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Dental use of antibiotics under fire |
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There is no scientific evidence that antibiotics ease toothache pain and swelling or speed healing after
root canal procedures. However, considerable evidence exists that they do pose a risk to the patient and
to the population as a whole, said two endodontists speaking at the American Association of Endodontists'
(root canal specialists) "56th Annual Session."
But dentists continue to routinely prescribe antibiotics, believing they are helping their patients who
often expect and want the medications, according to the two speakers, John W. Harrison, D.M.D., M.S.,
professor of endodontics, Baylor College of Dentistry, Dallas; and Richard E. Walton, D.M.D., M.S.,
professor of endodontics, College of Dentistry, University of Iowa, Iowa City.
"We have to end the era of antibiotics on demand," Dr. Harrison said. "I truly feel that dentists and
physicians believe they are doing patients a service when they give them antibiotics and feel that, even
if it does no good, it does no harm. But it's doing a lot of harm."
Discovered in 1928, and used widely during and after World War II to easily cure infections that once
claimed countless lives, penicillin and other antibiotics were hailed as miracle drugs, and many infectious
diseases were thought to be eliminated.
Yet, the extensive misuse of antibiotics for viral infections, trivial infections and non-infections has
brought about a worldwide problem of bacterial resistance, a result of genetic changes made by the bacteria
in response to the drugs. Today, bacterial strains resistant to all available antibiotics continue to be identified.
Harrison noted that "health care professionals must be educated to understand the resistance problem and
resolve to use these drugs with far greater restraint."
Although there are no statistics available specifically for dentistry, the Centers for Disease Control
estimates that more than one-third of all outpatient antibiotic prescriptions are unnecessary.
A common use in dentistry is with endodontic, or root canal, procedures, which are performed on an estimated
17 million teeth each year. An endodontic procedure is performed to save a tooth when the soft inner tissue
of the tooth, called the pulp, becomes diseased, usually by decay. This disease is sometimes considered an
infection requiring antibiotics, but it is usually a simple inflammatory response that an endodontic procedure
eliminates.
"The dentist wants to help the patient and worries about controlling an infection that might spread. But
there's no evidence that antibiotics do that; no one's done any studies," Dr. Walton said. "So the dentist
gives the patient antibiotics -- sometimes at the patient's request -- and the patient gets better. But the
patient gets better in spite of the antibiotics, not because of them."
Walton conducted one of the few clinical trials testing the effectiveness of antibiotics, given in conjunction
with root canal treatment, in treating an existing infection.
One-third of a group of patients with pain and swelling associated with a dental abscess received antibiotics,
one-third received a placebo and one-third received no medication. No significant differences in pain or
swelling were reported by the three groups after treatment, and recovery time -- about three days -- was similar
for all three.
"Many teeth that are treated with antibiotics are not infected," Walton said. "And even if there is infection
in a tooth, the antibiotics do no good because they can't reach the site of the infection because there isn't
any circulation inside a tooth with necrotic, or dead, pulp."
Antibiotics pose other risks to the patient. They can cause side effects, interfere with other medications and
even cause life-threatening reactions in people with allergies. They also are expensive. Some may cost more than
$100 for a one-week prescription.
Antibiotics may be beneficial in some dental procedures, the experts admitted, but many dentists do not perform
the appropriate assessments to make an accurate determination, said Harrison. They need to look for signs such
as facial swelling, swollen glands, fever and difficulty in opening the mouth.
"Pain is not among the criteria," Harrison stated. "Unfortunately, one of the most common drugs prescribed for
pain in this country is antibiotics."
While taking their message to dentists, the two endodontists also urged patients to use antibiotics responsibly.
"We all have to change, and the message for the public is that they have to participate in the prudent use of
antibiotics," Walton emphasized. "Don't demand antibiotics. When antibiotics are necessary, take them as directed.
Don't stop because you feel better. Don't self prescribe and don't borrow from a friend. Remember that when you
take an antibiotic, you are taking a potentially dangerous drug, and any time you use them you're contributing to
the development of resistant strains of bacteria."
SOURCE: "Just Say No to Antibiotics, Two Endodontists Urge," American Association of Endodontists, April 21, 1999.
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