I CAN readily think of two things that my patients do that upset me, and which undoubtedly have the same effect on any medical or dental practitioner. These are when they attempt to argue with me on dentistry and when they attempt to treat themselves with antibiotics.

Now there are two fundamental aspects to the control of infection: prevention and treatment. In both cases, nonpharmacologic (not using drugs) efforts are of considerable importance. In preventing, one must eliminate those factors that lead to infection: bacterial plaque, oral debris, decayed teeth, etc.

Post-surgical infections can be reduced by proper wound closure and the use of aseptic (sterile) and atraumatic (conservative) techniques. In treating infections, one must provide indicated local treatment of infection (scraping, incision, drainage etc.) and supportive care (ensuring adequate rest, nutrition, and fluid intake.)

Antibiotics are only a part of treatment for infections. The other major part is removal of the cause of the infection. Therefore, it means that 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-inflammed before instituting medication.

Someone who acquires a swollen face 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. Two things happen if an attempt is made to extract the offending tooth without first applying this treatment. 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 anaesthetics may[not] work sufficiently, so the patient would have a very painful extraction.

The need for antibiotic prophylaxis to prevent subacute endocarditis in patients with rheumatic heart disease who are to experience procedures that 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.

A 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 infection he prevents with antibiotics against the infections he causes with antibiotics due to the post-operation alterations in the normal flora of the mouth.

Most bacteria that cause dental infections are within the antibacterial spectra of penicillin G, penicillin V, phenethicillin, ampicillin, erythromycin, the tetracycline, lincomycin, clindamycin and the 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 the drug toxicity is particularly significant, as in infants, small children, the elderly, the debilitated, pregnant women, and those with liver and kidney disorders.