I HAVE no doubt that every dentist becomes annoyed when their patients do certain things. Now there are two things that patients do that upset me. They are, when they attempt to argue with me about aspects of dentistry and when they attempt to treat themselves with antibiotics.

There are two basic aspects to the control of infection: prevention and treatment. In both cases, nonpharmacologic (not using drugs) efforts are of considerable importance. In prevention, one must be concerned with eliminating those factors that lead to infection: bacterial plaque, oral debris, decayed teeth etc. The incidence of postsurgical infections can be reduced by proper wound closure and the use of aseptic (sterile) and atraumatic (conservative) techniques. In the treatment of infections, one must provide indicated local-treatment (scraping, incision, drainage etc.) and supportive care (ensuring adequate rest, nutrition, and fluid intake).

Antibiotic is only part of the treatment for infections. The other major part is the removal of the cause of infection. It means, therefore, that in order to solve the problem of a dental abscess the first step is to decide if the condition is acute or chronic. Acute abscesses must be drained and/or de-inflamed before instituting medication. Someone who acquires a swollen face with a painful area as a result of a decayed tooth is suffering from the first stage of a periodontal abscess. Anti-inflammatory and antibiotic therapy should be prescribed for at least five days. If an attempt is made to extract the offending tooth without first applying this treatment, two things may happen. The pus surrounding the tooth may disseminate to adjacent tissue or enter the bloodstream, thus exacerbating the situation. Secondly, due to the acidity of the swollen tissues, the anaesthetic may not work sufficiently and so the patient would have a very painful extraction.

The need for antibiotic prophylaxis to prevent sub-acute bacterial endocarditis in patients with rheumatic heart disease who are to experience procedures which are likely to precipitate bacteria in the bloodstream is well known. The recommended dosage for most patients is 600,000 units of procaine penicillin G mixed with 200,000 crystalline penicillin G administered intramuscularly one hour prior to the dental procedure, and once daily for two days following that.

The second aspect of prophylactic antibiotic coverage relates to the use of antibiotics to prevent infections after any dental operation. Studies show that apart from rheumatic heart disease, as stated above, there is no need of someone to take antibiotics before having any type of dental surgery, whether it is a simple extraction or periodontal surgery. The dentist must balance the infections he prevents with antibiotics against the infections he causes with antibiotics due to the postoperative alternations in the normal flora of the mouth. The term “drug abuse” does not only imply cocaine addicts but doctors who prescribe drugs to their patients indiscriminately.

Most bacteria that cause dental infections are within the antibacterial spectra of penicillin G, penicillin V, phenethicillin, ampicillin, erythromycin, the tetracyclines, lincomycin, clindamycin and cephalosporins.

Penicillin is the safest and most powerful antibiotic for severe infections. However, it should not be abused. It should only be used in severe infections, when the body defences are impaired, where drug toxicity is particularly significant, as in infants, small children, the elderly, the debilitated, pregnant women, and those with liver and kidney disorders.