Topical Tetracycline: Potential for Allergic Reaction or Bacterial Resistance
You will receive 1 credit(s) of continuing education credit upon successful completion of this course. The purchase price of this course is $49.00


This course presents a detailed discussion of allergic reactions and the development of bacterial resistance with regard to antibiotic use in treatment of adult periodontitis.

Learning Objectives:

Upon completion of this course, participants should be able to do the following:

  1. Identify the characteristics of a drug allergy reaction that distinguish it from other adverse reactions.
  2. Discuss the different types of allergic reactions and the drugs commonly associated with them.
  3. Describe the sensitization potential of topical tetracycline.
  4. Discuss the development of bacterial resistance and the factors that are believed to minimize it.


The high incidence of allergic reactions to some common dental antibiotics, primarily topical penicillin, has led to general concerns about all topical antibiotics. Delivery technologies providing for site-specific drug delivery have renewed interest in the use of topical antimicrobials to treat adult periodontitis. Despite tetracycline's widespread dermatologic use and increasing use in adjunctive treatment of adult periodontitis, the incidence of allergic response to topical tetracycline is very low. Studies with tetracycline fiber showed no significant change in the tetracycline susceptibility of gram-negative periodontal microorganisms. Our discussion of this important topic may help practicing dentists and periodontists distinguish between the allergic potential of sensitizing antibiotics, such as the penicillin, and that of low sensitizers such as tetracycline. In addition, this article briefly discusses bacterial resistance to increase understanding about the relative potential for tetracycline resistance with differing treatment regimens.



  1. Introduction
  2. Allergic Responses and Other Adverse Drug Reactions
    1. Allergic Response Types and Common Sensitizers
      1. Type I - Anaphylactic
      2. Type II - Cytolytic
      3. Type III - Arthus
      4. Type IV - Delayed Hypersensitivity
    2. Topical Tetracycline and Allergic Response
      1. Dermatologic Use
      2. Periodontal Use
  3. Bacterial Resistance
  4. Summary


  1. Slots J, Rams TE. Antibiotics in periodontal therapy: advantages and disadvantages. J Clin Periodontol. 1990; 7:479-493.
  2. Slots J. Subgingival microflora and periodontal disease. J Clin Periodontol. 1979; 6:351-382.
  3. Morrison SL, Cobb CM, Kazakos GM, et al. Root surface characteristics associated with subgingival placement of monolithic tetracycline-impregnated fibers. J Periodontol. 1992; 63:137-143.
  4. Baker PJ, Evans RT, Coburn RA, et al. Tetracycline and its derivatives strongly bind to and are released from the tooth surface in active form. J Periodontol. 1983; 54:580-585.
  5. Goodson JM. Pharmacokinetic principles controlling efficacy of oral therapy. J Dent Res. 1989; 68:1625-1632.
  6. Tonetti M, Cugini MA, Goodson JM. Zero-order delivery with periodontal placement of tetracycline-loaded ethylene vinyl acetate fibers. J Periodontal Res. 1990; 25:243-249.
  7. Gordon JM, Walker CB, Murphy JC, et al. Tetracycline: levels achievable in gingival crevice fluid and in vitro effect on subgingival organisms, Part I: Concentrations in crevicular fluid after repeated doses. J Periodontol. 1981; 52:609-612.
  8. VanArsdel PP. Drug allergy, an update. Med Clin North Am. 1981; 65:1089-1103.
  9. Arndt KA, Jick H. A report from the Boston collaborative drug surveillance program. Rates of Cutaneous Reactions to Drugs. 1976; 235:918-923.
  10. Moore JW, Brekke JH. Foreign body giant cell reaction related to placement of tetracycline-treated polylactic acid: report of 18 cases. J Oral Maxillofac Surg. 1990; 48:808-812.
  11. Klaassen CD. Principles of toxicology. In: Gilman AG, Rall TW, Nies A, et al, eds. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 3rd ed. New York, NY: Pergamon Press; 1990: 49-61.
  12. Genco RJ. Antibiotics in the treatment of human periodontal diseases. J Periodontol. 1981; 52:545-558.
  13. Andersen KE, Maibach HI. Allergic reaction to drugs used topically. Clin Toxicol. 1980; 16:415-465.
  14. Goh CL. Contact sensitivity to topical antimicrobials. Contact Dermatitis. 1989; 21:166-171.
  15. Klein-Szanto AJ, Conti CJ, Aldaz CM. Skin and oral mucosa. In: Haschek WM, Rousseaux CG, eds. Handbook of Toxicology Pathology. San Diego, CA: Academic Press; 1991: 165-193.
  16. Nater JP, de Groot AC, Liem DH. Drugs used on the oral mucosae. In: Unwanted Effects of Cosmetics and Drugs Used in Dermatology. Amsterdam, Netherlands; 1985; 13:143-161.
  17. Physicians’ Desk Reference. 48th ed. Montvale, NJ: Medical Economics Company, Inc; 1994: 1884, 1994.
  18. Wechsler HL, Kirk J, Slone J. Acne treated with a topical tetracycline preparation: results of a one-year multi-group study. Pharmacol Ther. 1978; 17:237-242.
  19. Frank SB. Treatment of acne with topical antibiotics. Postgrad Med. 1977; 61:92-98.
  20. Hirschmann JV. Topical antibiotics in dermatology. Arch Dermatol. 1998; 124:1691-1700.
  21. Wright AL, Colver GB. Tetracyclines--how safe are they? Oral and Experimental Dermatology. 1988; 13:57-61.
  22. Fisher AA. Adverse reactions to topical clindamycin, erythromycin and tetracycline. Current Contact News. 1983; 32:415-428.
  23. Shiloah J, Hovious LA. The role of subgingival irrigations in the treatment of periodontitis. J Periodontol. 1993; 64:835-843.
  24. Goodson JM, Cugini MA, Kent RL, et al. Multicenter evaluation of tetracycline fiber therapy, Part II, Clinical response. J Periodontal Res. 1991; 26:371-379.
  25. Gordon JM, Walker CB. Current status of systemic antibiotic usage in destructive periodontal disease. J Periodontol. 1993; 64:760-771.
  26. Satomi A, Uraguchi R, Noguchi T, et al. Minocycline HCl concentration in the periodontal pocket after administration of LS-007. Journal of the Japanese Association of Periodontology. 1987; 29:937-943.
  27. Alfant M, Walker CB, Bashkar P. Local delivery of tetracycline as a possible adjunct to conventional periodontal therapy. J Dent Res. 1983; 62:289.
  28. Christersson LA, Norderyd OM, Puchalsky CS. Topical application of tetracycline-HCl in human periodontitis. J Clin Periodontol. 1993; 20:88-95.
  29. Van Steenberghe D, Bercy P, Kohl J, et al. Subgingival minocycline hydrochloride ointment in moderate to severe chronic adult periodontitis: a randomized, double-blind, vehicle-controlled, multicenter study. J Periodontol. 1993; 64:637-644.
  30. Drisko C, Cobb C, Killoy W, et al. Clinical responses to tetracycline fiber periodontal therapy. J Dent Res. 1994; 73(special issue): 306.
  31. Corsair A. Long-term effect of tetracycline fibers on recurrent lesions in periodontal maintenance patients. Periodontal Clin Investig. 1994; 16(1):8-13.
  32. Concentration and localization of tetracycline following site-specific tetracycline fiber therapy. J Periodontol. 1992; 63:849-853.
  33. Goodson JM, Hogan PE, Dunham SL. Clinical responses following periodontal treatment by local drug delivery. JPeriodontol. 1985; 56:81-87.
  34. Heijl L, Dahlen G, Sundin Y, et al. A 4-quadrant comparative study of periodontal treatment using tetracycline-containing drug delivery fibers and scaling. J Clin Periodontol. 1991; 18:111-116.
  35. Newman MG, Kornman KS, Doherty FM. A 6-month multi-center evaluation of adjunctive tetracycline fiber therapy used in conjunction with scaling and root planing in maintenance patients: clinical results. J Periodontol. 1994; 65:685-691.
  36. American Hospital Formulary Service Drug Information. Bethesda, MD: American Society of Hospital Pharmacists, Inc; 1992: 1135-1139.
  37. Deasy PB, Collins AM, MacCarthy DJ, et al. Use of strips containing tetracycline hydrochloride or metronidazole for the treatment of advanced periodontal disease. J Pharm Pharmacol. 1989; 41:694-699.
  38. Eckles TA, Reinhardt RA, Dyer IK, et al. Intracrevicular application of tetracycline in white petrolatum for the treatment of periodontal disease. J Clin Periodontol. 1990; 17:454-462.
  39. Kornman KS. Controlled-release local delivery antimicrobials in periodontics: prospects for the future. J Periodontol. 1993; 64:782-791.
  40. Barg N. Antibiotic therapy in 1994: mechanisms of resistance. Hospital Formul. 1994; 29(suppl 3):13-17.
  41. Preus HR, Lassen J, Aass AM, et al. Prevention of transmission of resistant bacteria between periodontal sites during subgingival application of antibiotics. J Clin Periodontol. 1993; 20:299-303.
  42. Eady EA, Holland KT, Cunliffe WJ. Should topical antibiotics be used for the treatment of acne vulgaris? Br J Dermatol. 1982; 107:235-246.
  43. Seymour RA, Heasman PA. Tetracyclines in the management of periodontal diseases: a review. J Clin Periodontol. 1995; 22:22-35.
  44. Smilak JD, Wilson WR. Tetracyclines, chloramphenicol, erythromycin, clindamycin, and metronidazole. Mayo Clin Proc. 1991; 66:1270-1280.
  45. Williams BL, Osterberg SL, Jorgensen J. Subgingival microflora of periodontal patients on tetracycline therapy. J Clin Periodontol. 1979; 6:210-221.
  46. Larsen T. Occurrence of doxycycline resistant bacteria in the oral cavity after local administration of doxycycline in patients with periodontal disease. Scand J Infect Dis. 1991; 23:89-95.
  47. Goodson JM, Tanner A. Antibiotic resistance of the subgingival microbiota following local tetracycline therapy. Oral Microbiology and Immunology. 1992; 7:113-117.
  48. Olsvik B, Hansen BF, Olsen I. Tetracycline-resistant microorganisms recovered from patients with refractory periodontal disease. J Clin Periodontol. 1995; 22:391-396.
  49. Olsvik B, Hansen BF, Swenson J et al. Tetracycline-resistant bacteria from patients with refractory periodontal disease. J Dent Res. 1993; 72:404.
  50. Listgarten MA, Lindhe J, Hellden L. Effect of tetracycline and/or scaling on human periodontal diseases. JClin Periodontol. 1978; 5:246-271.

American Dental Association is an ADA CERP Recognized Provider.

ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.