AT least 8 out of every 10 patients who seek dental treatment do so because of an infection. Most, if not all, expect that if a person’s face is swollen, then their dentist will automatically prescribe medication. However, an immediate extraction is often required.
There are two basic methods to control an infection: prevention and treatment. In both cases, non-pharmacological (not using drugs) efforts are of considerable importance. In prevention, one must focus on eliminating factors that lead to infection: bacterial plaque, oral debris, decayed teeth, etc.
A bacterial attack can manifest as a condition which may range from a simple carie (tooth decay) to an acute facial abscess.
The incidence of post-surgical 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).
Antibiotics are only a part of the treatment for infections. The other major part is the removal of the cause of the 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 deinfected before instituting medication.
It is common for people with facial abscesses to consult physicians rather than dentists for treatment. While the physician can only prescribe an antibiotic, the dentist can also remove the aetiologic agent of the infection (which is crucial), in addition to prescribing the appropriate antibiotic.
Someone who acquires a swollen face with a painful area because of a decayed tooth is suffering from the first stage of a periodontal abscess. It is important for the dentist to carefully examine the patient and decide whether they should perform the extraction immediately. Depending on the stage of the infection, anti-inflammatory and antibiotic therapy may 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 tissues or enter the bloodstream, thus exacerbating the situation; and, due to the acidity of the swollen tissues, the anaesthetic may not work sufficiently, resulting in a very painful extraction.
The need for antibiotic prophylaxis to prevent sub-acute bacterial endocarditis in patients with rheumatic heart disease who are to undergo procedures likely to precipitate bacteria into the bloodstream is well known.
The recommended dosage for most patients is 600,000 units of procaine penicillin G mixed with 200,000 units of crystalline penicillin G, administered intramuscularly 1 hour prior to the dental procedure and once daily for 2 days following.
A second aspect of prophylactic antibiotic coverage concerns the use of antibiotics to prevent infections after dental procedures. Studies show that, apart from rheumatic heart disease as stated above, there is no need for a person to take antibiotics before undergoing any kind of surgery, whether it is a simple extraction or periodontal surgery.
Most bacteria that cause dental infections fall within the antibacterial spectra of penicillin G, penicillin V, phenethicillin, ampicillin, erythromycin, tetracyclines, lincomycins, 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’s defences are impaired, and where drug toxicity is particularly significant, such as in infants, small children, the elderly, the debilitated, pregnant women, and those with liver and kidney disorders.
