Antibiotic Stewardship

As part of our continuing education efforts within the practice, our most recent topic was antibiotic stewardship. This topic refers to the appropriate use of systemic antibiotics in the treatment of dental infections and prophylaxis. The overuse of antibiotics carries the risk of allergic reaction, anaphylaxis and the development of resistant bacteria that may harm the patient in any future infections.

We also use antibiotics in the role of premedication in one of two specific situations; prevention of bacterial cardiac (heart) endocarditis and orthopedic joint replacement. Both of these conditions are complex and have many variables in deciding as to when there is appropriate use in their indications. But recent literature has come out that may affect the recommendations that you hear from your dentist, cardiologist or orthopedic surgeon. In the January 2023 edition of the Journal of the American Dental Association, there is an investigation titled, “Quantifying the risk of prosthetic joint infections after invasive dental procedures and the effect of antibiotic prophylaxis”. The conclusions of the authors (Thornhill, M.H. et. al.) was that there was no significant association between invasive dental procedures and late periprosthetic joint infections and that there was no effect of antibiotic prophylaxis coverage of invasive dental procedures in the reduction of late periprosthetic joint infections. The practical implication here is that in the absence of benefit, the continued use of antibiotic prophylaxis poses an unnecessary risk to patients from adverse drug reactions and to society from the potential of antibiotic prophylaxis to promote development of antibiotic resistance. Dental antibiotic prophylaxis use to prevent joint infection should, therefore, cease.

At Spring Lake Dental Group, we pride ourselves on being lifelong students. This is a complex issue and deserves a serious conversation. We are always available to you to have that discussion. But prudent use of antibiotics is going to be a topic that will impact all of society and we would like to think that our use is evidenced based with appropriate follow up. Come in and let’s have that discussion.