Antibiotics in Dentistry: Advancements, Challenges, and Best Practices

Health

By Dr Randhir Seewoodharry Buguth

In 1928, Sir Alexander Fleming’s discovery of penicillin marked a watershed moment in medicine, offering a potent weapon against bacterial infections. Subsequent efforts by researchers like E. Chain and H. Florey in Oxford University led to the mass production of antibiotics, revolutionizing healthcare during World War II and beyond.

The collaboration between the UK and the US spurred the widespread availability of antibiotics, initially with low levels of bacterial resistance. This era saw the emergence of numerous pharmaceutical firms dedicated to producing these life-saving drugs, culminating in the monumental effort to provide 2.3 million doses of penicillin for soldiers during the D-Day invasion of Normandy in 1944.

In modern dentistry, antibiotics play a vital role, with UK dentists accounting for 10% of all antimicrobial prescriptions. Guided by rigorous standards set by institutions like the National Institute for Clinical Excellence (NICE), the Faculty of General Dental Practitioners (FGDP), the Royal College of Surgeons (RCS), and the Scottish Dental Clinical Effectiveness Programme (SDCEP), practitioners ensure judicious antibiotic use to combat the growing threat of antimicrobial resistance (AMR).

Despite these efforts, AMR remains a significant concern, with estimates projecting millions of deaths globally by 2050. Prescribing errors among general dental practitioners highlight the need for ongoing education and adherence to best practices to mitigate the risks associated with antibiotic misuse.

Antibiotics in dentistry are indicated for various conditions, including acute or chronic oral infections, cellulitis, systemic involvement, and situations where drainage or debridement is impractical. Special consideration is given to immunocompromised patients and those at risk of infective endocarditis, where antibiotic prophylaxis can be life-saving.

Recent research underscores the importance of pre-treatment antibiotic prophylaxis for high-risk patients undergoing invasive dental procedures, emphasizing the critical role of timely intervention in preventing adverse outcomes such as infective endocarditis-related fatalities.

While ideal practice involves bacterial culture and sensitivity testing to tailor antibiotic therapy, logistical constraints often limit its feasibility in routine dental care. Nevertheless, efforts to enhance antibiotic stewardship through pharmacist-led initiatives and stringent prescribing guidelines have yielded promising results.

During the COVID-19 pandemic, dental emergency units faced challenges, leading to temporary deviations from standard practices. However, adherence to guidelines emphasizing advice, analgesics, and antimicrobials helped mitigate risks associated with inappropriate antibiotic use.

Commonly prescribed antibiotics in dental practice include amoxicillin, metronidazole, clarithromycin, co-amoxiclav, and clindamycin. Dosage adjustments are made based on factors such as age, weight, and specific medical conditions, with special considerations for patients with kidney failure or allergies.

As part of comprehensive antibiotic stewardship efforts, public education campaigns are crucial to raise awareness of the risks associated with antibiotic misuse. Healthcare professionals must challenge unnecessary prescriptions, supported by governmental initiatives to safeguard public health.

In conclusion, antibiotics in dentistry represent a cornerstone of modern healthcare, but their prudent use is paramount to combatting AMR and ensuring optimal patient outcomes. Through collaborative efforts and stringent oversight, the dental community can continue to uphold the highest standards of care while safeguarding the efficacy of these life-saving drugs.

Mauritius Times ePaper Friday 31 May 2024