Current controversies in dental practice : Antibiotics- to prescribe or not to prescribe

Abstract

Background: As a result of greater understanding of disease processes, enhanced awareness of cost effectiveness and risk-benefit correlations, and better communication between medical and dental practitioners, the guidelines for antibiotic prophylaxis have been significantly altered. From the standpoint of surgical procedures, antibiotics are rather overrated when considering the incidence of infections. There is often confusion and misinformation concerning the indications and scientific basis for the use of antibiotics in conjunction with dental procedures. Methods: The medical and dental literature was reviewed for scientific evidence regarding the use of antibiotics to prevent local and systemic infections associated with dental treatment. Situations commonly considered by dentists for potential use of prophylactic antibiotics were reviewed to determine current evidence with regard to use of antimicrobial agents. This included prevention of distant spread of oral organisms to susceptible sites elsewhere in the body and the reduction of local infections associated with oral procedures. Results: There are relatively few situations in which antibiotic prophylaxis is indicated. Aside from the clearly defined instances of endocarditis and late prosthetic joint infections, there is no consensus among experts on the need for prophylaxis. There is wide variation in recommended protocols, but little scientific basis for the recommendations. The emerging trend seems to be to avoid the prophylactic use of antibiotics in conjunction with dental treatment unless there is a clear indication. Conclusions: Aside from the specific situations described, there is little or no scientific basis for the use of antibiotic prophylaxis in dentistry. The risk of inappropriate use of antibiotics and widespread antibiotic resistance appear to be far more important than any possible perceived benefit. Clinical Implications: Dentists should use antibiotic prophylaxis in only those specific situations in which there is a valid scientific basis for it. Changes in use of antibiotics are imperative if clinicians are to limit the resistance of bacteria to these drugs.