By Michael G. Rehme, DDS, NMD, CCN
After more than 40 years of practicing dentistry, I’ve learned many things about the usage of antibiotics.
Through my dental school education, I was taught over and over again that antibiotics should always be administered for swelling, inflammation, or any surgical procedure, such as extractions and periodontal treatments. Protecting our patients from infection and postsurgical complications was our main objective. This certainly seemed logical to me, so I never really questioned it.
As my dental office began to evolve into a biologic practice some 30 years ago, I began to pay more attention to the entire body and how the tooth/body connection really played a role in our overall health and well-being. I discovered that the human body was an amazing compensatory system designed to heal on its own – IF given the opportunity.
But this intriguing concept took me years to figure out.
I continued to prescribe antibiotics as I was taught until I began to get backlash from patients who questioned my professional advice on this matter. I was constantly being confronted with objections from patients who simply were not going to take antibiotics unless there were visual signs of pus (clinically known as “exudate”) or if they were experiencing fever or unusual swelling that required obvious intervention.
Their concerns were legitimate. They wanted their bodies to heal without the use of medications. They were concerned about destroying their normal gut flora and the development of resistant microbes as a result of antibiotic overuse.
Hearing my patients’ concerns, I knew it was time to revisit this topic and decide if any changes should be made for antibiotic therapy in our office.
A Paradigm Shift
Ultimately, I came to the conclusion that less is better. After doing my own research on dental antibiotic use and studying its relationship to treat infection, swelling, and inflammation, as well as support surgical procedures, I developed an effective and safe protocol for our office that simply made more sense to me.
Here’s what it looks like:
- Antibiotics ARE used when exudate (pus) is clinically observed during a dental procedure to reduce the patient’s current infection.
- Antibiotics ARE used for sinus infections. During the surgical extraction of upper posterior (back) teeth, a perforation into the sinus may develop due to a chronic infection along the sinus membrane. A perforation can also form while trying to remove root tips. In either case, antibiotics are definitely warranted to avoid further complications in the patient’s sinus cavity.
- Antibiotics ARE used for prophylactic coverage with prosthetic devices (e.g., hip or knee replacements) as recommended by a patient’s orthopedic surgeon(s).
- Antibiotics ARE used per patient request during dental procedures, even when no exudate (pus), swelling, or inflammation are clinically observed. If the patient asks for antibiotics to help in the healing process, we will administer them.
- Antibiotics are NOT used during a dental procedure when no swelling or inflammation are clinically observed. We explain how the body should be able to heal properly WITHOUT antibiotics and ask them to call us right away if they experience any unusual swelling or fever in the first few days after their procedure. If those symptoms emerge, we will prescribe antibiotics immediately.
- Antibiotics are NOT used during a dental procedure when there are signs of slight swelling and inflammation but no exudate (pus). Again, we explain how the body should be able to heal properly WITHOUT antibiotics and ask them to call us right away if they experience any unusual swelling or fever in the first few days after their procedure. If those symptoms emerge, we will prescribe antibiotics immediately.
Our office has successfully followed these guidelines for more than 15 years – a safe, yet conservative approach to supporting our patients’ care and healing. It’s just one more demonstration of our office mantra: Keep it safe and keep it simple.
Lewis MA. Why we must reduce dental prescription of antibiotics: European Union Antibiotic Awareness Day. BDJ. 2008;205(10): 537-538.
Fialkoff S. Only when necessary: The appropriate administration of antibiotics requires robust stewardship. Inside Dentistry. 2021;17(2).
Williams A. Many preventive antibiotics prescribed by dentists are unnecessary. Clinical Breakthroughs. 2019.