Dr Kim Nguyen on Antibiotics – Part 2

Antibiotics in dentistry

So when are antibiotics used for oral conditions?

There are two main ways dentists can use antibiotics:

1. Prophylactic
2. Treatment

In considering whether to prescribe antibiotics for a patient or not, dentists also consider whether the individual patient is at high risk of infection particularly if they have a weakened immune system. These include patients:

• with diabetes
• who are smokers or have lung disease
• taking medications that suppress their immune system
• with a history of Rheumatic Fever or Infective Endocarditis
• who are very young or very old patients
• with symptoms that suggest they have current severe infection, such as fever, rigors, inability to swallow or breathe

Prophylactic use

This is when antibiotics are used to prevent undesirable outcomes by reducing the amount of bacterial load in the mouth including after invasive procedures.

The surgical extraction of a tooth is a procedure in which patients can be prescribed antibiotics post-operatively to prevent infection as the procedure is very invasive.

For patients taking medications such as bisphosphonates we also follow Westmead Hospital guidelines to provide antibiotics prior to patients having a tooth extracted, to minimise the risk of osteonecrosis. They also follow up with a treatment course of antibiotics after the treatment as well.

Treatment use

Typically antibiotics that are used to treat ongoing infections of the mouth are used in conjunction with other treatment forms and not solely on its own.

Patients who have been diagnosed with a tooth related abscess or swelling are often given antibiotics in addition to root canal therapy or extraction and incision and drainage. The actual act of incising and draining a swelling allows pus which is dead bacteria to be drained, while the act of completing root canal or extracting the tooth removes the source of the bacteria.

What the antibiotic does is it helps contain the amount of bacteria spreading from the site of the infection to the rest of the face, head and body.

Next week: Dr Kim Nguyen on losing baby teeth