Antibiotic Use in Dentistry – Guidelines

Antibiotic is a Greek word – “Anti” meaning ‘against’ and “Bios” meaning ‘life’

Antibiotics are being used in Dentistry from a very long time. And as we have seen in the recent past over use or improper use of these antibiotic, antiviral and antimicrobial drugs there have been instances of appearance of Super Bug which is resistant to most of the drugs which we have. Hence a Dentist too has to keep in mind to prescribe Antibiotics only when required and there is no other option.

Guidelines of antibiotic use in dentistry

Important Guidelines to be followed before prescribing Antibiotics by a Dentist:

Some important guidelines which should be kept in mind by Dentists before prescribing Antibiotics for various dental conditions.

  • Make an accurate diagnosis to use Narrow Spectrum and avoid using Broad Spectrum Antibiotics
  • Based on Diagnosis use appropriate type of antibiotic and the Dose and Duration of the course
  • Consider using narrow-spectrum antibacterial drugs in simple infections to minimize disturbance of the normal microflora, and preserve the use of broad-spectrum drugs for more complex infections
  • Antibiotic therapy should be used as an adjunct to dental treatment and never used alone as the first line of care.
  • Antibiotics are indicated when systemic signs of involvement are evident.
  • Pain alone or localized swellings do not require antibiotic treatment but instead use Analgesics and plan the line of treatment to relieve the discomfort of the patient immediately for ex. draining of abscess to relieve pain and decrease the flora.
  • Fevers, malaise, lymphadenopathy or trismus are clinical signs that possible spread of the infection has occurred.
  • Keep in mind the interactions of antibiotics with other drugs being used by the patient
  • A rapidly spreading infection or persistent infections.
  • Antibiotics should be used only for a certain number of days only required to ‘‘kill the resistant strains” as the vast majority acquire their resistance via transposable elements that are preferentially transferred when antibiotics are used in sub-therapeutic doses or for long durations
  • Finish the course : ideally the antibiotic is prescribed for 3-5 days with a sufficient loading dose
  • Avoid unnecessary use of antibacterial drugs in treating viral infections
  • Most important: Have thorough knowledge of the side effects and drug interactions of an antibacterial drug before prescribing it

Important points to be followed before deciding “Duration of Antibiotic Course Prescribed  “

Antibiotics Course prescribed is always of 2 types Short Duration (2-3 days) and Long Duration (7-10 days) which is decided based on the

  1. Seviarity of the Infection
  2. Type of Organism
  3. Extent of the Disease progression

So the course of duration has to be decided keeping in mind these 3 important factors:

  • Antibiotics should be used only for a certain number of days only required to ‘‘kill the resistant strains” as the vast majority acquire their resistance via transposable elements that are preferentially transferred when antibiotics are used in sub-therapeutic doses or for long duration Finish the course : ideally the antibiotic is prescribed for 3-5 days with a sufficient loading dose
  • Short courses are preferred to long courses particularly when treating children. Children’s compliance with conventional courses is poor
  • There is evidence that short courses of antibiotics, with appropriate treatment are adequate for resolution of dental infections
  • Longer durations may result in: Reduction in the ability of the oral flora to resist the colonization of harmful micro-organisms which are not normal resident of the oral flora, thereby leading to superimposed infections by multi-resistant bacteria and yeasts.
  • In the majority of patients 2 or 3 days of oral antibiotics, in doses recommended by the BNF, will suffice for acute dentoalveolar infections.
  • Educate the patient regarding proper use of the drug and stress the importance of completing the full course of therapy (that is, taking all doses for the  prescribed treatment time).

antibiotic-resistance

Relatively Contra-indicated cases for Antibiotic Use in Dentistry: 

These are some of the Dental Conditions where prescribing an Antibiotic is not necessary but still Dentists are prescribing which is not required.

  • Acute Periapical infection
  • Dry Socket
  • Acute Pulpitis
  • Chronic Marginal gingivitis
  • Chronic Periodontitis

Dental Conditions in which Antibiotics are Indicated: 

In view of the recent appearance of the Super bug which has evolved due to the extensive use of antibiotics has got all the medical personals attention including Dentists to have a watch and restriction of Prescribing Antibiotics for Dental infections. The constant and continuous use of antibiotics produces resistant strains of Microorganisms which will later on become harder to treat. So it is advised to have a proper diagnosis and use narrow spectrum antibiotics without affecting the normal flora of the body.

  • Oral infection accompanied by elevated body temperature
  • Evidence of systemic spread,
  • Facial cellulitis and/or dysphagia.
  • Periodontal abscess
  • •Acute periodontal conditions where drainage is impossible
  • Acute nercotizing ulcerative gingivitis
  • Sinusitis
  • Pericoronitis

 

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