Antibiotics or No Antibiotics, That Is the Question: An Update on Efficient and Effective Use of Antibiotics in Dental Practice

Abstract

The antimicrobial resistance (AMR) phenomenon is an emerging global problem and is induced by overuse and misuse of antibiotics in medical practice. In total, 10% of antibiotic prescriptions are from dentists, usually to manage oro-dental pains and avoid postsurgical complications. Recent research and clinical evaluations highlight new therapeutical approaches with a reduction in dosages and number of antibiotic prescriptions and recommend focusing on an accurate diagnosis and improvement of oral health before dental treatments and in patients' daily lives. In this article, the most common clinical and operative situations in dental practice, such as endodontics, management of acute alveolar abscesses, extractive oral surgery, parodontology and implantology, are recognized and summarized, suggesting possible guidelines to reduce antibiotic prescription and consumption, maintaining high success rates and low complications rates. Additionally, the categories of patients requiring antibiotic administration for pre-existing conditions are recapitulated. To reduce AMR threat, it is important to establish protocols for treatment with antibiotics, to be used only in specific situations. Recent reviews demonstrate that, in dentistry, it is possible to minimize the use of antibiotics, thoroughly assessing patient's conditions and type of intervention, thus improving their efficacy and reducing the adverse effects and enhancing the modern concept of personalized medicine.

Keywords: antibiotics; antimicrobial resistance (AMR); dental medicine; oral infections.

Figure 1

Flowchart for tooth extraction/resective surgical periodontology/mucogingival surgical periodontology in adult patients. In children, posology adjustments must be used as described in Table 1 and Table 2. Abbreviations: g = grams; mg = milligrams; h = hours; die = daily dosage; per os = oral administration; ASA = American Society of Anesthesiology; AP = Antibiotic prophylaxis.

Figure 2

Flowchart for treatment of endodontic diseases in adult patients. In children, posology adjustments must be used, as described in Table 1 and Table 2. Abbreviations: g = grams; mg = milligrams; h = hours; per os = oral administration; ev = endovenous administration; ASA = American Society of Anesthesiology; AP = Antibiotic prophylaxis.

Figure 3

Flowchart for abscesses/suppurative infections in adult patients. In children, posology adjustments must be used as described in Table 1 and Table 2. Abbreviations: g = grams; h = hours; per os = oral administration; im = intramuscularly.