Most people know that antibiotics kill germs (or at least render them less harmful) and many regard them as the panacea for all infectious diseases.
Things are not quite as simple as that however, because bacteria can mutate and change or simply become resistant to antibiotics so that we cannot rely solely on them to cure all our ills. This situation is worsened by the fact that developing new types has proved more difficult than was expected, and it is therefore imperative to make the best use of those drugs we have.
Dentists have a number of antibiotics that can be used in dentistry in certain circumstances.
Types of antibiotics used in dentistry
Antibiotics can be classified in different ways; whether they are bactericidal or bacteriostatic, for example, or by means of the various classes of micro-organisms against which they are effective. There are a number of different types chemically and each type of antibiotic only works against certain kinds of bacteria.
Thus certain antibiotics are used to treat certain types of infection, and the ones most useful in dentistry include:
- Penicillins, e.g. penicillin V and amoxicillin which are broad-spectrum antibiotics since they are active against a wide range of bacteria.
- Macrolides, e.g. erythromycin which is useful for those who are allergic to penicillin.
Then there is
- Clindamycin which acts against certain varieties of bacteria termed anaerobic – i.e. they exist and thrivewithout the need for oxygen, and these are sometimes found in deep periodontal pockets or bone infections.
And then also
- Metronidazole which is also active against anaerobic micro-organisms and is especially useful in cases of acute ulcerative gingivitis. Also a common choice for those with penicillin allergy.
The indications for antibiotic therapy
It is generally recognized by dentists that antimicrobials have their use in dentistry to control or prevent infection, but they are adjuncts to operative procedures rather than definitive treatments by themselves.
Antibiotics are, however, necessary when infection in the jaw is severe and acute, or threatening to get out of control. This is evidenced by a raised body temperature, and there is often considerable swelling of the face. If infection spreads into the bloodstream from a local jaw abscess it is straight away more serious since it can cause septicemia with infection spreading to the heart or other parts of the body.
In dentistry, antibiotics are also used as a prophylactic measure in cases where an infection could develop following a dental procedure and could be potentially serious. An example of this would be where a patient has a compromised heart valve condition as a result of suffering from rheumatic fever at some time in their life. A bacterial shower into the bloodstream following a scaling procedure by the dentist could cause some bacteria to alight on damaged or weak heart valves with possible serious consequences. The need for prophylaxis is an uncertain one for some categories of patients, and guidelines will differ depending on where you live.
Antibiotics may be used as an adjunct to periodontal (gum) treatment to control acute infections or be inserted locally into periodontal pockets in cases of chronic periodontitis. It’s important to use the antibiotic most appropriate for the kind of dental infection that is likely present.
Disadvantages of antibiotics
Antibiotics, like any medications, are not without the possibility of side effects. These are mostly mild gastrointestinal upsets but can occasionally involve an allergic reaction or even anaphylactic shock. The possibility of resistance developing to them is another problem previously mentioned, which can sometimes be due to inadequate dosing or the patient not finishing a course. The common infecting bug Staphylococcus aureus is fast becoming resistant to most known antibiotics and this is likely to be a real problem for the future.
The inappropriate use of antibiotics is another problem which leads to excessive use and the increasing likelihood of resistant strains of bacteria developing. These drugs are no use against viral infections and not appropriate for certain dental conditions such as “dry socket”. This a very painful condition following the extraction of a tooth and delayed healing leaving jaw bone exposed with food packing and infection. Antibiotics taken systemically are not well absorbed into bone and are of little use in treating this condition. Localised packing with medicaments is the answer, but often antibiotics are mistakenly prescribed, sometimes perhaps because patients expect them.
Dental infections involving the teeth themselves or the gums are treatable with operative procedures such as drainage and debridement. This can involve root treatment or extraction of a tooth, or mechanical or ultrasonic cleaning of gum sockets. Most often these measures are quite adequate without the need for antibiotic prescription. Read more on abscess treatment.
To sum up, antibiotics are extremely helpful in certain situations which confront the dentist but their use should be specific and not indiscriminate.