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 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.