Antibiotic use in dentistry

Antibiotics are prescribed by dentists in dental practice, during dental treatment as well as for prevention of infection. Indications for the use of systemic antibiotics in dentistry are limited because most dental and periodontal diseases are best managed by operative intervention and oral hygiene measures. The use of antibiotics in dental practice is characterised by empirical prescription based on clinical and bacteriological epidemiological factors, resulting in the use of a very narrow range of broad-spectrum antibiotics for short periods of time. This has led to the development of antimicrobial resistance (AMR) in a wide range of microbes and to the consequent inefficacy of commonly used antibiotics. Dentists can make a difference by the judicious use of antimicrobials – prescribing the correct drug, at the standard dosage and appropriate regimen – only when systemic spread of infection is evident. The increasing resistance problems of recent years are probably related to the over- or misuse of broad-spectrum agents. There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of drugs in dentistry.

Rationale

The human oral cavity contains a very broad range of microorganisms. Some authors speak of more than 500 different species, and Liebana et al even reported that all known microorganisms associated with humans are at some time found in the oral cavity as either transient (the majority) or resident (only a few) species. The bacteria that cause odontogenic infections are generally saprophytes. The microbiology in this sense is varied, and multiple microorganisms with different characteristics can be involved. Anaerobic and aerobic micro-organisms are usually present in the oral cavity, and numerous aerobic species cause odontogenic infections — the most common being Streptococcus spp.

Indications

Antibiotic prophylaxis for infectious diseases of dental or oral origin is more prevalent than the antibiotic treatment of such infections. Antibiotics are not an alternative to dental intervention; rather they are adjunctive to clinical intervention. The major use of antibiotic prophylaxis in dental procedures is for procedures that cause bleeding in the oral cavity, and administration of antibiotics for such cases has become common practice among dentists. Antibiotics are also commonly indicated in dental practice for treating immunocompromised patients, patients with evident signs of systemic infection and if the signs and symptoms of infection progress rapidly.

Antibiotics are typically prescribed in dental practice:

• for the treatment of acute and chronic infections of odontogenic and non-odontogenic origins,
• as prophylactic treatment to prevent focal infection in patients at risk (as a result of systemic conditions such as endocarditis, artificial heart valves and congenital heart disease) and
• to prevent local infection and systemic spread among patients undergoing surgical oral or dental treatment.

Antibiotics commonly used to treat odontogenic infections

Antibiotic	Administration route	Posology
Amoxicillin	p.o.	500 mg/8 hours 1000 mg/12 hours
Amoxicillin/ clavulanic acid	p.o. or i.v.	500–875 mg/8 hours* 2000 mg/12 hours* 1000–2000 mg/8 hours †
Clindamycin	p.o. or i.v.	300 mg/8 hours* 600 mg/8 hours †
Azithromycin	p.o.	500 mg/24 hours, three consecutive days
Ciprofloxacin	p.o.	500 mg/12 hours
Metronidazole	p.o.	500–750 mg/8 hours
Gentamycin	i.m. or i.v.	240 mg/24 hours
Penicillin	i.m. or i.v.	1.2–2.4 million IU/24 h ‡ Up to 24 million IU/24 hours †

i.m., intramuscular; i.v., intravenous; p.o., per os (oral).

*p.o. administration.;† i.v. administration;‡i.m. administration.

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Source: Data courtesy of the U.S. National Library of Medicine. Since the data might have changed, please query MeSH on Antibiotic use in dentistry for any updates.

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