I BELIEVE it is safe to state that every infection that results in a disease in any part of the body can, at least theoretically, be prevented. As I have declared many times in this column, dental diseases, including tooth decay, are mostly infections caused by bacteria.
Now, there are two basic aspects to treating and/or controlling an infection, but ideally, it is best to prevent it first. In both cases, non-pharmacologic (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.
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 the aspects of dentistry, and when they try to treat themselves with antibiotics.
Now, 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 to solve the problem of 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.
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 (such as scraping, incision, and drainage) and supportive care (ensuring adequate rest, nutrition, and fluid intake).
Someone who acquires a swollen face because of a decayed tooth is suffering from the first stage of 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 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 anaesthetics may not work sufficiently, and so the patient would have a harrowing extraction.
The need for antibiotic prophylaxis to prevent sub-acute endocarditis in patients with rheumatic heart disease who are to undergo 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.
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 for someone to take antibiotics before having any 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-operative 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 tetracyclines, 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’s 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.