Antibiotics in Dentistry
Published September 22, 2019
In this blog post I'll address antibiotics in dentistry. The topic is of particular interest as of late as many guidelines have changed in recent years causing much confusion for dentists, dental patients, and physicians. The confusion has been so great that a few months ago a study was released by the Journal of the American Medical Association reporting that over 80% of antibiotic prescriptions by dentists were unnecessary. You read that correct; over eighty percent!
Before you start asking why dentists are so bad at prescribing, let me give you a little background. As dentists, we prescribe antibiotics for the two main reasons of active infections and prevention of infections. The unnecessary over prescribing of antibiotics is mostly in the attempt to prevent infections; otherwise known as premedication. This has historically been used for patients with heart conditions and artificial joints where the patient takes a high dose of antibiotics prior to a dental appointment. The theory was that the dental appointment would lead to a higher amount of bacteria from the mouth entering the bloodstream and thus travelling to the heart or artificial joint.
Nearly twenty years ago when I started my career, we were told by the physician groups to prescribe antibiotics for everything from a heart murmur to every joint replacement patient for the rest of their lives. As dentists we were just doing what the medical community had recommended through the American Heart Association (AHA) and the American Academy of Orthopedic Surgeons (AAOS) guidelines.
The confusion today comes from the fact that the guidelines have been adjusted several times and currently very few people need premedication. The AHA guidelines were updated in 2007 to state that only those with artificial heart valves require a premedication. The AAOS guidelines from 2013 state only those with artificial joints who have severely compromised immune systems require premedication. The challenge comes from the fact that many orthopedic surgeons have not followed the guidelines and are telling patients to continue to take the antibiotics because that is the way they have always done it – therefore many dentists are feeling pressured to prescribe when it is not necessary. In the same way, patients are demanding the antibiotic prescriptions because they are scared of an infection due to being told previously there was a risk. The current research shows there are greater risks of taking the antibiotics versus not premedicating.
Now that you have the background, let’s get to the practical part – why does this matter? The reason is antibiotic resistance. Through the overuse of antibiotics, there has been an alarming increase in antibiotic resistant infections and more and more antibiotics are becoming ineffective. This is a serious issue facing all of us and the risk of so called ‘super bugs’ becomes more real with fewer antibiotics that work to treat them. Therefore, it may seem like a small thing to take an antibiotic yourself and you may feel you are willing to take the risk. But, in fact, the more people do this puts all of us at risk.
Even though this article relates to dentistry, I’ll close by sharing some tips that you can use to help prevent and control the spread of antibiotic resistance:
Use antibiotics only when prescribed by a health professional.
Never demand antibiotics from your health professional if they don’t recommend them.
Always follow the instructions for taking any prescribed antibiotics, don’t stop taking them before the prescriptions states.
Never share or use leftover antibiotics.
Never self-prescribe, buy unregulated foreign antibiotics, or use veterinary antibiotics.
Practice good hygiene by washing hands, adequately cooking food, and avoiding people when sick.