Beruflich Dokumente
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Peedikayil FC
Department of Pedodontics and Preventive Dentistry, Kannur Dental College, Kannur, Kerala State, India Correspondence: Dr. Faizal C P, Department of Pedodontics and Preventive Dentistry, Kannur Dental College, Anjarakandy, Kannur, Kerala, India 670612. E-mail: drfaizalcp@gmail.com Access this article online
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Key words
Antibiotics, antibiotic resistance, antibiotic prophylaxis, pediatric antibiotics
Introduction
Antibiotics are prescribed in dental practice for prophylactic and therapeutic reasons. Prophylactic antibiotics are prescribed to prevent diseases caused by members of the oral flora introduced to distant sites in a host at risk or introduced to a local compromised site in a host at risk.[1] In most cases, prophylaxis is used for prevention of endocarditis. Therapeutic antibiotics are prescribed, in most cases, to treat diseases of the hard and soft tissues in the oral cavity after local debridement has failed.[2] Antibiotics are prescribed for oral conditions related to endodontic, oral surgical, and periodontal manifestations. Unwarranted use of antibiotics are reported in children; [3] mostly for ear and dental infections. However, in children, increasing microbial resistance to antibiotics is a well-documented and is a serious global health concern.[3-5] Antibiotic resistance is due to inappropriate use of antibiotics by clinicians. One factor that may contribute is the inappropriate use of antibiotics in dentistry.[3] According to Dr. Thomas J. Pallasch,[6] antibiotic misuse in dentistry mainly involves prescribing them in inappropriate situations or for too long, which includes - giving antibiotics after
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a dental procedure is complete in an otherwise healthy patient to prevent an infection, which in all likelihood will not occur Using antibiotics as analgesics, particularly in endodontics; employing antibiotics for prophylaxis in patients not at risk for metastatic bacteremias Using antimicrobials to treat chronic adult periodontitis, which is almost totally responsive to mechanical treatment Using antimicrobial therapy in lieu of mechanical therapy for management of periodontitis Using antibiotics and antimicrobials chronically in periodontitis Using antibiotics instead of surgical incision and drainage of infections Using antibiotics to prevent claims of negligence The impression is that antibiotics continue to be prescribed by dentists as much or more as in the past, despite the scarcity of clinical trials demonstrating the need for antibiotics. Dentists want to make their patients well and to prevent unpleasant complications. These desires, coupled with the belief that many oral problems are infectious, stimulate the prescribing of antibiotics.[7] Textbooks, continuing education lectures, and dental school instructors have likely directed that
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antibiotics be used (albeit empirically). There is also the impression that patients get better when given antibiotics. The reality is that signs and symptoms are usually cyclical and will often improve spontaneously, then deteriorate later. The temporary improvement is likely in spite of and not because of the prescribed antibiotic. The antibiotic prescribed most frequently is penicillin or an analog, especially amoxicillin.[8-10] However, other newer-generation antibiotics are becoming more widely used because of the belief that these are more effective, and they are more expensive. This belief may be based more on marketing than on the fact, as their effectiveness has not been demonstrated in clinical trials.[11]
Antibiotics are rarely recommended for the treatment of mild traumatisms, although in cases involving important soft tissue or dentoalveolar lesions, antibiotic prophylaxis against infection is advisable Good antibiotic coverage is required in children with dental avulsion programmed for reimplantation
Endodontic diseases
Endodontic diseases involve the dental pulp and related periradicular tissues. The dental pulp is the viable connective tissue within a tooth. Its major function is to form the tooth around itself. The bacteria may reach the pulp canal through a caries lesion, via direct pulp tissue exposure after trauma, or via iatrogenic mechanisms. Penetration takes place through the dentinal tubules, dentinal cracks, or defective dental restorations. If a patient presents evidence of acute pulpitis, the required dental management should be provided (pulp therapy or extraction). Antibiotic treatment is usually not indicated if the infectious process only reaches the pulp or the immediate adjacent tissues in the absence of signs of systemic infection (i.e., fever or facial swelling).[18-21] Whether this pulpal and periapical pathosis is a true infection (an invasion of tissues by pathogenic bacteria) is debatable, Most bacteria recovered from these lesions are common facultative and obligate anaerobic oral bacteria that are relatively nonpathogenic, which have not been shown to proliferate readily in the host tissues. Rather, they seem to be able to survive best in necrotic tissues. Therefore, the damage they cause may be secondary. Furthermore, there is good evidence that these lesions are actually caused by immune mechanisms reacting to toxins and histolytic enzymes produced by the bacteria.[22] Even if this condition were indeed an infective process, the effectiveness of antibiotic therapy would be questionable. As there is no circulation within the necrotic pulp or an abscess, it is unlikely that an antibiotic would reach the bacteria in the therapeutic concentrations.
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Endodontic flare-ups
Adverse reactions (known as flare-ups) occur infrequently. Antibiotics are frequently administered to prevent adverse post-treatment sequelae of root canal treatment and oral surgery. Controlled prospective clinical trials have demonstrated that antibiotics are not beneficial in treating symptoms after root canal treatment.[15,19,22]
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invade the space between the tooth and the tissue, which may then become traumatized by occlusion from an upper tooth. This damage results in a secondary infection with pain and swelling, usually on the inside of the mandible extending posteriorly toward the pharynx. Occasionally, the infection is severe with extensive swelling to the face, and the patient is febrile. Treatment of milder forms of pericoronitis is debridement (irrigation under the flap) or removal of the soft tissue, and more serious infections require more aggressive therapy, including antibiotics.[19,23] As the offending microorganisms are from the oral cavity, the antibiotic of choice is penicillin or its derivatives.
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Antibiotic selection
Oral antibiotics that are effective against odontogenic infections comprise of penicillin, clindamycin, erythromycin, cefadroxil, metronidazole, and the tetracyclines. [8,9,11] These antibiotics are effective against Streptococci and oral anaerobes. Penicillin V is the penicillin of choice in cases of odontogenic infection. It is a bactericidal, and although the spectrum of action is relatively limited, it is appropriate for the treatment of odontogenic infections. For the prophylaxis of endocarditis associated with dental treatments, amoxicillin is the antibiotic of choice. Amoxicillin with clavulanic acid (clavulanate) can be used in certain cases, as it offers the advantage of preserving activity against the betalactamases commonly produced by microorganisms associated with odontogenic infections.[13] Clindamycin is an alternative in the case of patients who are allergic to penicillins. The drug is bacteriostatic,
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Agent
Amoxycillin Ampicillin or Cefazolin / ceftriax Cephalexin or Clindamycin or Azithromycin / clarithromycin
Children
50mg/kg 50mg/kg IM /IV 50mg/kg IM/IV 50mg/kg 20mg/kg 15mg/kg 50 mg/kg IM or IV 20 mg/kg IM or IV
although bactericidal action is clinically achieved with the generally recommended dosage. The latest generation macrolides, clarithromycin, and azithromycin can also be used if a child is allergic to penicillin. Cephalosporin and cefadroxil are additional options when a broader spectrum of action is required. Metronidazole is usually used against anaerobes, and is characteristically reserved for situations in which only anaerobe bacteria are suspected. Tetracyclines are of very limited use in dental practice, as these drugs can cause alterations in tooth color, they must not be administered to children under eight years of age, or pregnant or nursing women.[17]
with a continuous assessment of dental practices, a better understanding of the pathogenesis of these infections, including the host immune response to bacteremia, along with prospective clinical trials, which will allow for more evidence-based decisions.
References
1. Dajani AS, Taubert KA, Wilson W, Bolger AF, Bayer A, Ferrieri P , et al. Prevention of bacterial endocarditis: Recommendations of American heart association. J Am Dent Assoc 1997;277:1794- 801. 2. Fine DH, Hammond BF, Loesche WJ. Clinical use of antibiotics in dental practice. Int J Antimicrob Agents 1998;9:235-8 3. Tenover FC, Hughes JM. The challenges of emerging infectious diseases: Development and spread of multiply-resistant bacterial pathogens. J Am Med Assoc 1996;275:300-4. 4. Smith A, Bagg J. An update on antimicrobial chemotherapy, 3: Antimicrobial resistance and the oral cavity. Dent Update 1998;25:230-4. 5. American Dental Association Council on Scientific Affairs. Antibiotic use in dentistry. J Am Dent Assoc 1997;128:648 6. Pallasch TJ. Global antibiotic resistance and its impact on the dental community. Calif Dent Assn J 2000;28:215-33. 7. Hart CA, Kariuki S. Antimicrobial resistance in developing countries. BMJ 1998;317:647-50. 8. Peterson LJ. Antibiotics for oral and maxillofacial infections. In: Newman MG, Kornman KS, editors. Antibiotic/Antimicrobial Use in Dental Practice. St. Louis, Mo: Mosby; 1990. p. 159-71. 9. Sae-Lim V, Wand CY, Trope M. Effect of systemic tetracycline and amoxicillin on inflammatory root resorption ofreplanted dogs teeth. Endod Dent Traumatol 1998;14:216-20. 10. Salako NO, Rotimi VO, Adib SM, Al-Mutawa S. Pattern of antibiotic prescription in the management of oral diseases among dentists in Kuwait. J Dent 2004;32:503-90.
Conclusions
Appropriate and correct use of antibiotics is essential to ensure that effective and safe treatment is available. Practices that may enhance microbial resistance should be avoided. To improve standards of care, dentists need to be up-to-date in their knowledge of pharmacology in dental education, as well as in the continuing education,
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11. Dailey YM, Martin MV. Are antibiotics being used appropriately for emergency dental treatment? Br Dent J 2001;191:391-3. 12. Peterson L. Principles of management and prevention of odontogenic infections. In: Peterson L, Ellis E, Hupp JR, Tucker MR, editors. Contemporary oral and maxillofacial surgery. 3rd ed. St. Louis, Missouri: Mosby-Year Book, Inc.; 1998. 13. Planells-del Pozo P, Barra-Soto MJ, Santa Eulalia-Troisfontaines E. Antibiotic prophylaxis in pediatric odontology. An update. Med Oral Patol Oral Cir Bucal 2006;11:E352-7. 14. Brook I. Microbiology and management of endodontic infections in children. J Pediatr Dent 2003;28:13-8. 15. Siqueira Junior JF. Aetiology of root canal treatment failure: Why well-treated teeth can fail. Int Endod J 2001;34:1-10. 16. Dodson TB, Perrott DH, Kaban LB. Pediatric maxillofacial infections: A retrospective study of 113 patients. J Oral Maxillofac Surg 1989;47:327-30. 17. Peterson L. Principles of management and prevention of odontogenic infections. In: Peterson L, Ellis E, Hupp JR, Tucker MR, editors. Contemporary oral and maxillofacial surgery. 3rd ed. St. Louis, Missouri: Mosby-Year Book, Inc.; 1998. 18. American Academy of Pediatric Dentistry. Guideline on use of antibiotic therapy for pediatric dental patients. Chicago (IL): American Academy of Pediatric Dentistry; 2009. 19. Walton RE, Zerr M, Peterson L. Antibiotics in dentistry--a boon or bane? APUA Newsletter 1997;15:(1) 20. Johnson BS. Oral infection: Principles and practice of antibiotic therapy. Infect Dis Clin North Am 1999;134:851-70.
21. Maestre Vera JR. Treatment options in odontogenic infection. Med Oral Patol Oral Cir Bucal 2004;9(Suppl S):19-31 22. Dahlen G, Moller AJ. Microbiology of Endodontic Infections. In: Slots J, Taubman M, editors. Contemporary Oral Microbiology and Immunology. St. Louis, MO: Mosby; 1992. p. 458. 23. Delaney JE, Keels MA. Pediatric oral pathology: Soft tissue and peri odontal conditions. Pediatr Clin North Am 2000;47:1125-47. 24. Bogle RG, Bajpai. Antibiotic Prophylaxis Against Infective Endocarditis: New Guidelines, New Controversy? Br J Cardiol 2008;15:279-80. 25. American Academy of Pediatric Dentistry (AAPD). Guideline on use of antibiotic therapy for patients at risk of infection: American Academy of Pediatric Dentistry (AAPD); 2007. 26. American Academy of Pediatric Dentistry. Clinical guideline on dental management of pediatric patients receivingchemotherapy, hematopoietic cell transplantation, and/or radiation. Pediatr Dent 2005;27(suppl):170-5. 27. American Dental Association, American Academy of Orthopaedic Surgeons. Advisory Statement: Antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc 1997;128:1004-7.
How to cite this article: Peedikayil FC. Antibiotics: Use and misuse in pediatric dentistry. J Indian Soc Pedod Prev Dent 2011;29:282-7. Source of Support: Nil, Conflict of Interest: None declared.
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