Periodontal disease becomes more difficult to treat the longer it is ignored. There are different levels of severity of periodontal disease ranging from mild inflammation to damage to tissue and bone. Patients should be advised to see their dentists regularly for cleanings and to check for signs of early periodontal disease. In many cases however, the disease progresses without an individual seeking treatment or changing their oral hygiene habits. Further treatment is then required with scaling and root planning –often in combination with topically applied antibiotic and antimicrobial products.

Products used for treating periodontal disease that are available from a compounding pharmacy include antibiotics and antiseptics, along with topical anesthetic gels to help make treatment less painful. The products that are commercially available may not be in the forms that are most effective and can have limited options for customization. Obtaining these medications at a compounding pharmacy can also be more affordable.

Antibiotics and Antiseptics for Periodontal Disease

Antibiotics and antiseptics are used between scaling and root planning appointments as an adjunct treatment to maintain results. They are also sometimes used as an alternative to more invasive surgery.

There are different types of antibiotics and methods of administration that are available from a compounding pharmacy. At our pharmacy the most popular forms we make are topical gels and mouth rinses.  These localized delivery methods avoid the systemic effects of orally administered antibiotics. Products we make at our compounding pharmacy include:

• Minocycline Gel
  Minocycline and doxycycline are tetracycline antibiotics that eliminate bacteria that cause periodontal disease. These medications are often tried first as they provide additional benefits that include reducing inflammation and slowing the destruction of tissue and bone. Combining a tetracycline antibiotic with scaling and root planing has been shown to produce better results than scaling and root planing alone. Minocycline 2% gel is available from our pharmacy.
• Hydrogen Peroxide Gel
  Hydrogen peroxide is sometimes used as an alternative to antibiotics or in combination with them. The application of hydrogen peroxide gel with a tray has been used for many years as an adjunct treatment to scaling and root planing. There are additional benefits to the consistent use of hydrogen peroxide gel including teeth whitening and fresher breath.
• Chlorhexidine Gluconate Mouth Rinse and Gel
  Chlorhexidine gluconate is an antiseptic that controls plaque and gingivitis and is available in multiple forms. It can be made into a mouth rinse that works well to reduce inflammation and prevent bleeding. It can also be made into a gel that is applied with a toothbrush. A unique formulation of chlorhexidine combined with the anesthetic dyclonine in one mouth rinse can provide both an immediate relief of pain and a reduction in disease symptoms. Chlorhexidine gluconate is sold in different forms under the brand names Peridex and Periogard.

Topical Anesthetics for Scaling and Root Planing

Scaling and root planing is a deeper cleaning than a normal dental cleaning that is used if there is plaque and calculus under the gums. It involves removing the plaque and tartar from above and below the gum line and smoothing out rough spots of the tooth root. Many patients find scaling and root planing to be painful, especially early on in treatment. The initial probing that is done to detect periodontal disease can be the most painful as the gums are still inflamed. The use of a topical anesthetic gel can make scaling and root planing less painful and result in an easier visit for both the patient and dentist. Pain reduction with a topical anesthetic encourages patients to return to the office for regular maintenance visits. Topical anesthetic gels include TAC 20, Profound, and The Baddest Topical in Town (BTT 12.5).

Bone Binder for Repairing Damage from Periodontal Disease

If removal is necessary, a bone binder can be used to encourage tissue and bone regeneration before implantation. There are bone binders that, when combined with a bone graft material, will both replace bone and provide a scaffold for the growth of new bone. Fusion Bone Binder is one popular option available from our pharmacy. Fusion is a calcium sulfate material that contains resorbable surgical grade plaster of paris with 10% carboxymethylcellulose (CMC). The calcium sulfate/CMC material is mixed with gentamicin 3% solution to form the bone graft binder.