Antibiotic use in Dentistry

By Kevin Siao

After lot of delay I have finally reached the point of beginning my blog. Topics will include useful tips as well as interesting incidents that happens in my practice. Hopefully they will benefit you directly or indirectly.

The first topic I decided to write about is "use of antibiotic in dentistry". I chose this because of the following;

1) Antibiotics are very commonly used in dentistry.

2) Antibiotic are overused in dentistry.

3) Antibiotics are improperly used.

4) My concern for public health at large.

At the time I wrote this several months ago in paper version for my practice waiting room reading, CRE infection was the news. For those of you who never heard of CRE infection, it stands for "Carbapenem-resistant Enterobacteriaceae Infection". They are a family of germs that are difficult to treat because they have high level of resistance to antibiotics.

Carbapenem are a group of antibiotics that are usually reserved to treat serious infections caused by germs that are highly resistant to antibiotics. Sadly, some of these germs can no longer be treated with these antibiotics anymore due to development of resistance by some germs. This was first discovered in 2001.

Coincidently, a few months ago I was reviewing Biology with my son who is in first semester of his first year in college. One of the chapters was about evolution. An entire sub section was about emergence of antibiotic-resistant bacteria, specifically Methicillin-resistant bacteria to very commonly used antibiotic. This is a major concern for the medical and scientific community. Major enough that it has found its way in college Biology textbooks.

Many of my patients who have been with me for 20 years are aware of three things pertaining to this topic:

1) I wrote about this concern about 16 years ago.

2) I do not advocate antibiotic use for 'little' things.

3) I have emphasized 'complete' use of all prescribed antibiotic.

Here's the ABCs of antibiotic use;

A: Avoid "abuse" or overuse of antibiotic. Antibiotic is not required for most dental conditions. Treating the condition is all that is required. For instance removing the broken tooth, getting root canal done when indicated, treating gum infection with scaling and curettage may be all that you need without resorting to antibiotic.

Besides 'overuse' of antibiotic there are instances of 'Ineffective' use of antibiotic. This occurs when patients use antibiotic prescribed for one condition, for another condition. For instance using unfinished antibiotic prescribed by another doctor for urinary tract infection for dental infection or vice versa.

B: Beware of using 'expired' antibiotics. Occasional use of expired pain medication is one thing. Use of expired antibiotic is strongly discouraged. Expired pain meds may be less effective to pain but expired antibiotic that become less effective can result in development of resistant germs.

C: Complete the entire amount of antibiotic prescribed to you. I still come across patients not completing the entire course of the prescribed medications. Reasons varies from simply forgetting one or even two dose everyday to thinking there is no need to take anymore when pain is gone. Some are even known to save some 'in case' of future need! It is important to take on time to keep a sustained level of the drug in your blood.

I have emphasized this for years and will do so again in the future. If you come across anyone not following the above simple steps please let them know. Running out of effective antibiotic will be a NIGHTMARE for mankind. For those of you who has the stomach for it google "flesh eating disease". Viewers discretion advised!

Until next time...