Antibiotics and dentistry

The Sydney Morning Herald recently published an article about overuse of antibiotics in Australia and stated that “Prescribing Service data showed Australians’ antibiotics use was above the OECD average, with 40 per cent of people taking them in the past 12 months.” (Read more: http://www.smh.com.au/national/health/why-antibiotics-can-be-health-risk-20120419-1xa34.html#ixzz1soqupIc4)

As I am sitting here, half way through a course of antibiotics prescribed to me by my GP for a suspected chest infection, nine months pregnant, still struggling to breathe and battling an excruciating cough (six weeks and counting), lack of sleep and all the pre-baby drama, I begin to ponder the importance of this article.

I am a very conscientious patient and medicine consumer. I avoid pharmaceuticals unless absolutely necessary and follow my doctor’s advice on the dosage, frequency and duration of any needed treatment. So far, through my pregnancy I have avoided taking any medication for a painful wisdom tooth infection, upper respiratory tract infection which left me bed-bound all through Christmas, a gastro-intestinal infection and this persistent six week cough which feels like it’s bringing the birth of my baby closer by the minute:) I know, you don’t need all the gory detail of my ailments over the past nine months, but with a preschooler/”germ factory” in the family, this is by no means unusual. To be honest, throughout those illnesses, my GP never recommended antibiotics as the infections were viral. As a health professional, I understand that antibiotics do not eliminate viruses. However, this most recent bout of illness prompted my GP to prescribe a course of ‘pregnancy-safe’ antibiotics. I am taking them, but my cough is not getting better- once again, probably a legacy of the viral component of my illness (and sometimes, bacteria and viruses can strike together).

II am boggled by the statistics of prescribed antibiotics use in Australia. I feel that a lot of it is not the public’s fault, but also the fault of their health professionals, who may find the use of antibiotics as the quickest way to ‘treat’ their patients. I know that this can also be tempting in a dental emergency, where dentists or medical GPs may not be able to accurately diagnose or haven’t got enough time to treat the affected tooth or gums. There is also a level of mis-information amongst the health professionals regarding the most appropriate treatment of dental problems and it is always best to see a dentist when your teeth or gums give you grief. Dentists are equipped to intervene and begin appropriate treatment without medication, whereas your medical GP will only have medication at their disposal until you get to see the dentist.

As a dentist, my prescription pad lasts me almost two years. In dentistry, antibiotics are pretty much useless, the best painkiller is an over-the counter anti-inflammatory and the ‘cure’ for infections and pain is intervention (this can be an intervention by the dentist to ‘fix’ the tooth or clean the gums, or by the patient, to eliminate potential causes of pain)!

When do dentists still use antibiotics?

• Acute, painful teeth or gum infections which cause considerable swelling of the nearby area and sometimes fever – it is important to note the difference between these types of infections and just painful abscesses, localised to one tooth only and not causing any other, systemic, signs and symptoms.
• Intravenous antibiotics are used in cases where tooth or gum infections have been allowed to progress untreated and have caused facial cellulitis- swelling of the face, neck, eye area, sometimes even obstructing the airways and not allowing the sufferer to swallow– this type of antibiotic treatment requires an immediate referral to the emergency department and a hospital admission for up to 7 days!
• Acute, painful infections and swelling of the tissues around an impacted wisdom tooth, often accompanied by a constant discharge of pus from the area – while ‘wisdom teeth infections’ are self-limiting and usually die down within 7-14 days, they can actually be very severely debilitating, they can cause a mild fever, severe pain may be associated with them and they impair normal jaw function (eating, speaking, even moderate pressure on the area). In these most severe cases, a specific type of antibiotic is used for quickest results.
• Post-operative secondary infections following teeth extractions or other surgical procedures- these procedures do not automatically put you at risk of an infection, but in a small number of patients, altered healing due to internal or environmental factors, can lead to an infection of the vulnerable site. In this case, topical treatment of the site with antibacterials (iodine, eugenol, chlorhexidine) may need to be combined with systemic treatment with oral antibiotics, depending on the severity of the infection.
• Prophylactic antibiotic treatment for prevention of endocarditis infections – a small percentage of our population are at risk of bacterial endocarditis, which may be caused by a transient contamination of one’s blood stream with bacteria living on teeth and gums. There is a very small chance of this happening during some invasive dental treatment (deep scaling of teeth and gums, some local anaesthetic injections, surgical procedures and teeth extractions). The jury is out on whether antibiotic prophylaxis is as necessary as we once thought and whether the risk of contracting bacterial endocarditis exceeds the potential risk of antibiotics (allergic reactions, antibiotic tolerance). Usually, patients who are required to receive this sort of antibiotic treatment are well aware of their risk and have been advised to do so by their specialist Cardiologist or Orthopaedic surgeons.

Why is antibiotic overuse so dangerous:

• Every time you take an antibiotic, especially from the penicillin family as well as some other types, you are at risk of developing an allergic reaction. This risk increases with the frequency of antibiotics you take. Therefore, varying the type of antibiotics you take is important if you must take them close together.
• Bacteria build resistance to antibiotics (as well as other antibacterial agents). This may make less harmful bacteria more harmful as they would require more potent antibiotics to eradicate and in some cases, these types of antibiotics have not yet been developed. This resistance does not only build in the person, but also in the community. Bacteria in our environment can be exposed to traces of antibiotics from improper disposal of left-over drugs and even purposeful feeding of these antibiotics to livestock and poultry. Every jar of pills that leaves the controlled storage of a pharmacy becomes a potential risk to all of us.
• You may not respond to a course of antibiotics if it is given to you to soon after you have already finished a course. This may put you at risk of severe and untreatable infections.
• Use of the ‘wrong type of antibiotic’ can contribute to bacterial resistance, yet not help with your infection and pain. It is important that a professional sees you to diagnose the type of infection you have, in order to recommend the most appropriate type of antibiotics for you.

How we can all help protect our community from more problems:

• Visit your dental professional whenever you experience dental (or mouth) pain! Dental pain is usually a manifestation of some more widespread problem- it may not be very serious, but your dentist will be able to quickly help you resolve it either way.
• Follow strictly the advice of your GP or dentist regarding type, frequency and duration of your antibiotic treatment. 
• Try to relieve pain by using over the counter pain relief products, but follow dosage instructions! Antibiotics are not painkillers- even though the pain associated with a serious infection subsides after a few doses of antibiotics, this is a slower (and more dangerous) way to pain relief. When it comes to toothaches, try using an over the counter painkiller, such as a paracetamol or ibuprofen based treatment. Ibuprofen has been proven time and time again as the most effective pain reliever for dental pain, even more so than narcotics.
• Finish your course of antibiotics and discard any left-over medication! The best way to do this is to drop them off at your local pharmacist, rather than letting the medicine end up in landfill.
• DO NOT SELF-MEDICATE! Not all antibiotics are the same, you may have the wrong antibiotic in your cabinet and this can cause some serious side effects and contribute to the wider problem of resistance. Even if you suffered similar symptoms when these ‘old’ medicines were prescribed, you cannot be sure you are suffering from exactly the same condition. See someone before you take any medication!

Do not insist on being given pharmaceuticals for your condition. In dentistry, intervention is the only real ‘cure’ for painful conditions. Diagnosing some dental conditions can take time, but it is important that your symptoms are not distorted by overuse of painkillers and antibiotics, so trust your dentist and do not delay recommended treatment.

If you have any questions, contact us at The Dentist at 70 Pitt Street, via email: info@thedentist.net.au or by phoning (02) 92326367.