Dentaltown June 2017 - 42

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dalmacija
Member Since: 04/14/15
Post: 38 of 123

Good topic. Couple of questions. Is it accurate to say the more invasive a procedure, the
more likely an infection is to occur? Also, for those of you that do endo, I have found that antibiotics relieve pain in symptomatic patients often, even though there is no noticeable cellulitis or
pus/swelling present. What do those who won't give antibiotics do in these cases? ■
2/24/2017

Timmy G
Member Since: 04/14/02
Post: 40 of 123

The problem is patient compliance. QID drugs have the very worst compliance. Pen V is
QID, Amox can be BID or TID, depending on dose. The fewer times we ask a patient to take a
drug per day, in general, the better. The best choice is no good if patients can't or won't follow
dosing schedule. ■
2/24/2017

rockstardentist
Member Since: 10/25/13
Post: 46 of 123

I only prescribe antibiotics if preop cellulitis, pus, high risk (diabetes and old), and if we
are all going away for vacation. The only postop issues (about 3-5 a year) I've had are smokers
with dry sockets. Dry sockets aren't infections and will heal with time. I give my patients my
cell number and tell them to contact me with issues such as fever and increased swelling. The
extraction site should count as its own gigantic fistula and drain the remaining infection. ■
2/24/2017

pjmop
Member Since: 02/15/05
Post: 53 of 123

My understanding of the lit is:
Antibiotic resistance is like global warming. Any manmade attempt to stop it is futile, all we
can do is maybe slow it down. All of our "rules" have almost zero effect on resistance; antibiotics will be used mostly as they should be and sometimes when they shouldn't. Nobody is
saying that antibiotics should not be used at all, which is really the only way to have a meaningful impact on bacterial resistance. All of these "rules," which differ from practitioner to
practitioner, have little to no effect on resistance.
If the patient needs antibiotics, hit it hard (loading dose) and stop taking it when symptoms
improve (for most clinical situations, yada, yada). ■
2/24/2017

keepin it simple
Member Since: 10/13/11
Post: 59 of 123

I'm very surprised by the number of dentists on this thread who are prescribing antibiotics
after extractions. I do so only when they come in with swelling. I can't think of any instances
where a patient came in postoperatively with an infection, and I spent some time in public
health. I think that if you are having problems with this, then it is more likely that you are
misdiagnosing your postoperative complications.
I do understand the CYA reasoning behind it, though. A jury understands what an antibiotic is and it would be difficult to defend not using one if it could have made a difference. And
give them the full course if you prescribe it. That is what people on the jury have been hearing
their whole life. ■
2/25/2017

supermax
Member Since: 08/17/08
Post: 68 of 123

We as clinicians understand ethical principles of beneficence and nonmaleficence, risk
and benefits of antibiotics, etc., but in reality when the case goes south, you are under a
judicial umbrella where they give less crap about our scientific evidences. Yes, you can bring
expert witnesses in your favor but ultimately the question always asked is, "Doctor, if you
had given antibiotics, would there be a different outcome? Would Mr. or Mrs. Jones be still
alive?" In my opinion, that question alone is more than enough to win hearts of jury in a
favor of the plaintiff.
Continued on p. 44

JUNE 2017 // dentaltown.com

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