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When to use antibiotics, how much to use and what type of antibiotic to use is making its way to the forefront of health care. This is due to an alarming rise in the number of antibiotic resistant superbugs. According to the Center of Disease Control and Prevention more than 2 million people in the US are hospitalized and more than 23,000 die each year from superinfections caused by antibiotic resistant bacteria. About 10% of outpatient antibiotics prescriptions are prescribed by dentists which equates to approximately 25.6 million per year. And it has been estimated that 30-50% of the scripts written by dentists were not necessary. As a result, dentists need to familiarize themselves with instances and conditions that warrant antibiotic prescriptions. With that being said let us look at a few instances.
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In 2007 the American Heart Association changed its stance on what patients should be pre-medicated and which should not be. In fact the AHA got more specific in their guidelines and recommended that four types of patients should receive antibiotics 1 hour prior to dental treatment:
Pre-medication with antibiotics prior to dental treatment has been modified to include only those patients with serious underlying cardiac conditions that have high risk for adverse outcome.
Prior to 2002, it was common place for dentists to pre-medicate patients with artificial joints like hips, knees, pins etc. In 2014 the ADA, after reviewing clinical studies, concluded that patient’s with prosthetic joints do not require pre-medication. If however there is any doubt or concern it is recommend that a medical consultation form be sent to the patient’s orthopedic surgeon to determine if premedication is indicated or not.
There are multiple reasons why dentist routinely prescribe antibiotics when treating endodontic problems with a patient. Some of those reasons include:
Now that we have reviewed a few reasons why dentists prescribe antibiotics in association with endodontic pain and/or abscess, let us look at what the empirical evidence says.
If the clinician finds that patient does require antibiotic treatment, the preferred antibiotic of choice is Penicillin due to the fact that endodontic infections are typically caused by obligate anaerobic bacteria. The penicillin class includes amoxicillin and Augmentin. If the patient has an allergy to penicillin or penicillin proves ineffective, clindamycin may be utilized. Finally, Metronidazole can also be considered alone or in combination with penicillin/amoxicillin in treating swelling associated with endodontics.
Studies show that antibiotic treatment in association with having impacted third molars removed has concluded that there are several benefits:
It should be noted that only about 5% of patients that have had third molars removed will develop post-operative infection. As a result, it is recommended that antibiotics not be prescribed following routine extraction of impacted third molars unless:
Antibiotics prescribed in association with routine dental extractions is not advised unless:
The overuse of antibiotics in the pre and post treatment of dentistry is widespread and contributing to the creation of antibiotic resistant superbugs. As a result, it is advised that the clinician have a proper diagnosis of the patient’s problem and prescribe a narrow spectrum antibiotic to address the condition. Conditions that warrant antibiotic treatment include:
Antibiotics are a powerful adjunct to be utilized with other clinical treatment and should not be solely relied on to treat dental infections.