Antibiotic Stewardship

In the past, dentists routinely prescribed antibiotics to prevent any chance of infection and ensure patients' comfort; however, now that we better understand their inherent potential for harm, guidelines for prescribing have moved from a "just in case" approach to "only when absolutely necessary." This month's cover story examines the risks associated with the administration of antibiotics and discusses the current guidelines for their use in various clinical situations.

Over the years, my antibiotic prescribing practices have changed dramatically. We used to automatically prescribe them for patients with minor issues, such as an abscess, because the nature of infection and the potential for adverse effects from antibiotics were poorly understood. We simply wanted to prevent pain; we didn't know that we could actually be causing issues for our patients, such as C. difficile infection, and contributing to a global antibiotic resistance that ultimately weakens the effectiveness of these medications when they are truly needed.

Regarding infections of endodontic origin, I will prescribe antibiotics after delivering definitive treatment, but not in the absence of serious symptoms, such as fever and significant swelling. Alternatively, if one of my patients has undergone joint replacement and may be at elevated risk for developing infection from a dental procedure, I communicate with his or her orthopedist. Whatever the individual need, I believe that this decision-and the prescribing-are in the wheelhouse of the treating physician. Given our increased awareness of the dangers, it's more important than ever for dentists to follow current prescribing guidelines and join the healthcare community at large in its effort to improve patient safety and combat resistance globally.

I've been attending midwinter dental meetings and trade shows for the past 34 years. With COVID-19 limiting our potential for in-person education this year, Inside Dentistry can help fill the void. On p. 40, we've aggregated descriptions and links to 10 of our most popular CE courses, and even more great courses are available at id.cdeworld.com.

Robert C. Margeas, DDS
Editor-in-Chief, Inside Dentistry
Private Practice, Des Moines, Iowa
Adjunct Professor
Department of Operative Dentistry
University of Iowa, Iowa City, Iowa
rmargeas_eic@aegiscomm.com