Dr Rick Bonomo DMD Clinical Subjects





Antibiotics and Dentistry

By Dr. Rick Bonomo


Infections have probably killed more human beings than any other force. Be it by infant mortality or the dying man's friend (pneumonia) infections have always been with us.
Paleontologist Steven Jay Gould argues that bacteria are the dominant life form on the planet! Man has had to accept bacteria as part of not only death but life. Research has indicated that some of the components of our cells were once separate organisms that became so close to us that they actually became us!
Nature is filled with instances of different life forms intimately co-existing, in fact it's the rule rather than the exception. Many animals can only digest their food with the help of enzymes produced by bacteria in the digestive system. Bacteria live in and on our bodies and protect us by preventing other more dangerous organisms from infecting us. These organisms are called our normal flora - like our own private garden.
When the delicate balance between symbiots is disrupted is when disease occurs. There was little we could do but depend on our highly evolved immune system to save us until we discovered Penicillin and the age of the miracle drugs was born.
Although our immune system and the modern pharmaceutical industry are quite competent- the bacteria are better. Bacteria can develop resistance to any antibiotic in short order. It takes modern pharmaceutical companies years and millions of dollars to develop the next generation antibiotic. It may take the bacteria one infection to develop immunity.
Successful treatment is also dose related. Whereas treatments used to be successful with 100,000 units of penicillin, it is now common to give doses as high as 3 million units of penicillin - four times a day! Unfortunately most antibiotics are not this safe and the toxic dose may be reached before the infection is cured.
You may have heard the phrase "What doesn't kill me - makes me stronger." This is the bacteria's theme song. You may also recall your doctor saying, "Take the antibiotic pills as directed until all the pills are gone". Unfortunately, after half the prescription is gone - we get lazy and forgetful, "But it doesn't hurt anymore", we say.
The best chance to eliminate the greatest number of bacteria is to complete the course of treatment. What happens when we take half a course is - the bacteria develop resistance.
Another way to induce bacterial resistance is to take antibiotics frivolously -such as when we have a common cold - always caused by a virus and not affected by antibiotics.
By repeatedly exposing bacteria to our weapons - it gives them more opportunities to develop resistance. And this is precisely what has happened. We now have tuberculosis that is resistant to all known antibiotics and other bacteria are also escaping our ability to deal with them.
All of the above is a description of the environment in which the following takes place:
I am often asked when planning surgery whether an antibiotic will be given before surgery. There are a few cases when this is indicated but generally the answer is no. The current practice in this office is to not give antibiotics "prophylactically".
The literature supports preventive antibiotic treatment only when the patients defenses are compromised in some way such as immune deficiency states, Diabetes Mellitus or the presence of a heart murmur, prosthetic heart valve, or prosthetic joint. But not every patient requires antibiotics.
In these cases the probability of infection is so high and the consequences of that infection potentially so deadly that antibiotics are recommended.
The protocols for modern surgical prophylaxis dictate that the antibiotic be given in a large dose at the time of surgery and one or no postoperative doses. This is based on the theory that the antibiotic should be in the blood when the bacteria are in the blood. The antibiotics are not given preoperatively nor postoperatively so as to not induce resistant strains.
These issues have been addressed for years by the American Heart Association, The American Dental Association, Orthopedic societies, and just about every other organization that has an opinion has published it.
The American Heart Association has taken the lead in establishing guidelines for the administration of antibiotics for heart patients under going surgery of the mouth, respiratory tract, and genitourinary tracts because this is when the serious infections have been observed. Specifically: sub-acute bacterial endocarditis - or infection of the inside of the heart.
The most recent guidelines were published in the Journal of the American Medical Association (JAMA) June 11, 1997 and reported in the Journal of the American Dental Association.
An expert panel of dentists and orthopedic surgeons from the American Dental Association and the American Academy of Orthopedic Surgeons recently reviewed all available data regarding prophylaxis for prosthetic joint patients undergoing dental treatments. This statement was published in the Journal of the American Dental Association in July, 1997.
With the growing concern over antibiotic resistance, the potential risks as well as benefits of antibiotic use must be considered. Risks include toxic reaction to the drug, allergic reaction, and the selection and transmission of bacterial resistance as described.
The above bodies distribute these advisory statements to delineate the limited circumstances in which prophylaxis should be used. Your dentist and physician should advise you of all reasonable treatment options.






Copyright by Dr. Rick Bonomo