Antibiotic Resistance in Dentistry

The purpose of prescription antibiotics is to kill bacteria that are causing an infection. Sometimes, when antibiotics are used frequently, bacteria start to become resistant to treatment. Antibiotic resistance develops naturally but is exacerbated by overuse and incorrect use of medication. Once bacteria have become resistant to antibiotics, the resistant bacteria can spread the same way as normal bacteria do, and infections then become more difficult to treat.

Overuse and Incorrect Use of Antibiotics Includes:

• Prescribing antibiotics when they are not needed
• Using antibiotics differently than prescribed
• Sharing antibiotics with another person
• Discontinuing use of antibiotics before the full round has been completed

Tips for Preventing Antibiotic Resistance Include:

• Practicing good hygiene to prevent getting sick
• Staying home when you are sick to prevent the spread of infection
• Ensuring your vaccinations are up to date
• Discussing antibiotic use with your healthcare provider
• Taking antibiotics as directed and always completing the recommended dosage even after you start to feel better

The role of healthcare providers in preventing antibiotic resistance is to ensure they prescribe antibiotics only when needed, prescribe the correct dose for the correct duration, and choose the most appropriate antibiotic for the situation. Antibiotic use in dental procedures is sometimes needed if there are complications after oral surgery. Another common use of antibiotics in dentistry has typically been the administration of a low dose antibiotic prior to routine dental procedures in patients who have orthopedic implants (e.g. hip or knee replacements), heart conditions, or are otherwise at higher risk of infection. Historically, the concern has been that dental procedures could lead to an infection that would spread through the blood to the artificial joint, the heart valves, or the lining of the heart, causing the tissue to become inflamed.

Dental Association Recommendations

In 2012, the American Dental Association (ADA) and the American Academy of Orthopedic Surgeons (AAOS) released an updated guideline on the use of preventative antibiotics during dental procedures. The Canadian Orthopedic Association (COA), the Canadian Dental Association (CDA) and the Association of Medical Microbiology and Infectious Disease (AMMI) Canada have also reviewed the latest findings to conclude that routine use of antibiotics in dentistry is not recommended. This conclusion is based on the evidence that:

• Most bacterial oral infections occur outside of dental procedures
• Most joint and heart infections are not related to bacteria in the mouth
• There are few known cases where a direct connection can be drawn between a prosthetic joint or heart infection and a recent dental procedure

If you are concerned about your risk of infection during dental procedures, or have previously been advised to take antibiotics prior to your dental procedures, it is best to discuss your situation with your family dentist to determine if or when antibiotics are needed. Remember that due to the risk of antibiotic resistance, the latest guidelines recommend that patients avoid regular use of antibiotics when symptoms of a bacterial infection are not present.