What is Adjunctive Therapy

What is Adjunctive Therapy

Adjunctive therapy is the term used to describe the “additional” forms of therapy, other than cleansing the root surface mechanically to disrupt the plaque/biofilm. This mechanical therapy is known as “scaling and root-planing, a very familiar term.  Adjunctive therapy includes such things as systemic antibiotics (taken orally), localized or slow release antibiotic which are applied to the periodontal pockets at the dental office, soft tissue laser applications, rinsing with antimicrobial solutions, and irrigation of the pockets with antiseptics. All of these help improve the therapeutic outcome of non-surgical therapy,  and may be used by the dental team individually or as a group. Systemic antibiotics, of course, are various antibiotics prescribed either individually or in combination depending on the nature of the pathogens to be treated. Once we have determined the identity of the bacteria, we can target our antibiotic therapy to match their sensitivity. 

Slow release or site specific antibiotics are preparations developed to be inserted into the pockets and slowly release their

antimicrobial activity over a period of two to three weeks. Examples, all of  which have been shown to be effective, are:

1. Periochip: A small chip of chlorhexidine gluconate which has potent antibacterial effects. The chips are inserted into the pockets and left in place to slowly dissolve.

2. Atridox: A unique formulation which contains the antibiotic tetracycline and a gel. It is dispensed in a syringe into the pockets. When the antibiotic containing gel enters the pocket and comes into contact with moisture it hardens, and then slowly dissolves over a two to three week period.

3. Arestin: The antibiotic Minocycline is incorporated into tiny microspheres and deposited into the pockets with a special syringe. The activity has been shown to last up to three weeks.

There are dental lasers designed for “soft tissue use” which are used by many offices to enhance the results of scaling and root-planing. There are many studies to support tis type of therapy, but it is still somewhat controversial. The use of antiseptic rinses is well established, and the additional use of post scaling preparations of iodine has been shown to have a beneficial additive effect, as well. The selection of adjunctive therapeutic treatment depends, of course, on the dentistand his/her team, and hinges on their previous success with the various approaches.

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