Dentaltown December 2017 - 42

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The problem for your patient now is that there is little blood supply in any of the facial
spaces. The bacteria can go crazy there. It will certainly be an I&D procedure and I think things
will clear up, but live and learn.
1. If you are taking out root tips, go ahead and try to take them all out. Leaving one after
you "stir up the bacteria" by taking out the others is asking for trouble.
2. Always give antibiotics postop and/or preop when extracting necrotic teeth. Poking
around with your luxators, etc., will push some of the infection where it shouldn't go.
Clindamycin is the best if they can take it.
I'm sure things will work out here and only cost you a stomach lining. Good luck. ■
8/26/2017

LouisianaDDS
Member Since: 10/30/10
Post: 11 of 88

davidpalmer
Member Since: 04/14/00
Post: 12 of 88

When giving CYA antibiotics, do you give a full 10-day course or shorter? ■
8/26/2017

There were a few studies on this. It's better to hit it hard and short, rather than soft and for
an extended time. Generally, we give Clindamycin 300mg BID for five days or Pen VK 500 BID
seven days. ■
8/26/2017

extr
Member Since: 12/06/12
Post: 14 of 88

Thanks! And, yeah, trust me, I learned the lesson. When she came back the first time I gave
her Clinda 300 because she's allergic to Pen VK and sent her to ER, but that didn't work so she
came back after eight days or so with swelling and had to send her to OS again and get it drained
in the hospital. OS took out the root tip and said the infection was from that last root tip where
the PARL was; even though the socket was debrided, she just got infected. So, for next time, I
am putting them on ABX. ■
8/26/2017

alanrw
Member Since: 05/16/11
Post: 17 of 88

So, we are back to postop ABX for all extractions? I thought we were supposed to be moving
away from that model. ■
9/2/2017

saerdna123
Member Since: 02/11/15
Post: 23 of 88

In Sweden, you would lose your license if you prescribed post-extraction ABX. Postextraction, the source of infection should be gone. For severely immunodepressed patients we do
prophylactic ABX. The problem in the case presented is that the infected root was not removed.
I must ask why. Why would you leave that root? ■
9/2/2017

davidpalmer
Member Since: 04/14/00
Post: 44 of 88

I know exactly what will happen around here if I follow the ADA guidelines on postop
ABX and something goes wrong. I'll take my chances on being sued for prescribing too many
postop ABX. ■
9/3/2017

alanrw
Member Since: 05/16/11
Post: 45 of 88

Sadly, the next generation of practitioners will be saddled with infections that are immune
to ABX. Then they will be sued because "they should have known which super ABX to use." ■
9/3/2017

wizexo
Member Since: 07/19/05
Post: 50 of 88

I have been an expert witness in two cases where a dentist prescribed CYA antibiotics and
the patients developed anaphylactic reactions to the antibiotic amoxicillin both times. Neither
doctor could document infection, both doctors lost their cases. ■
9/5/2017

DECEMBER 2017 // dentaltown.com

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