Why Do We Do Antibiotic Prophylaxis and The Current American Dental Association Guideline For That?
Oral health plays a crucial role in maintaining a healthy body. Recent studies presented evidence that a connection lies between keeping the mouth healthy, and the wellbeing of the entire body1. For optimal oral health, a daily routine is recommended. Unfortunately, problems can develop with the teeth even when properly caring for teeth. When complications with the teeth, gums or any surrounding tissues in the mouth develop, a dental procedure may be necessary to provide a relief of any symptoms presented. Symptoms are not always only physical, such as pain and discomfort, but can also cause mental interference. When teeth become crooked or when a tooth that is visible when smiling becomes damaged, anxiety may develop as a consequence.
Some of the most common dental procedures2 performed on the general population include fillings, repairs, bonding, crowns, caps, veneers, braces, bridges, implants and extractions. Dentures, along with gum surgery, are also relatively common, especially amongst those who suffer from periodontist disease. During certain procedures, a patient may be placed under certain risks – one particular risk that concerns both the dentist and the patient is the possibility of an infection occurring as a complication.
Antibiotic Prophylaxis As A Preventative Measure Against Infection
The risk of developing an infection following a dental procedure causes a concern for patients, as well as for the dentist or oral surgeon performing the procedure. For the last few decades, this particular risk that has been associated with dental procedures have been addressed through the use of antibiotic prophylaxis. Providing antibiotics to a patient that has an existing infection, as well as those who may be at a high risk of developing an infection following a dental procedure, helps to reduce the prevalence of complications. The most significant risk factor that concern dentists and patients would be infective endocarditis in patients with a prosthetic heart valve3.
While some patients may be at risk of developing infection after they have undergone an invasive dental procedure, there are other concerns surrounding the use of antibiotic prophylaxis that need to be addressed. In particular, the risk of antibiotic resistance4 is a problem that can cause antibiotic use in a patient to become less effective in the future, leading to the possibility of serious complications should the patient develop an infection later in their life.
Yet another concern would be the risk of the patient experiencing side-effects during the use of antibiotics – sometimes, the preventative benefits offered by antibiotic prophylaxis is concerned to be outweighed by the possible risk of side-effects that may develop. The most common side-effects of antibiotics5 include stomach upset and diarrhea, but there are more serious side-effects that could also occur. Abdominal cramps, vomiting, the development of a rash – these are all concerns that need to be considered. Antibiotic use has also been associated with a higher risk of candida infections, as well as possible impairments in immune function6.
ADD Guidelines For Antibiotic Prophylaxis
The American Dental Association is an important resource for physicians, dentists, oral hygienists and oral surgeons, providing updated information regarding a number of topics surrounding dentistry. The association has released a set of guidelines that offer physicians and dentists an indication as to whether it may be appropriate to utilize antibiotic prophylaxis as a way to prevent infection when a particular dental procedure needs to be carried out, and when the use of this strategy may hold risks that outweigh the potential benefits.
In the past, the use of antibiotics prior to undergoing a dental procedure was quite common. Recent changes to the antibiotic prophylaxis offered by the ADD now states that this strategy should be used less frequently than in the past, in order to avoid potential complications, with the development of antibiotic resistance being of the most significant concern.
According to the new data released by the ADD7, dentists and physicians should now only consider the use of an antibiotic prophylaxis strategy in patients who have been diagnosed with a particular heart-related condition that could predispose the patient to the development of infective endocarditis as a complication of a dental procedure. Additionally, patients with prosthetic joints might also be at a higher risk of a hematogenous infection at the particular location where the prosthetic joint is located. In such a case, antibiotic prophylaxis might also be useful. In all other instances, this preventative strategy is not recommended.
Dental procedures are often required to fix crooked teeth, to treat an infectious tooth, to provide a relief of the symptoms caused by an oral disease, and in some other scenarios. The execution of such a procedure can place a patient at a risk of developing infection, which may develop after the procedure has been completed. Antibiotic prophylaxis provides a method of preventing an infection as a complication of a dental procedure, but recent changes to the ADD guidelines for this option suggests that the use of antibiotics prior to performing a dental procedure is not truly as crucial as once thought.
1 Multiple Authors. Mouth: A portal to the body. Dental Research Journal. 2012. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612210/
2 Common Dental Procedures. Your Oral Health CA.
3 Multiple Authors. Dental procedures, antibiotic prophylaxis, and endocarditis among people with prosthetic heart valves: nationwide population based cohort and a case crossover study. The BMJ. 7 September 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5588045/
4 Carl Llor, Lars Bjerrum. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Therapeutic Advances in Drug Safety. December 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232501/
5 Everett Stephens. Antibiotics (Side Effects, List, Types). EMedicine Health. https://www.emedicinehealth.com/antibiotics/article_em.htm#what_are_symptoms_of_an_allegic_reaction_to_an_antibiotic
6 Claudia Spampinato, Dario Leonardi. Candida Infections, Causes, Targets, and Resistance Mechanisms: Traditional and Alternative Antifungal Agents. BioMed Research International. 26 June 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3708393/
7 Antibiotic Prophylaxis Prior to Dental Procedures. https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis