Antibiotic use in the United States has become a major healthcare issue. Far more antibiotic prescriptions than necessary are being written and the germs that they are meant to kill are developing resistance to them. There is a time and a place for antibiotics in dentistry, but prescribers need to exercise much more prudence when using antibiotics and should be sure they are really needed when they write the prescription.
The best way to prescribe an antibiotic is to know exactly which bacteria are causing an infection and prescribe an antibiotic that will kill those bugs. In medical practice a sample of the infected tissue can be taken and grown in the laboratory. This can then be studied with a microscope to determine what bacteria are causing the infection. In dental practice we don’t have that option. The mouth harbors so many bacteria that it is impossible to determine with accuracy which germs are causing an infection. Therefore we have to take the shotgun approach to killing the germs, which is shoot them with a germ killer that will kill the most common ones involved with oral infections and rely on the patient’s immune system to finish the job. Penicillin is still the go to choice for oral infections along with its similar cohort Amoxicillin. These 2 antibiotics will be effective in the majority of oral infections. The dose of this drug that is most commonly prescribed is 500mg four times daily for a week. Many people are allergic to the penicillin, although most people who say they are allergic to them are really just susceptible to their side effects such as nausea and diarrhea. Although 10% of people will report a penicillin allergy the real percentage is closer to .3%. Still, a prescriber must take the patient’s word on this one, because a true allergy could be life threatening. Fortunately, we have alternative antibiotics to use that are effective for oral infections when penicillin allergy is an issue. Erythromycin, clindamycin, and azithromycin can be used in penicillin allergic patients. They have a different way of killing the germs, and have different dosages but will also work to treat the infection. Regardless of which antibiotic is prescribed, it is very important to take all the medication prescribed. Stopping the medication because the infection is getting better can lead to the infection quickly getting worse.
The other use for antibiotics in dentistry is to prevent bacteria from becoming prevalent in the bloodstream of patients with certain heart valve problems and for people with recent joint replacements. This is called bacteremia, and it can occur when any dental procedure that causes bleeding is preformed. Taking an appropriate dose of antibiotic one hour before the dental procedure, premedication, is important for patients with these conditions. The most appropriate antibiotics for this purpose are amoxicillin or clindamycin for penicillin allergic patients.
It is the responsibility of the dentist to prescribe antibiotics when necessary, and also to have the judgment to not prescribe them when not necessary. These medications are not M & M’s and without a reduction in the number of antibiotics taken in this country we are going to have an epidemic of super germs that we won’t have effective treatments for. As a patient, don’t insist on an antibiotic prescription for every minor infection. By treating the problem and cleaning the infected area with debridement, irrigation with antiseptics, and other conservative means your immune system can deal with the infection. Rely on your doctor’s judgment and prudence.
Dr. Joel Slaven, DDS