Grundet den øgede risiko for samtidig optræden af MP og RA er det vigtigt, at RA-patienter går regelmæssigt til kontrol hos tandlægen. Parodontiets tilstand følges nøje ved registrering af plakmængde, blødning ved pochemåling [lommemåling], pochemål og kliniske fæstetab. Tillige tages regelmæssigt røntgenbilleder for at følge evt. ændringer i knogleniveauet, så der i tide kan sættes ind med individuel mundhygiejneinstruktion og nødvendig parodontalbehandling. Der kan ligeledes være øget indikation for supplerende antibiotisk behandling som led i parodontalbehandlingen, hvis de parodontale destruktioner er omfattende. Endelig er det vigtigt, at tandlægen kender til patientens medicinering, ændringer heri og aktiviteten af RA, så indkaldeintervallet kan tilpasses individuelt.
Adjunctive use of systemic antibiotics in the treatment of periodontitis and peri-implant infections has for many years been in focus for investigators due to the diversity in clinical picture and variability in treatment response in these conditions. Antimicrobial resistance has emerged as a serious problem worldwide and is one of the most important threats to global health as a result of misuse/overuse of antibiotics. Considering the diversity of the microbiota in the oral cavity and its potential to be a reservoir for antibiotic resistance genes, the misuse of antibiotics can result in negative effects for the individual and its surroundings. With the questionable positive long-term effect of antibiotics in most periodontal infections, use of antibiotics should be restricted and only considered after microbiological diagnostic testing that includes species identification and antibiotic susceptibility testing. For peri-implant infections, there is scarce evidence for the use of systemic antibiotics with no proven effective treatment protocol for good results on a long-term basis. HEADLINES • The microbiota in the oral cavity has the potential to act as a reservoir for antibiotic resistance genes. • The use of systemic antibiotics in the treatment of periodontal and peri-implant disease may thus be harmful for the ecosystems of the individual and its surroundings. • Considering the questionable positive and limited long-term effect in periodontal treatment, the use of systemic antibiotics should be restricted to aggressive periodontitis and/or unresponsive cases of advanced periodontitis. • Microbiological analysis including susceptibility testing are recommended in cases where antibiotics are considered as an adjunct to systematic periodontal treatment." • The scientific evidence on the use of systemic antibiotics as an adjunctive treatment for periimplantitis is scarce with no proven effective treatment protocol.
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