Antibiotics in Dentistry: National Guidelines

Due to the high frequency of antibiotic use in dentistry and the relatively recent introduction of antibiotic surveillance programmes it is plausible that the dose, duration and type of antibiotics used in dentistry can vary greatly across different national guidelines. However, it must be acknowledged that some variance may be explained by differing local rates of resistance.

Antibiotic treatments in  Periodontal Infections

In order to compare the current approaches to antibiotic use in different countries, we will compare and contrast the antibiotic use to treat and manage two of the most common periodontal infections: Periodontal Abscess and Periodontitis/Gingivitis. To compare the therapeutic approach to both infections we will compare and analyse the national guidelines indicated for each study and any relevant scientific findings in the following countries: The United Kingdom, Ireland, Germany and Taiwan. We will consider the following parameters when evaluating the current guidelines: Dose, dosage duration of treatment and follow-up antibiotics (proposed alternatives if allergies are present will also be analysed if appropriate).  

Periodontal Abscess 

Periodontal abscess describes the localized accumulation of pus in the alveolar bone at the root apex of the tooth.  Periodontal abscess usually presents as a polymicrobial infection consisting of facultative anaerobes, involving the viridans, mitis and anginosus streptococci, and also in conjunction with obligate anaerobic cocci such as the Prevotella and Fusobacterium species (Robertson and Smith, 2009)

Table displaying first line antibiotic use against periodontal abscess in the United Kingdom, Ireland, Germany and Taiwan. Data adapted from ‘Drug Prescribing for Dentistry’ SDCEP, 2016 (UK), ‘Antibiotic Prescribing’ NHS, 2019 (Ireland). ‘Zahnärztliche Mitteilungen’ DGZMK, Issue 17, 2002 (Germany). Kao Wen Kai et al. (2014) Clinical guidelines for Patients Requiring Antibiotics Before Dental Treatment.

Periodontitis  

Periodontitis is an inflammatory disease associated of the periodontium and is associated with the biofilm of the oral cavity, which is comprised of over 700 types of bacteria therefore, indicating the key role of oral bacteria in the development of the disease (Aas et al., 2005).

Table displaying antibiotic use in conjunction with scaling and root planning to treat periodontitis in the United Kingdom, Ireland, Germany and Taiwan. N/A represents not indicated in national guidelines. Data adapted from ‘Antimicrobial Prescribing for General Dental Practitioners’. FGDP, 2014 (UK), ‘Antibiotic Prescribing’ NHS, 2019 (Ireland).

Fellow Dentist, remember:

An important component of each national guideline investigated is the emphasis on local management techniques in lieu of antibiotic use, which is a key step towards reducing antimicrobial resistance. Each of the guidelines only recommends antibiotics to treat periodontal abscess if there is evidence for systemic involvement, with a clear protocol in place which is available to consult prior to advancing with treatment. Particularly as periodontal abscess is primarily a local infection which can be treated with drainage and as it is usually isolated from the circulation, the use of antibiotics to treat a minor PD abscess is counterproductive. The importance of these guidelines promoting antibiotic stewardship should be not overlooked, due to the high frequency of antibiotic prescription by dentists.

This post was written by Jonathan Dalrymple, German  Frentzen, Bryan, and Lennart  Prufer, 2nd Year Students in Microbiology and Virology. Great job!!!!