The use of antibiotics has saved lives by preventing and treating bacterial infections, but their overuse has dangerous effects. Antibiotics can produce harmful drug reactions and can disrupt healthy gut flora. The overuse of antibiotics accelerates the development of antibiotic resistance. Bacteria that become antibiotic resistant cause infections harder, sometimes impossible to treat as antibiotics become less effective. Thus, in May 2015, the World Health Organization advises a global action plan to combat antibiotic resistance.
In dentistry, dentists prescribe either prophylactic or therapeutic antibiotics. Prophylactic antibiotics are used to prevent infection, and are classified as primary or secondary. Primary prophylaxis is used to prevent initial infection, such as preventing surgical site infections. Secondary prophylaxis is used to prevent infection at a distant site, such as preventing infective endocarditis. Whereas therapeutic antibiotics are used to treat infections, and are classified as primary or adjunctive. Primary therapy is rarely used in dentistry, for it is used as first-line treatment if definitive care is not possible. More often, adjunctive therapy is used in conjunction with oral health treatment.
Research in British Columbia suggests that antibiotic prescriptions by dentists are increasing, with broad-spectrum amoxicillin as the most common. However, the use of narrow-spectrum agents decreased. This is unfavorable since narrow-spectrum antibiotics are less likely to lead to antibiotic resistance.
From the limited evidence supporting the use of prophylactic antibiotics in preventing infections after surgical interventions, the researchers suggests that dentists refrain from prescribing antibiotics to healthy people when the chance of infection is low. Dentists should consider the type and site of the surgery, potential morbidity associated with infection, and the general health of the patient when deciding whether to prescribe prophylactic antibiotics.
For therapeutic antibiotics, the researchers again recommend avoiding antibiotics when other treatments such as site irrigation, dressing material, analgesics, and proper oral hygiene are more effective. Dentists should consider antibiotics only when persistent, severe symptoms or purulent discharge last for at least 7 days.
K. Stein, J. Farmer, S. Singhal, F. Marrra, S. Sutherland, C. Quiñonez. The use and misuse of antibiotics in dentistry. JADA. 2018; 149(10): 869-884.
Brian Y. Kuo DDS FAGD
💊 Be sure to follow your dentist's and pharmacist's directions when taking antibiotics and any other prescription drugs!