Antibiotic choices for dental infection

The principle bacteria found in odontogenic infection are:
  • Streptococcus
  • Peptostreptococcus    
  • Peptococcus
  • Fusobacterium
  • Bacteroides
  • Actinomyces species
The antibiotics used to treat dental infections are:
  1. Penicillin is the drug of choice for dental infection (Penicillin G administered parenterally,  Penicillin V delivered orally)
  2. Erythromycin is a second choice and will become the first selection in patients who have an allergic reaction to penicillin.
  3. Cephalosporins can be used if Erythromycin cannot be used, but their cost is higher than other groups and lack of advantage over other drugs. 
  4. Clindamycin administered orally or lincomycin administered parenterally are for treatment of bone and anaerobic infections. Clindamycin is very efficient against all odontogenic pathogens, but its potential gastrointestinal toxicity makes the drugs unfavorable to use.
  5. Tetracycline is the third choice for dental infections for patients over the age of 13. However, they are useful in the treatment involving gums such as acute necrotizing ulcerative gingivitis 
  6. Metronidazole (Flagyl) has excellent activity against anaerobic gram-negative bacilli, it is only moderately effective against facultative and anaerobic gram-positive cocci, and should not be used alone in the treatment of acute odontogenic infections.
  7. Streptomycin and Vancomycin are used prophylactically for the prevention of infective endocarditis in patients with prosthetic heart valves.
  8. Nystatin is a first-choice for treatment of oral Candida infections
  9. Ketoconazole, an antifungal drug, may be used for monilial infections of the oral cavity refractory to Nystatin
All antimicrobial agents mentioned may cause adverse reactions of varying degrees of severity. Most orally administered antibiotics to some degrees cause gastrointestinal disturbances to fatal anaphylactic shock and development of resistance. The penicillin, followed by the cephalosporin and tetracycline, are most frequently implicated in these reactions.

For detailed side-effects of each drug see "Drugs in Dentistry."

It is important only to prescribe antibiotic for a condition that is medically necessary. According to the recent data published by Centers for Disease Control and Prevention (CDC), every year antibiotic resistance is rising due to over-prescription of antibiotics. Soon there won't be any antibiotic to combat with bacteria efficiently.

Dentists play a significant role in limiting over-prescription of antibiotics by:
  • Not prescribing antibiotics before the presence of infection, i.e., before or after impacted healthy wisdom tooth extraction without pericoronitis
  • Not prescribing antibiotics to oral ulcers that didn't have a secondary infection, e.g., aphthous ulcers, dry socket
  • Operative intervention for dental disease, e.g., root canal therapy, incision drainage rather than antibiotic prescription 
  • Prescribing antibiotics at the correct frequency, dose, and duration 
  • Not prescribing antibiotics based on non-clinical factors, before assessing the dental problems
  • Not prescribing antibiotics for condition that caused by virus, e.g., herpes simplex
  • not prescribing prophylactic antibiotics before dental procedures to medically fit patients