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| At initial consultation |
A 61 year old male presented with severe generalised gingivitis and advanced periodontitis. There were no intercurrent diseases and he was a non-smoker. Here is the periodontal condition at the intial visit. Note the intensity and extent of gingival inflammation. A single course of azithromycin 500mg was prescribed. Usually, I would subsequently see a person about 4-6 weeks after prescribing azithromycin; at this time I assess the periodontal response to azithromycin and then formulate a definitive periodontal treatment plan.
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| One week after initial consultation |
This man was keen to start periodontal debridement, so I saw him again one week after the first visit when a clinically significant improvement in his periodontal condition was evident. There had been no other intervention other than the azithromycin. The man reported that his 'gums had stopped bleeding the day after taking the first azithromycin tablet' and 'the gums changed colour from red to pink'.
This case raises intriguing questions about azithromycin's mode of action; we know that it is a powerful antibiotic and is particularly active against Gram -ve bacteria found in dental biofilm. This could account for the improved gingival condition, although one might expect such a degree of resolution to occur 3-4 weeks after supra- and subgingival debridement and OHI. It is apparent that the anti-inflammatory property of azithromycin has kicked in soon after the drug had been taken. The improved gingival health was not dependent on removal of plaque or calculus.
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