Why prescription of antibiotics by dentists has been a major concern

Prescription of antibiotics or anti-inflammatory medicines by dentists has been a subject of concern in many countries; however, this remains a neglected issue in India.
 
The US Centre for Disease Control and Prevention (CDC) and the American Dental Association have been making efforts to draw attention towards the overuse of dental prescriptions by dentists. Similar sentiments have also been expressed by various researchers in India. A recent survey in Hyderabad by K Pavan Kumar confirms that the practice of prescribing antibiotics is high. In India, the overuse of antibiotics — mainly amoxicillin, metronidazole, ciprofloxacin and ibuprofen by dentists is a huge problem as antibiotics and pain-killers are being used indiscriminately for routine prophylactic use, or for pain; meaning that antibiotics are used even before a dental treatment begins.

 
Indiscriminate prescription of pain-killers causes complications like drug resistance, allergic reactions, acidity and even damage to multiple organs.
 

Emergency Dentistry as a science deals with infection control and pain relief. Both of which necessitate the use of the antibiotics and pain killers. Since dental treatments are generally a long process requiring multiple sittings — the procedure often requires multiple prescriptions to control pain and infection. It is a common phenomenon now that a patient getting multiple root canals, extractions and implants undergo treatment for almost six months. However, it is neither necessary nor warranted to take antibiotics multiple times. It is suggested that a dentist should club procedures that need medications to manage prescriptions and reduce the risk of overuse. Cases of full mouth rehabilitation are especially at risk of overuse.

 
One of the biggest risks of overuse of medication is drug resistance. The bacteria or the disease-causing organism tends to develop resistance to antibiotics with frequent usage, and the medicine slowly becomes ineffective. This means that the patient has to shift to another highly expensive antibiotic that come with additional side effects. The resistance to antibiotic is a major concern, and also drug allergies such as skin rashes, abdominal problems or breathing difficulties.
 
Many times, antibiotics used for killing disease-causing organism not only kill the bad bacteria but also the good bacteria necessary for good health — especially the oral cavity and the gut. The microbial imbalance, or dysbiosis effect, on the normal bacteria in gut severely affects the function of the microbiome (combined good & bad bacteria). This makes a person more susceptible to diseases related to immune altered responses.

 
Many routine treatments in dentistry like root canal, impactions, dry sockets and crowning are operative in nature where antibiotics can be easily avoided. Covering antibiotics are only necessary if the instruments are not completely sterilised and asepsis is not maintained in the surgery.