Responsible Use of Antibiotics in Dentistry with Dr. Nicholas Makhoul
Dr. Nicholas Makhoul spoke with Dr. John O’Keefe about the importance and incidence of antibiotic prophylaxis. Highlights Dr. Nick Makhoul recently spoke at the Annual Spring Meeting in Toronto in May as part of a panel. His lecture focused on antibiotic usage for common oral surgery procedures, specifically the use of antibiotic prophylaxis for the removal of wisdom teeth, alveolar bone grafts and dental implant placement. Research has shown that most practitioners when prescribing prophylactic antibiotics are not timing the dosing properly. In order for the antibiotic to prevent and reduce post-surgical infection rates, they must be taken by the patient 30-90 minutes prior to the surgical incision (on average 60 minutes). It is important to remember that prophylactic antibiotics should be prescribed based on the degree of difficulty of the surgical procedure, the risk of post-operative surgical site infection as well as individual patient considerations. The recommended prophylactic regimen is the same used to prevent endocarditis:
- 2 g p.o. Amoxicillin 60 minutes before the procedure
- 600 mg p.o.Clindamycin 60 minutes before the procedure (for patients allergic to penicillin)
It has been commonplace for practitioners placing bone grafts to routinely prescribe a course of antibiotics post-operatively for 7-10 days. Presently, it is felt that it is more judicious and effective to give one pre-operative dose to decrease the risk of infection. However, it is important for clinicians to treat any infection in a patient who presents with a pre-operative infection prior to alveolar surgery. Signs & Symptoms of a Surgical Site Infection:
- Surgical site infection usually takes ~7-10 days to develop
- Warmth and pain in the area of the surgery
- Foul taste in the mouth lasting longer than the first few days
- Recurrence of swelling after the initial post-operative swelling has subsided
Watch the short version of the video interview Watch the full video interview Additional Resources
- Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications
- Ren, Y.-F., & Malmstrom, H. S. (2007). Effectiveness of Antibiotic Prophylaxis in Third Molar Surgery: A Meta-Analysis of Randomized Controlled Clinical Trials. Journal of Oral and Maxillofacial Surgery, 65(10), 1909–1921.