Antibiotic Use in Dentistry – Guidelines, Indications and Contraindications

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 overuse or improper use of these antibiotics, antiviral and antimicrobial drugs there have been instances of an appearance of Super Bug which is resistant to most of the drugs which we have. Hence a Dentist has to keep in mind to prescribe Antibiotics only when required and when there is no other option.

Guidelines of antibiotic use in dentistry

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 the 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
  • Complete 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 – We have seen that for example in a common cold, it is known to be a Viral infection but patients tend to take Antibiotics which is completely useless. 
  • Most important: Have thorough knowledge of the side effects and drug interactions of an antibacterial drug before prescribing it

Points to be followed before deciding the “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. The severity of Infection
  2. Type of Organism involved
  3. The extent of Disease progression

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

  • Antibiotics should be used only for a certain number of days 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 the 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).


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 – Good Root Canal Cleaning using Irrigation liquids is more than enough to clear any periapical infection and the body immunity takes over.
  • Dry Socket – It is a local condition which requires localized treatment and no systemic antibiotics are required
  • Acute Pulpitis – Pulpectomy is the best solution and no antibiotics are needed
  • Chronic Marginal gingivitis – Proper Scaling and Root Planning are sufficient without the need for any Antibiotic therapy
  • Chronic Periodontitis – Localized drug delivery in the form of gels etc along with immediate treatment planning is sufficient

Dental Conditions in which Antibiotics are Indicated: 

In view of the recent appearance of the Superbug 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 pus drainage is impossible
  • Acute necrotizing ulcerative gingivitis
  • Sinusitis
  • Pericoronitis

Antibiotics are a boon to humanity which help the person in fighting against the bacterial infections in the body, as useful as they are when misused can turn to be lethal for any future infections which can lead to severe complications. So use antibiotics carefully without misuing or overusing the medication. 

Latest Comments
  1. Ken Halligan

    Hi Varun

    I had a mechanical aortic valve fitted some 19 years ago.
    On Friday I will have two fillings in back molars which have been previously filled when I was a child.
    Is antibiotic prophylaxis indicated?

  2. Varun

    There is nothing to worry about it, you will not be needing Antibiotic prophylaxis as it is not a surgical procedure but a simple filling. Make sure you mention about the mechanical aortic valve to your Dentist, as some instruments are contraindicated in such patients.

  3. pintu

    hi. varun
    i would like to know that which is the best antimicrobial drug tha amoxyclav 625 mg???? which will prefer ?

  4. Varun

    Yes, it is the most commonly used and most preferred drug in Oral infections. There are some who prefer Ofloxacin + Ornidazole combination as well.

  5. Guddu

    My dentist recomend cefexime 200mg .after Extraction of my mobile tooth . I want your suggetion about my antibiotic because i hv never seen any dentist prescribing cefexime

  6. Varun

    Cefixine is being regularly used by Dentists these days, even I prescribe to some patients which complain about nausea etc on taking Ammoxicillin. Cefixine works really well on Oral Cavity and any diseases relating to tooth as it works on the following bacteria which are the main organisms seen in tooth infections – Anaerobic streptococcus, Lactobacillus, Actinomyces, Streprococcus, Veillonella. It also acts on Streptococcus mutans which is the main causative organism in Dental caries.

  7. Anjali

    Hi, sir I found it very beneficial.prescription information is good.can I discuss my prescription with you.

  8. donna

    9 days of anti botic had 3 implants very bad breathe still hurts

  9. Michael

    I had bilateral hip replacement about 18 years ago. Currently I have an abscessed tooth that needs to be extracted. What is the best course of action for my situation? Should the infection be completely resolved? Or is it all right to be somewhat symptomatic of the infection when I have the tooth extracted? What would be the best antibiotic in my situation?

  10. Varun

    Hi Michael, there have been many studies to see the relation between a prosthetic hip and tooth infection. But none were conclusive showing a relation between the two, but it has been followed from long to make sure that Antibiotic prophylaxis is needed before having a dental procedure and it is useful to have the abscess come down before going for Dental Treatment.
    About the antibiotics, Pencillins are known to be the best option but it is best to consult your Dentist to be certain about the Antibiotic which best suites your needs.

  11. Michael

    Thank you so much for your quick reply! Your information definitely alleviates some anxiety. Thanks again!

  12. Sarah

    Mr. Varun
    can I have the references used in this article, as it is not easy to find contraindications for antibiotic in dentistry references online, beside the ones that are listed are more specified and in detail.

    Thanks a lot.

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