Dental Antibiotics: Life-saving or Life-threatening Drugs?

Failure of antibiotics to effectively treat an infection in the mouth or elsewhere in the body can pose a life-threatening risk.

Higher in-hospital death rates associated with antibiotic-resistant bacteria have been found, yet hospitals are often reluctant to advise individuals (or their surviving families) that a resistant infection is/was implicated due to the hospital’s fear of being blamed for failing.

Sepsis and the spread of infection toward vital structures may occur rapidly for people with dental infections and these conditions can be life-threatening (see image below). Ensuring quick, appropriate and effective treatment is extremely important – for these people effective antibiotics are vital. Infections that are resistant to antibiotics pose a serious risk to dental patient safety.

Image sourced from the FDI White Paper (Reproduced with permission of Prof (Dr) M Verma and Dr S Mohanty).

Most dental infections are, however, amenable to treatment by a dental procedure (such as extraction of the tooth) to remove the source of the infection without the need for antibiotics. Dentists are surgeons, skilled and equipped to diagnose and treat acute dental conditions during urgent appointments. This highlights the importance of ensuring access to dental, rather than medical, care for people with acute dental conditions. It also reminds us of the importance of unscheduled dental appointments being long enough to provide a dental procedure rather than just an antibiotic prescription.

Optimising dental prescribing will, at the same time, increase patient safety by reducing the risk of adverse reactions. Reports have indicated that dental prescribing has contributed to the incidence of Clostridoides difficile (C. difficile) in the community. Antibiotic‐related colitis caused by C. difficile is associated with significant morbidity and can be life threatening, especially for elderly and medically compromised patients. Clindamycin is recognised as being associated with significant rates of fatal and non-fatal adverse drug reactions associated with C. difficile infections.

Increasing rates of allergy/anaphylaxis due to antibiotics have also been reported. Furthermore, incorrect labelling of patients as penicillin-allergic has been shown to result in increased morbidity, mortality and healthcare costs due to the use of broad-spectrum alternatives.

In the exercise which follows, you will be introduced to a series of real cases where patients experienced adverse reactions to antibiotics prescribed by dentists. The medico-legal outcomes are also included. For clinicians, basing decisions on relevant guidelines may be a valuable way to defend against accusations of clinical negligence.

Balancing the benefits and risks of antibiotics is an important aspect of dental antibiotic prescribing. Guidelines are available to support you in this, and as you saw last week, ensuring you use guidelines which are locally relevant to your context is really important. Prescribing in accordance with your local guidelines improves outcomes for all of us and especially for the most vulnerable in our society. Ensuring access to the right care for the right patient at the right time is an essential element of this optimisation.