Antibiotics are not necessary to prevent toothache

If you want to give an antibiotic for a toothache or an endodontic infection to your patient next time please you have to reconsider it.

We listen very often to our patients say that taking antibiotics prior to an endodontic treatment procedure can´t  hurt because they have taken them for many years. Many of our patients believe that antibiotics can help to relief tooth pain including sensitivity to heat and cold. They also have been conditioned to believe that the antibiotics are needed in all the dental infection, no matter the localized or small it may be.

Many of us, the clinicians, and our patients are comforted when using antibiotics, because mentally, legally and sincerely we believe they help clinically. But we have to ask ourselves if we are helping or hurting our patients when exposing them to antibiotics.

In 2014, the American Dental Association (ADA) commented about the prophylactic use of antibiotics prior to dental procedures in patients with prosthetic joints. The conclusion was that “in general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental treatment to prevent prosthetic joint infection.”

In fact, over the years, there has been a clear trend in reducing need for antibiotics in dentistry. We can’t always assume that antibiotics are safe or that they benefit our patients. Patients who have received antibiotics for years for endodontic and dental treatments may not be safe if they continue to use them repeatedly.

Would you say that your patients won’t develop an allergic reaction to an antibiotic, even if they have been taking it for years? How many of us develop allergies only after repeated exposures to certain allergens, including latex and seasonal allergies? What about other risks from antibiotic use? These may include the increased risk of resistance to antibiotics.

In 2004, the ADA said, “Any perceived potential benefit of antibiotic prophylaxis must be weighed against the known risks of antibiotic toxicity, allergy and the development, selection and transmission of microbial resistance.”

In endodontics, there are some fundamental indications and scenarios that do and do not require antibiotics. Over the years, I’ve seen dentists recommended antibiotics for endodontic related pain or infections, when they had no clear clinical indications for their use and, unfortunately, did not help.

So, with your good intentions in mind, please think twice and be very calculated before recommending or administering antibiotics to your patients. They can cause more harm than good.

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