When reaching for locally applied antimicrobials, (LAAs), always take into account these considerations for patient safety and effectiveness:
• Pre-existing conditions, allergies: Conditions such as pregnancy, breastfeeding, or certain systemic diseases might contraindicate the use of some LAAs. Also consider allergies to certain antibiotics.
• Type of antimicrobial: Some LAAs contain minocycline, doxycycline, chlorhexidine, or metronidazole. Select the most appropriate method based on the bacteria targeted.
• Delivery system: Choose from gels, fibers, chips, and microspheres, depending on pocket depth, ease of application, and desired release duration.
• Concentration/release rate: Both play a role in achieving therapeutic levels within the periodontal pocket.
• Biocompatibility/biodegradability: Make sure the antimicrobial is biocompatible with surrounding tissues and biodegradable to avoid the need for removal.
• Adjunctive therapy: LAAs are typically used as an adjunct to mechanical debridement, such as scaling and root planning. Make sure thorough mechanical debridement is accomplished before applying the LAA.
• Potential side effects: Consider localized discomfort, allergic reactions, or staining and always inform patient.
• Monitoring and follow-up: Always monitor the treated sites to determine if further intervention is needed.