Dental antibiotics

Dental Antibiotics: What Medications to Choose and How to Use Them Correctly

What Are Dental Antibiotics?

During dental treatment, various situations may occur, requiring the use of antibiotics in order to prevent or treat infections. Antibiotics prescribed by dentists have become an important part of dental treatment. Dentists prescribe 7%-11% of all antibiotics, including macrolides, beta-lactams, tetracyclines, metronidazole, clindamycin, etc.

The following are the antibiotics that may be used during dental treatment:

• Penicillin;
• Tetracycline;
• Amoxicillin and ampicillin;
• Clindamycin;
• Erythromycin;
• Chlorhexidine;
• Cephalosporin;
• Metronidazole;
• Sulphonamides;
• Cotrimoxazole.

Antibiotics are also used for preventing infections due to pathogens that are always live around teeth.

What Conditions Require Treatment with Antibiotics?

Dental antibiotics are used for the treatment of conditions divided into the following two categories:

• Postoperative infections;
• Dental Abscesses.
Postoperative infections include:
• Bacteraemia (bacteria found in the blood that may cause various infections due to the following procedure: subgingival scaling, tooth extractions, or too intensive tooth brushing);
• Infective endocarditis (it is a life-threating infection that may occur after dental procedures);
• Prophylaxis (should be used thoughtfully considering antibiotic resistance).
The following types of dental abscesses exist:
• Lateral periodontal abscesses;
• Acute dentoalveolar abscesses.
The following are recommended dosages of some dental antibiotics:
• Penicillin V: 500 mg 4 times per day;
• Clindamycin: 300 mg 3 to 4 times per day;
• Amoxicillin: 500 mg 3 times per day;
• Metronidazole: 500 mg 3 to 4 times per day.

How to Choose the Right Dental Antibiotic?

The goal of dental therapy is to treat infections and prevent complications. Amoxicillin is the first-line medication, but it cannot be used in all cases because of amoxicillin resistance found in 34% of Prevotella species. This antibiotic can be substituted with clindamycin, metronidazole, and others.

Cephalosporins do not provide any benefits over penicillin V, but it is preferable to use if a patient is in the hospital. Cephalosporins can successfully fight S aureus. If the patient has an allergy to penicillin, it can be substituted with clindamycin. Macrolides such as azithromycin and erythromycin should not be used in treating odontogenic infections because they may cause a range of problems. Tetracyclines may be used for the treatment of periodontal infections, but they are not recommended in case of infections occurred due to odontogenic.

If the cause of the infection has been destroyed and the patient does not respond well after 2-3 days to clindamycin or penicillin V, then metronidazole can be added, which is effective for the treatment of anaerobic bacteria but useless in the treatment of obligate aerobes.
Antibiotics like amoxicillin and penicillin are often used to prevent a range of infections that may occur after dental procedures. If a patient has an allergenic reaction to the mentioned above medications, he or she may be prescribed with erythromycin.

Clindamycin is used for the treatment of infections due anaerobic bacteria, such as abscesses in soft tissue and bone in patients that do not respond adequately to erythromycin or penicillin. Chlorhexidine is used to control gingivitis, plaque, and periodontal pockets.

Tetracyclines can be prescribed for the treatment of periodontal disease.

How Long Dental Antibiotics Should Be Taken

Today, the treatment with antibiotics is recommended to keep short-term, which requires that antibiotics have certain properties, including the following:

• High bactericidal activity;
• Quick onset of action;
• Lack of ability to create resistant mutants;
• Effective activity against non-dividing bacteria;
• Easy penetrations into tissues;
• Resistance to adverse infection conditions, such as anaerobiosis, pus, low pH, etc.

Long courses of antibacterial treatment tend to destroy the commensal flora. Also, the use of an antibiotic for up to twenty-one day may lead to the occurrence of antibiotic resistant strains.

Short courses are better than long, particularly for children.

The Use of Dental Antibiotics for Prophylaxis

Prophylactic antibiotics are taken before conducting a range of dental procedures in order to reduce the risk of the occurrence of complications, like dry socket, infections, etc.

According to the evidence, prophylaxis is not always necessary and often is ineffective. For instance, it was found that metronidazole given in a single dose is ineffective for the prevention of dry socket. For most dental surgical procedures, antibiotic prophylaxis is not recommended.

The risk of the occurrence of bacterial endocarditis is very low. According to the BSAC and AHA, the use of prophylaxis antibiotic may only be recommended for patients who are in the high-risk group of bacterial endocarditis. Also, it has been concluded that even regular tooth brushing is riskier in terms of the occurrence of bacterial endocarditis than dental treatment. Currently, there is no evidence proving that antibiotic prophylaxis has any clinical effectiveness.

Unfortunately, the recent studies have shown the abuse of prophylactic antibiotics. Dentists tend to prescribe antibiotics based on the principle ‘just in case.’ Considering that the world must urgently start doing actions preventing the occurrence of antibiotic resistance, such an approach of dentists makes the situation much worse.

All in all, dental antibiotics are crucial for the treatment in many cases, but it is extremely important to prescribe them only when they are really needed. Antibiotics should be taken at the right dose, frequency, and duration.