment in these patients.