Dentistry with antibiotic prophylaxis

Introduction

Over use of antibiotics results in a global crisis which leads to increased number of bacterial species which are antibiotics resistant that were commonly used for the treatment of infections. Overuse of these antibiotics may lead to bacterial emergence.

Efforts to reduce antibiotics use in healthcare, especially dentistry. These efforts are reduced antibiotics use in food production in animals to increase growth, elimination of use of antibiotics when disease is not associated with a bacterial infection, reduced usage with endodontic treatment when there is pulpal involvement, prophylactic antibiotics before dental treatment.

Goff and colleagues1 reviewed and examined the prophylactic antibiotics need before dental treatment for IE prevention in cardiac disease history patients and for prosthetic joints infection prevention. Traditionally, these were two main indications for prophylactic antibiotics in dentistry.

There is lack of clarity for prophylactic antibiotics requirement, that causes confusion between patient, dentist and patient’s physician. Goff et al.1 reviwed the 65 years ago published guidelines to prevent IE. ADA (American Dental Association) in 1972 involved, with the elimination of the post-procedural dose but retention of the pre-procedural dose, a significant change occurred in 1997. The prophylaxis rationale are questioned as bacteremia can be there following toothbrushing and to reduce the oral microbial burden, proper oral hygiene performed daily is more important than prophylactic antibiotics. Unnecessary antibiotics use can be associated with adverse events for the patient as well as for the society.

Data analysis from Medicare and commercial insurance carriers examined data for a four-year period which included 91,438 patients with 168,420 dental visits and found that more than 80% of prophylactic antibiotics prescriptions for were unnecessary.2

Epidemiological modelling indicated that to prevent infection of the prosthesis, adverse events impact with prophylactic antibiotics far exceed any benefit of using these drugs. Orthopedic surgeons continue to recommend prophylactic antibiotics for prosthetic joint replacement patients.3 That patients considered as being at high risk who receive prophylactic antibiotics for their entire lives. 0.8 and 1.5%4 joint prosthesis patients with infection experience, and the infection consequences can be more severe and there is need for prosthesis placement, overprescribing antibiotics consequences can also be detrimental. Clostridium difficile Super-infection can occur with antibiotics administration.5, 6 This infection causes morbidity and occasionally mortality. Long term antibiotics overuse is associated with resistant bacterias development. In US, joint replacement is a common surgical procedure.7

The three antibiotics used in adult surgical prophylaxis, where weight-based dosing is recommended, are cefazolin, vancomycin, and gentamicin. For patients receiving cefazolin, 2 g is the current recommended dose except for patients weighing greater than or equal to 120 kg, who should receive 3 g.

To prevent infective endocarditis, prophylactic antibiotic is not recommended.8 For patients with cardiac disease history,current recommendations for prophylactic antibiotics to prevent IE.

In children, CHD disorders which require antibiotics prophylaxis, it is recommended in case of Cyanotic CHD which is not fully repaired and the use of conduits and shunts, congenital defect which is completely replaced with prosthetics, for six months after the procedure and repaired CHD with residual defects like abnormal flow at or near the prosthetic device.10, 11

To prevent prosthetic joint infections, antibiotic prophylaxis current recommendations are as follows:

Recommended Antibiotic Prophylaxis Regimen

If patient is allergic to penicillinClindamycin 600 mg orally, ½-1 hour before treatment.

Conclusions

Prophylactic antibiotics before dental treatment has been reduced in 20 years due to that there is reduced use of unnecessary antibiotics. Antibiotic prophylaxis is still recommended for medically compromised patients with advanced or congenital cardiac problems, history of prosthetic joint complications.

Source of Funding

None.

Conflict of Interest

None.