so today we're going to cover all the essentials that you need to
know about prescribing antibiotics as a dentist
okay so we're not going to go into detail on how antibiotics work and the different types
but instead we'll cover the basic essentials that you need to know we'll go through each disease
where you might need to prescribe antibiotics and for each one we'll mention when you should refer
them to a e instead when you should prescribe antibiotics and what you should prescribe
the first one i want to start with is a dental infection or abscess it could be an acute apical
abscess chronic apical abscess or a lateral periodontal abscess these can sometimes present
as large swellings and at times the infection or the swelling might be so severe that you might
need to send them to a e so the times when you should refer them to any are number one if
they have a temperature higher than 39.5 degrees celsius number two if there are signs of spreading
cellulitis and number three very severe swelling now some of the ways that you can check this out
is the patient struggling to swallow or stick their tongue out is the swelling compromising
the airway or is the patient struggling to close the eye and another final way you can check this
out is by trying to palpate the lower border of the mandible if you can't palpate it they
need to go A&E in all of these cases you should still try to establish drainage but regardless of
whether you're successful or not you still need to send them to a e because they might need iv
antibiotics now the best way to do this is to call your local hospital switchboard and ask to speak
to the max facts on call you could then describe the situation and suggest iv antibiotics if they
agree you can send the patient to a e with a brief letter of their history this way once the patient
gets to a e the max facts on cord already be aware of the situation and they can get bleeped when the
patient arrives okay so we got all the severe cases out of the way if the patient doesn't need
to go any when would you prescribe antibiotics for acute or chronic or periodontal abscesses
most of the time removing the source of the infection can be enough but you should prescribe
antibiotics as an adjunct treatment when there is systemic involvement like a high temperature or
malaise and when the infection is spreading so for example a large swelling lymph node involvement
or cellulitis in all of these cases you should try and establish drainage and also prescribe
antibiotics the first line antibiotic for acute chronic or periodontal abscesses is amoxicillin
you would prescribe 500 milligrams to be taken three times a day for five days
if the patient has a penicillin allergy the second line antibiotic is metronidazole
and you would prescribe 400 milligrams three times a day for five days in very rare cases you might
get a patient that's allergic to penicillin and takes warfarin which is a contraindication for
metronidazole in that case you should speak to a specialist before prescribing clindamycin or
clarithromycin because the antibiotics contribute to antimicrobial resistance
and could cause bowel infections okay so next on the list is pericoronitis and necrotizing
ulcerative gingivitis and i put these two together because the antibiotics you would prescribe are
the same but first referring to any pericoronitis is the one that you might need to actually refer
to any and the signs for are exactly the same as the ones we discussed before for abscesses you
just have to keep in mind because pericoronitis is at the back of the lower arch there's a lot
of spaces it can spread to so sometimes you can see some very large swellings so watch out for
all the signs that i mentioned before so when would you prescribe antibiotics well in mild
cases of necrotizing ulcerative gingivitis local measures like a scale or oral hygiene instructions
might be enough but in severe cases you would always prescribe it as an adjunct treatment
for pericoronitis as well you should always try to control it with local measures like debridement
and irrigation good oral hygiene and Corsodyl mouthwash but you should prescribe antibiotics
if there is systemic involvement or spreading infection as we talked about before so the first
line choice of antibiotics for pericarditis and necrotizing ulcerative gingivitis is metronidazole
because of the gram-negative anaerobic nature of these infections you would prescribe metronidazole
400 milligrams to be taken three times a day for three days if the patient can't take metronidazole
because they take warfarin or if they're pregnant or if they have an alcohol dependency
you would prescribe amoxicillin 500 milligrams to be taken three times a day for three days
so the ones we've covered so far the most common ones that you'll be dealing with
but there are still some others we need to go through firstly antibiotic prophylaxis for
patients who are at risk of infective endocarditis it used to be that you would prescribe antibiotics
before dental treatment for a wide variety of heart conditions but in 2008 nice introduced new
guidelines which made it so that it was only recommended for specific cases and these are
patients with a prosthetic valve patients with a previous episode of infective endocarditis
patients with a congenital heart disease patients with an acquired valvular heart
disease with stenosis or regurgitation and patients with hypertrophic cardiomyopathy
now you wouldn't prescribe antibiotics for any dental treatment that these patients have only
invasive ones and i'll put a screenshot of the table on the screen so you can see so if you're
about to do invasive dental treatment on one of these high risk patients you should contact their
cardiologist to see if they recommend antibiotic prophylaxis if they do they'll most likely ask
you to prescribe three grams of amoxicillin to be taken an hour before the treatment if the
patient is allergic to penicillin and then 600 milligrams of clindamycin an hour before will do
now another scenario where you might want to prescribe prophylactic antibiotics is when
you re-implant an avulsed permanent tooth the IADT released a new set of guidelines
this year and it recommends amoxicillin as the first land antibiotic but oddly it
doesn't mention any dosages or anything but the American academy of pediatric dentistry
published a paper which mentioned a standard 500 milligram amoxicillin course for seven days
and for children 50 milligrams per kilogram per day divided in doses every 8 hours
and finally the last one we wanted to talk about is sinusitis this was another
one where antibiotics were more commonly prescribed for but the new guidelines say
to only prescribe antibiotics if there is persistent symptoms or purulent discharge
lasting at least seven days or severe symptoms they advise amoxicillin 500 milligrams to be taken
three times a day for seven days or if they're allergic to penicillin to take doxycycline 100
milligrams where you take two capsules on the first day followed by one capsule for
the next six days for these patients you should also advise menthol steaming
painkillers and over-the-counter decongestants and that was all for antibiotics if we didn't
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