Have you wondered whether antibiotics should be prescribed before you have a dental procedure? After all, what’s dubbed “antibiotic prophylaxis” has been common practice for decades. How could a step that’s meant to prevent possible infection be a bad thing?
Or maybe you’ve assumed that the use of antibiotics following treatment is an extra protection we all need. Surely keeping the bugs away is important.
There is more to this story than meets the eye. See, there are only a few conditions that warrant antibiotic use. Yet antibiotics taken before and after dental visits can cause serious side effects, including allergic reactions, emergency room visits, and a nasty infection called Clostridioides difficile (C.diff).
Actually, for the majority of people, the cons vastly outweigh the pros.
Let’s take a look at the dental-antibiotic facts
In 2007, The American Heart Association reduced its guidelines for a condition that understandably worries dentists: infective endocarditis (IE). IE is caused by a bacteria which enters the bloodstream and travels to, and infects, the heart.
This guideline change was the biggest in over 50 years! The list of patients recommended to receive preventative antibiotics was slashed. It now only includes people with underlying heart conditions that are associated with “the highest risk of adverse outcome from infective endocarditis.” This should have dramatically dropped prescriptions, with 90% fewer patients requiring antibiotics.
However, dentists — who as a group are the third largest antibiotic prescribers in the USA — are not following the guidelines. In a survey of 5,500 US dentists, 70% reported prescribing preventative antibiotics even against guideline recommendations.
And it’s not just the prescription of antibiotics before oral surgery that matters. This class of drug is regularly prescribed after surgery and for various oral conditions and interventions. Dentists and physicians often prescribe antibiotics either as a precaution for, or in cases of, intraoral swelling and dental pain, the top reasons for dental emergencies. In most cases, even the American Dental Association (ADA) recommends dentists, specialists and physicians DO NOT prescribe antibiotics. Instead, the go-to approach should be conservative dental treatments (including incision and drainage). Up to 85% of antibiotic prescriptions are “suboptimal or not indicated”.
All this antibiotic use — and the ramifications such as antimicrobial resistance — are concerning many health professionals, as it should be! It has become a critical issue worldwide.
What can you do when dental pain or swelling strike?
The ADA Center for Evidence-Based Dentistry recommends against the use of antibiotics. Instead, it supports seeking dental treatment and, when necessary, taking over-the-counter pain relievers like acetaminophen and ibuprofen. And don’t automatically assume that antibiotics are needed in your case. If they are prescribed, ask the dentist or doctor to confirm that they are following ADA or AHA guidelines.
A better path for dental care
Dentists can make a difference by using antibiotics only when indicated. That is, only when “systemic spread of infection is evident.” When prescribed, the correct choice, at the standard dose, for the right amount of time matters. In other words, antibiotics should only be used when someone faces the very real risk of body-wide infection. In this case, prescription should follow best practice.
If not antibiotics, then what should be done to reduce the rare risk of something like IE following dental care?
A complete oral care regime may offer the best protection against the bacteria that causes IE, as well as a preventing and aiding recovery of other dental conditions.
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