Prophylactic use of antibiotics in dentistry
The indications for the use of antimicrobials in dentistry are (i) treatment of acute infection and (ii) prophylaxis against infection (single-dose prophylaxis and perioperative prophylaxis). Antibiotic prophylaxis refers to the administration of antimicrobials in situations where there is no actual infection, but where the risk of infection is substantial, for example, in the case of invasive procedures at contaminated sites. The aim of antibiotic prophylaxis is to prevent the development of either systemic or local infection complications. Severe underlying diseases including immunosuppressive illnesses and their treatment have been shown to predispose the patient to systemic odontogenic infections. Manipulation of infected oral tissues, such as measurement of periodontal pockets, calculus removal and tooth extraction, in particular, is known to cause bacteraemia. Therefore, antibiotic prophylaxis is used in connection with invasive procedures in infected areas in patients at elevated risk for endocarditis or other systemic infection complications. In addition, preoperative single-dose prophylaxis is also appropriate in generally healthy patients when treating infection foci surgically and if antimicrobial treatment is needed. Amoxicillin is the first-line drug of choice, due to its appropriate antimicrobial spectrum and especially its excellent absorption.