Review of Current Guidelines for Prophylactic Antibiotic Prescriptions
Antibiotic prophylaxis prior to dental procedures is common and prescribing rates among dentists has remained steady, despite a decrease in overall antibiotic prescriptions nationally.44 Guidelines regarding antibiotic prophylaxis for dental procedures in patients with certain medical conditions has evolved over time. Previous guidelines have recommended that patients with certain systemic conditions (i.e., recent prosthetic joint replacement, cardiac valvular incompetency) receive antibiotics prior to dental care. In these cases, these patients were considered at an increased risk for bacteremia during dental procedures leading to distant site infections (e.g., infective endocarditis and prosthetic joint infections). Updates to previous guidelines have significantly narrowed the scope of patients who are recommended to receive antibiotic prophylaxis for routine dental care.4 These revisions were meant to reduce adverse events associated with antibiotic use, to reflect the low levels of evidence of the effectiveness of antibiotic prophylaxis to reduce distant infections, and a lack of demonstrable association between endocarditis, prosthetic joint infection and dental treatment.45-48 Since patients demonstrate transient bacteremia after activities of daily living, including mastication and oral hygiene measures, that are in proportion to their levels of gingival inflammation and plaque deposits, dental treatment is unlikely to add significant additional risk for such patients.49-51
Furthermore, it has been common practice to utilize antibiotic prophylaxis prior to invasive surgical dental procedures, such as tooth extraction and endosseous dental implant placement.52,53 The rationale for such treatment has been the reduction of post-operative infections and adverse healing events as well as a reduction in the contamination of dental implant surfaces during dental implant placement.52-56 Recently, however, the appropriateness of this practice has been questioned as the overuse of antibiotics and the untoward adverse reactions and antibiotic resistance have become more of a public health concern.57 It has also been noted that many surgical patients who may benefit from a single dose of antibiotic pre-procedurally, receive an additional post-procedural prescription that may be unnecessary.4 The goal of dental practitioners should be to most appropriately dispense antibiotics so that they improve outcomes while also reducing the risk of harm to patients and communities.