Antibiotics for Dental Use Contributing to SuperBugs

Research has shown that antibiotics prescribed by dentists for various dental surgeries and procedures may contribute to the development of Clostridium difficile (C. diff), a serious and potentially deadly infection with severe diarrhea. A common questions many patients ask if they are having their wisdom teeth out includes if they should take antibiotics. This topic has been covered before on teethremoval.com, for example see http://www.teethremoval.com/antibiotic_resistance.htmlhttp://blog.teethremoval.com/patients-perception-of-antibiotic-need-after-teeth-removal/,and http://blog.teethremoval.com/the-effect-of-a-single-dose-of-antibiotics-prior-to-wisdom-teeth-surgery/. The current guidance seems to recommend a single dose of antibiotics prior to surgery for high risk patients for postoperative infections but other healthy patients do not need any antibiotics prior to surgery.

During the annual ID Week2017, which is an annual meeting of the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA) and the Pediatric Infectious Diseases Society (PIDS), researchers presented their findings on antibiotic prescriptions leading to C. diff. The researchers discussed work by the Minnesota Department of Health (MDH) which tracked community-associated C. diff infections, meaning those that did not occur in a hospital or nursing home setting, in five different counties in Minnesota. In the study, MDH researchers interviewed 1,626 people with community-associated C. diff between 2009 and 2015. During the six-year study, it was determined 15% of those with C. diff who had taken antibiotics had them prescribed for dental procedures. The study found patients who were prescribed antibiotics for dental procedures were older and often received clindamycin, an antibiotic that is associated with C. diff infection. Of those patients who had received antibiotics for a dental procedure, 33% had no mention of antibiotics in their medical charts. During  medical appointments, patients should bring up dental visits and medications as it may not be in their chart. Healthcare providers should also make an effort to ask patients about dental visits and medications.

Dentists write more than 24.5 million prescriptions for antibiotics a year. Dentists appropriately prescribe antibiotics in some situations, such as to treat infections stemming from a tooth abscess. Some dentists prescribe antibiotics prophylactically before a dental procedure to prevent a heart infection in patients with heart conditions, or to prevent an infection of an artificial joint, such as a knee or hip replacement. A prior study by MDH found 36% of dentists prescribed antibiotics in situations that are generally not recommended by the American Dental Association (ADA). These dentists further reported challenges to making proper antibiotic prescribing decisions, including confusion about or conflicts among guidelines. The ADA no longer recommends preventive antibiotics in many cases it used to. Recommendations today highlight that the risk of taking antibiotics is greater than the risk of an infection in many cases. In addition, inappropriately using antibiotics can lead to drug-resistant bacteria, which are very tough to treat and a public health threat.

Antibiotics kill good and bad bacteria in the gastrointestinal system. Killing the good protective bacteria allows for the potential growth of C. diff bacteria which can even occur after just one dose of antibiotics. While the ADA has expressed a commitment to antibiotic stewardship, a 2015 MDH survey of dentists found less than half are concerned about adverse drug effects, antibiotic resistance, or C. diff during their decision making process to prescribe antibiotics. It is possible many of these dentists are not aware that their patients develop C. diff. Thus promoting more communication between dental and medical providers and improved history taking can help. The bottom line is that if you are having any dental procedures done, be mindful that nowadays in many cases having an antibiotic recommended to take prior to the procedure is no longer the case.

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