When Should Antibiotics Be Prescribed as Part of Dental Treatment - Savina Dental Clinics Malta and Gozo

We are always encouraged to maintain good oral hygiene. This helps to preserve your smile and keep dental related diseases and conditions at a minimum. But regardless of how much care you give to your mouth and teeth, some bacteria still hang around. These bacteria can find their way into the bloodstream.

For most people, the body’s immune system does a great job of killing off any bacteria that end up in the bloodstream while for others, these bacteria can affect any site of weakness, such as a defective or prosthetic heart valve. It’s for the latter demographic that dentists prescribe antibiotics before specific dental procedures.

Antibiotics like penicillin, clindamycin, and amoxicillin help to kill bacteria. Besides their usefulness in fighting infections, not everyone is aware of their role in preventing infection in vulnerable people. Therefore, in this piece, we list situations where antibiotics should be part of the dental procedure and treatment.

The Connection Between Antibiotics and Dental Treatment

Bacteria are found in different body parts, including the skin and the mouth. Generally, they stay put. But with a small lesion or cut, they find their way into the bloodstream. This mostly happens during dental treatments involving bleeding, such as teeth cleaning. And in some cases, hard brushing and flossing can lead to similar problems. In actual fact, bacteria enter our bloodstream from the mouth every time we chew food and brush our teeth but our immune system is well-adapted to deal with this unless individuals suffer from certain conditions.

While in the bloodstream of susceptible individuals, the bacteria can cause an infection in any body part. The most affected tissues include the heart valves and lining. Also, those with orthopaedic implants are at a high risk of infection.

Instances When a Dentist can Prescribe Antibiotics

Most patients believe antibiotics are unnecessary during dental procedures and can be avoided. Although this is very often true, unfortunately, it is not always the case. Here are some instances where antibiotic prescriptions help prevent even bigger problems:

If you have a heart condition

The AHA (American Heart Association) first recommended the use of antibiotics in 1955 for patients with heart diseases or conditions, including a thickened, leaking, or artificial heart valve or a past history of infective endocarditis (infection of the heart lining). A bacterial infection can cause a blockage in the blood vessels resulting in a stroke.

Luckily, endocarditis is rare and can be managed through antibiotics. But on the flip side, it can be quite difficult to treat and become life-threatening if no precautions are taken. The AHA recommends such patients to take antibiotics an hour before the dental procedure.

During treatment of odontogenic and non-odontogenic infections.

An odontogenic infection is where the infection stems from the tooth or the supporting structures. The most common odontogenic infections result from a dental nerve becoming necrotic (dying) underneath a deep filling or extensive decay, periodontal disease, and failed root canal treatments. The infection may start and remain local or spread along the jaw and face.

On the other hand, non-odontogenic infections are those that affect the neck and face, the parotid gland (one of the major salivary glands), the oral mucosa as well as oropharyngeal candidiasis (thrush).

In such instances, antibiotics (or antifungals) become essential in preventing infections before the dental procedure is conducted.

During prophylactic treatment

Prophylactic treatment is aimed at keeping your teeth healthy and treating the early stages of dental conditions and diseases. A simple, regular cleaning process can save you hundreds in dental treatment costs as well as helping you save your natural teeth.

Part of the treatment involves removing dental plaque and calculus to eliminate bacteria that cause gum disease and tooth decay. In cases of severe neglect and/or the presence of pus in the gingivae, antibiotics or antibacterial mouthwashes may be necessary prior to treatment.

After joint replacement surgery

Those who have undergone joint replacement surgery are at a high risk of developing an infection on the joint implants. In some severe cases, there may be loss of the implant’s bone support, leading to subsequent surgeries to fix it. This is why a dentist will often recommend the use of antibiotics prior to certain dental procedures if a patient has undergone joint replacement surgery.

If you have a past joint implant infection

Unfortunately, no surgery is risk-free, including a joint implant. The new joint may get infected a couple of hours, days, or even years after the surgery.

Some joint implant infections can be treated non-surgically and for others, surgery is required. Once the infection is cleared, you should be careful not to get reinfection. Unfortunately, bacteria from a dental procedure may cause reinfection and that is where antibiotics therapy is necessary before treatment.

Patients with autoimmune disorders such as lupus and rheumatoid arthritis

Autoimmune diseases are usually rare and stem from abnormal immune responses to tissues and substances in the body, including bacteria. These diseases are often heterogeneous and multifactorial and might exist in several cell types and organs.

So far, science shows a strong link between bacterial infections and autoimmune disorders. Because of this, steps to reduce infection should be taken during dental procedures, including the usage of antibiotics (1).

Possible side effects of antibiotics

Possible side effects of antibiotics after dental treatment - Savina Dental Clinics Malta and Gozo

While antibiotics prevent infections, they do nothing for viral, and fungal infections. Moreover, they do not always cure toothaches. Your dentist has to examine your mouth and determine the cause of your pain in order for them to prescribe what is necessary for your situation. If there is no active infection you will not be prescribed antibiotics.

With that said, below are some possible side effects of antibiotics:

You develop a resistance to antibiotics

Antibiotic resistance is a threat to public health. However, resistance, in this case, refers to the drug not killing bacteria – not that your body doesn’t react to the antibiotics.

When bacteria develop resistance, the antibiotics prescribed are useless against them, and they continue to thrive, making it very difficult to treat certain infections. This makes it imperative not to self-prescribe antibiotics and to take them exactly as recommended by your dentist or doctor.

Other side effects include:

  • Stomach upset and/or diarrhea
  • Dizziness
  • Nausea
  • Yeast infections
  • Rashes
  • Serious allergic reactions
  • Interactions between other medication and antibiotics

To know if you could develop these side effects, talk to your dentist. Most side-effects are mild and temporary and will subside on cessation of antibiotic treatment buy it is especially important to report severe diarrhea as it could mean that you have a C. difficile infection which requires immediate treatment.

Antibiotics & Dental Treatments Conclusion

Once you consult your dentist and you are prescribed antibiotics, follow the prescription to the letter respecting both the dosage (the strength of the antibiotics) as well as the number of times you ought to take it lest you risk the medication not working. Most importantly, always maintain a healthy mouth and smile by brushing your teeth after every meal. Be sure to clean between the teeth with floss or interdental aids and visit your dentist for regular dental checkups (twice a year).

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Savina Clinic – Dental & Implantology Centres are friendly, state-of-the-art practices in Malta and Gozo dedicated to comprehensive quality dental care. Savina Dental is an innovative dental practice in Malta and prides itself on the high-quality customer service, low waiting room times, attention to detail and the advanced dental technology at their disposal.

Joseph Xuereb
Principal Dental Surgeon & Owner of Savina Dental Clinics, Dr Joseph Xuereb BChD (Hons), MFGDP(UK), MGDS RCS(Eng), FFGDP RCS(UK), FICD is a general dental practitioner with a special interest in Implant and Restorative Dentistry. Dr Joseph & the teams' full biographical information can be found here.