The next time you are about to prescribe your patient an antibiotic for a toothache or an endodontic infection, stop, and reconsider.
You may often come across patients who self-medicated their toothache with antibiotics. You will also find patients who insist on being prescribed antibiotics “just to be safe”.
May people are conditioned to believe that antibiotics can only help, and never harm. They also may believe that antibiotics are needed for any form of dental infection, or symptoms of pain and sensitivity.
Clinicians sincerely have their patients’ well-being in mind with respect to managing their pain and infections. However, even many clinicians prescribe antibiotics needlessly because they sincerely psychologically believe that it is beneficial.
Antibiotics are getting overused across dentistry, especially in endodontics, leading to more allergies and greater resistance among patients. Not all infections need antibiotics, and alternative treatments may be just as effective without the risks.
When it comes to dentistry, especially endodontics, the big question with antibiotics is: to give, or not to give? The best way to explore that answer would of course be to review clinical cases as an example.
Suppose a patient comes to your practice and complains of sensitivity to cold and hot, there’s a deep carious lesion that is in contact with the pulp, and the patient is in pain and discomfort. Ask yourself, is there infection involved in this situation?
Let’s examine the symptoms. The patient feels pain due to cold and hot stimuli. Which means, there’s no infection, there’s no bacteria. The tooth in question is still vital. The pain is due to sensitivity. In a case like this, antibiotics are NOT indicated.
Now, consider the same patient, fast forwarded two months. The patient had a root canal treatment, and has now developed an apical lesion, and the symptoms include tenderness to percussion. So clearly there is an infection the periapical area, and it has also probably spread to the root canal system.
If you give an antibiotic, you have to remember that there is no blood supply to carry the antibiotic in to where the source of the infection is. So, while it may prevent spreading of the infection for a short period of time, it’s still not going to treat the source of the problem. Hence in this situation, in the absence of a space infection and lymphadenopathy, antibiotics are NOT indicated.
Once again, fast forward same patient and they present with a big swelling, lymphadenopathy, inability to swallow, and fever. Now, this patient absolutely requires antibiotics, because the infection is systemic.
Over the years, there has been a clear trend in dentistry towards a reduced need for antibiotics. This trend should be encouraged by all practicing dentists.
So think twice and be very calculated before recommending or administering antibiotics to your patients. Additionally, discourage your patients from self-medicating with antibiotics. More often than not, it could cause more harm than good.
