Antibiotics typically prescribed in dental practice for some of the following purposes
- Treatment for acute odontogenic infections
- Treatment for non-odontogenic infections
- Prophylaxis against local infection in patients at risk (endocarditis and joint prostheses)
- Prophylaxis against local infection and systemic spread in oral surgery
Narrow-Spectrum Antimicrobial Agents Encountered in Dentistry
Clindamycin
- Bacteriostatic (bactericidal at higher doses)
- Active against some aerobic gram +ve cocci (including Staph aureus, S. epidermidis, streptococci and pneumococci), some anaerobic gram –ve bacilli, many anaerobic gram +ve non–spore-forming bacilli, many anaerobic gram +ve cocci & clostridia.
- Indicated for the treatment of infections caused by susceptible microorganisms; used as a prophylactic antibiotic in high-risk patients allergic to penicillin for the prevention of both bacterial endocarditis and infections of total joint replacements
Metronidazole
- Bactericidal
- Active against most anaerobic cocci and both gram –ve bacilli and gram +ve spore forming Bacilli
- Has been used as adjunct in treatment of periodontitis and ANUG; commonly co-prescribed with amoxicillin (combined use with amoxicillin or amoxicillin/clavulanic acid has not been approved by FDA)
Penicillin V Potassium
- Bactericidal
- Cell-wall synthesis inhibitor
- Active primarily against gram +ve cocci (including S. aureus), gram +ve & gram –ve bacilli, spirochetes)
- Use is limited to treatment of minor infections such as ulcerative gingivostomatitis and to the prophylaxis and continued treatment of streptococcal infections
Amoxicillin
- Bactericidal
- Active against many gram –ve & gram +ve organisms; not Effective against β lactamase–producing bacteria
- Empirical antibiotic for oral infections, sinusitis & skin Infections; prophylactic antibiotic in high-risk patients for the prevention of bacterial endocarditis
Amoxicillin + Clavulanic Acid
- Bactericidal
- Active against a wide spectrum of gram –ve & gram +ve organisms, including βlactamase producing bacteria
- Used for the treatment of sinus, oral and respiratory infections
Ampicillin
- Bactericidal
- Active against many gram – ve and gram +ve organisms; not eff. against βlactamase–producing bacteria
- Commonly used empirical antibiotic for oral infections, sinusitis & skin infections. Prophylactic antibiotic in high-risk patients unable to take oral medication for the prevention of bacterial endocarditis
- Broad-Spectrum Antimicrobial Agents Encountered In Dentistry – Cefadroxil, Cefazolin, Cephradine, Azithromycin, Clarithromycin, Erythromycin, Tetracycline (Doxycycline, Minocycline)
Antibiotic prophylaxis NOT required for
- Routine anesthetic injections though non-infected tissue
- Taking dental radiographs
- Placement of removable prosthodontic appliances
- Placement / adjustment of orthodontic appliances
- Placement of orthodontic brackets
- Shedding of deciduous teeth
- Bleeding from trauma to the lips / oral mucosa
Oral cavity is intensely colonized by bacteria. The maximum concentration found in bacterial plaque (~ 1011 – 1012 microorganisms per gram of wet weight) and abundant bacteria is present on back of tongue / cheek / palatal mucosa. Up to 200 different bacterial species isolated from a single oral cavity. Thus, antibiotics sould be prescribed according to the clinical scenario, the treatment required and patient’s systemic condition.
Article by Dr. Siri P. B.
