Acute periodontal conditions
Acute periodontal conditions
- Acute periodontal conditions include necrotising gingivitis, necrotising periodontitis and pericoronitis.
- Local measures should be used to treat these conditions in the first instance.
- Metronidazole is the drug of first choice where there is systemic involvement or persistent swelling despite local measures.
- A suitable alternative is amoxicillin.
- Before prescribing antibiotics, refer to the BNF or BNFC for drug interactions.
- When antibiotics are prescribed, record the reason for this, including the diagnosis, in the clinical notes.
- Advise patients to space out doses as much as possible throughout the day
See the Bacterial infections management guide for a summary of the management of various dental conditions associated with bacterial infections
More about Acute periodontal conditions
Necrotising gingivitis is an acute painful, superficial infection of the gingival margins associated with anaerobic fuso-spirochaetal bacteria and is more common in patients who smoke, the immuno-suppressed and those with poor oral hygiene. Other risk factors include malnutrition and stress.16 Necrotising periodontitis is diagnosed when there is connective tissue attachment loss and bone destruction. In mild cases of necrotising gingivitis and necrotising periodontitis, local measures may be sufficient but more severe cases may also require treatment with antibiotics, metronidazole being the drug of first choice. A suitable alternative is amoxicillin.
Pericoronitis is an inflammatory condition accompanied by superficial infection of the operculum, with occasional local spread, that is often associated with anaerobic bacteria. In most cases treatment with local measures will be sufficient for resolution of the symptoms. However, where there is systemic involvement or persistent swelling despite local measures, a three day course of metronidazole can be prescribed. A suitable alternative is amoxicillin.