Dentaltown June 2017 - 41

I prescribe more often than literature suggests mostly because of one time a patient ended up
in the hospital. Additionally, I deal with many who "haven't been to a doctor in years" or lie to
save money or get out of pain and I'm sure there's an uncontrolled diabetic or two in the mix. ■

johnnyreed
Member Since: 03/14/15
Post: 20 of 123

2/19/2017

Another thing that will really save you in an adverse event is a really good informed-consent
form that spells all of this out. ■

mouthjanitor
Member Since: 03/11/15
Post: 24 of 123

2/19/2017

If the patient goes south and you did not give antibiotics, don't expect a jury to see it your
way. They are not concerned about ADA guidelines to prevent abuse of antibiotics. All they
see is a distraught family and a "careless" dentist who could've given antibiotics and Mr. Jones
would still be alive. I could win the prosecutor's case and I'm not a lawyer. All your arguments
were spelled out in court. Whoever said it was right or fair? Nearly every extraction in my office
gets antibiotics and intense postop instructions. ■

davidpalmer
Member Since: 04/14/00
Post: 25 of 123

2/19/2017

I take out a lot of teeth in my practice and during my years in the IHS, prisons and
Appalachia. I do only thirds one day a week. I've seen three true postop infections in eight years
where they were not swollen coming in. I don't do routine follow-ups. I do a detailed sit-down
on what to expect 1-3 days after the ext and we look each other in the eye and I make sure they
get it. I do a care call at 24 hours and they know they can call/text me if problem arises after that.
I use antibiotics when:
1. Moderate/severe swelling is coming in.
2. Significantly med is compromised.
3. There is a long surgical time.
4. My spidey sense is tingling.
The head and neck have a massive blood supply so that helps us all. But if they come back
with pain or worry about infection, they get antibiotics pronto. ■

TonyCannoli
Member Since: 06/29/06
Post: 32 of 123

2/19/2017

There are a couple of ways you can look at it. I've been a practicing OMS for almost
20 years-I never prescribe routine postoperative antibiotics. I rarely see patients with serious postoperative infection. For thirds, I routinely Rx chlorhexidine and have few dry-socket
problems. If I see something at the time of surgery that looks suspicious, I will cover, but cover
appropriately. Any foreign material placed (grafts, membranes, etc.) patients automatically get a
five-day course of antibiotic coverage.
But here's the other thing to consider: Most antibiotics these days have been so overused and
abused that there's so much resistance they really don't work. So honestly, if you think you're
doing somebody a good deed by Rx'ing Amox 500 tid x 5-7d, chances are you're probably trying
to slay a dragon with a pea shooter. And if folks are allergic to penicillin, most folks seem to
gravitate to Clinda but so many are afraid of C. diff. that they never Rx enough while they're not
really aware that resistance to Clinda is a big problem too.
So, I kind of think of it as you're just doing something to make you think you're doing
something. If you're getting a lot of postop infections, then you should begin to ask yourself why.
Is it something I'm doing (poor surgical technique, not enough irrigation to clean out debris,
not identifying situations that demand antibiotic coverage, etc.) or is it really the patient (DM2,
tobacco use, etc.)? ■

dmlddsoms
Member Since: 02/21/17
Post: 35 of 123

2/24/2017

dentaltown.com \\ JUNE 2017

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