Antimicrobials in Periodontal Treatment: Ecological Effects and Risks of Resistance

Abstract Body: Periodontitis results from a complex interplay between dysbiotic subgingival biofilms and an exuberant immune response leading to loss of periodontal tissues. Consequently, antimicrobials such as systemically and topically applied antibiotics or antiseptics can be used in periodontal therapy adjunctively to subgingival debridement for resolving dysbiosis in the subgingival biofilm and establish health-associated microbial communities. Nevertheless, clinicians need also to be aware of potential negative effects associated with the use of antimicrobials. Although the oral cavity has been highlighted as a potential reservoir of antimicrobial resistance (AMR) genes, there is little awareness in the dental community of the potential risks associated with over-use of antibiotics and even less when it comes to antiseptics. With the latter, which are commonly used over longer periods of time, also risks associated with undesired ecological changes of the oral microbiota need to be considered. This presentation will provide an update on adjunctive antimicrobial procedures for periodontal treatment, their clinical evidence as well as on potential risks and draw recommendations for clinical practice.