Antibiotics or No Antibiotics, That Is the Question: An Update on Efficient and Effective Use of Antibiotics in Dental Practice
Abstract
:1. Introduction
2. Types of Antibiotics and Administration Protocols
3. Antibiotic Prophylaxis for Dental Procedures in Patients at Risk for Infection
4. Chlorhexidine
5. Use of Antibiotics in Dentistry
5.1. Antibiotics in Endodontics
5.2. Antibiotics in Periodontology
5.3. Antibiotics in Extractive Oral Surgery
5.4. Antibiotics in Implantology and Regenerative Techniques
6. Conclusions
7. Highlights
- ➢
- Antibiotics in dental practice can only be used in selected situations, for specific patients and using appropriate techniques, generally with short preoperative schemes. Postoperative schemes can be adopted for long-duration surgeries with osteotomy or for antibiotic therapies in complicated abscesses.
- ➢
- Antibiotics must be considered as pharmacological adjuvants that cannot cover or replace medical intervention.
- ➢
- Correct management of oral bacterial load/contamination with elimination of infective foci, dental biofilms and good periodontal health, along with atraumatic surgical techniques, are the main factors influencing the success rates of interventions, rather than antibiotic administration.
- ➢
- Antibiotics are not able to reduce clinical symptoms such as pain and swelling.
- ➢
- Routine tooth extractions in healthy patient can be executed without antibiotics, with the same incidence of complications.
- ➢
- Implant insertion can be managed with short preoperative AP to reduce risk of failure, whilst no beneficial effects are obtained with postoperative regimen schemes.
- ➢
- Chlorhexidine must be used properly and for short periods due to the possibility of inducing cross-resistance to antibiotics.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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First Choice |
---|
Amoxicillin = 1 g with oral administration (per os)/8 h for 7 days or more |
Amoxicillin + clavunalate = 1 g per os/8–12 h for 7 days or more |
Amoxicillin (500 mg per os/8 h) + metronidazole (500 mg per os/ 8 h) = AP for patients at risk of bisphosphonate-related osteonecrosis of the jaws (BRONJ) or medication-related osteonecrosis of the jaws (MRONJ); AT in combination with nonsurgical treatment for aggressive periodontitis |
Patients Allergic to Betalactams |
Claritromicine= 250–500 mg per os/12 h for 7–14 days |
Azitromycine= 500 mg per os/24 h for 3 days or more Clindamycin= 300 mg/6 h for 7–14 days |
Posological Adjustments in Children (Weight < 20 Kg and/or Age < 10 Years) |
Amoxicillin = 12.5–25 mg/Kg/8 h |
Macrolids = 15 mg/Kg/24 h Clindamycin = 5 mg/Kg/6 h |
First Choice |
---|
Amoxicillin = 2 g with oral administration (per os)/1 h before procedure |
Amoxicillin + clavunalate = 2 g per os/1 h before procedure |
Patients Allergic to Betalactams |
Macrolides = 500 mg per os/1 h before procedure |
Clindamycin = 600 mg per os/1 h before procedure |
Posology Adjustments in Children (Weight < 20 Kg and/or Age < 10 Years) |
Amoxicillin = 50 mg/Kg |
Macrolides = 15 mg/Kg Clindamycin = 20 mg/Kg |
● Patients at high risk of infective endocarditis |
● Immunocompromised patients with leukopenia <3.500 u/mm3 or seral levels of immunoglobulins <2 g/L |
● Patients ASA 3,4,5 |
● Patients undergoing to high dose irradiation on jawbones, or to assumption of amino-bisphosphonates/denosumab |
● Patients with joint prosthesis with high risk of adverse outcomes |
● Patients undergoing prolonged and extensive surgical interventions |
● Patients undergoing surgery in infected sites |
● Patients undergoing insertion of fixtures and/or biomaterials |
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Buonavoglia, A.; Leone, P.; Solimando, A.G.; Fasano, R.; Malerba, E.; Prete, M.; Corrente, M.; Prati, C.; Vacca, A.; Racanelli, V. Antibiotics or No Antibiotics, That Is the Question: An Update on Efficient and Effective Use of Antibiotics in Dental Practice. Antibiotics 2021, 10, 550. https://doi.org/10.3390/antibiotics10050550
Buonavoglia A, Leone P, Solimando AG, Fasano R, Malerba E, Prete M, Corrente M, Prati C, Vacca A, Racanelli V. Antibiotics or No Antibiotics, That Is the Question: An Update on Efficient and Effective Use of Antibiotics in Dental Practice. Antibiotics. 2021; 10(5):550. https://doi.org/10.3390/antibiotics10050550
Chicago/Turabian StyleBuonavoglia, Alessio, Patrizia Leone, Antonio Giovanni Solimando, Rossella Fasano, Eleonora Malerba, Marcella Prete, Marialaura Corrente, Carlo Prati, Angelo Vacca, and Vito Racanelli. 2021. "Antibiotics or No Antibiotics, That Is the Question: An Update on Efficient and Effective Use of Antibiotics in Dental Practice" Antibiotics 10, no. 5: 550. https://doi.org/10.3390/antibiotics10050550