Addressing Antibiotic Resistance in Periodontal Treatment

Posted on June 25, 2016

June 22, 2016- For years the Centers for Disease Control and Prevention has been warning about the rise in antibiotic resistant bacteria and the challenges those bacteria pose to our health. In a recent publication on the website Perio-Implant Advisory, Dr. Duane Keller explains how bacteria become resistant to antibiotics and points a way to a non-antibiotic therapy for gum disease that follows the guidelines for chronic wound care and relies on oxidative and oxygenating agents.

Bacterial communities (biofilms) that cause infections leading to gum disease lie deep in periodontal pockets, the spaces between the teeth and gums which are hard to reach with toothbrush, rinse, or floss. The pocket is a unique space for chemotherapeutic modalities of care because it can be topically accessed, but keeping medicaments deep in the pocket for a significant amount of time was the most significant challenge for dentists until the invention of the Perio Tray® (Perio Protect, St. Louis, MO). 

While it looks a lot like a mouth guard, the Perio Tray® is specially fabricated with internal peripheral seals and extensions to place and hold medication deep in periodontal pockets.Research shows that the Perio Tray® can deliver medication into pockets as deep as 9mm (1-3mm is healthy). 

Hydrogen peroxide, even at a low concentration of 1.7%, has proven to be a highly effective antimicrobial when delivered and held deep in the pockets with the Perio Tray®. Peroxide can break down the protein chains in bacterial cell walls, lysing the cell wall and killing the bacterium. More importantly, the oxygen that the peroxide releases under the pressure of the Perio Tray® changes the micro-environment of the periodontal pocket. The oxygen is toxic to anaerobes, helps promote a healthy oral flora, and fosters growth of new blood vessels.

All of this is good news for the millions of patients (47% of American adults) with chronic gum disease. In combination with professional dental cleanings, the Perio Tray® with 1.7% hydrogen peroxide is only needed for minutes each day. When it is used at home between professional dental cleanings, the Perio Tray® delivery of peroxide puts biofilm communities on the defensive, limiting their ability to reproduce and trigger inflammation and leading to better long-term results. 

For more information on the Perio Tray® by Perio Protect, visit

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