Antibiotics in Dentistry: A Narrative Review of the Evidence beyond the Myth

Abstract

Antibiotics have undoubtedly revolutionized medicine and the health and survival of patients with life-threatening infections, being nonetheless free from potential adverse effects, and the risk of intestinal dysbiosis, antimicrobial resistance, and the resulting consequences for the patient’s health and the public purse. The present study narratively reviewed the epidemiological data on worldwide antibiotic consumption and administration in dental practice, patients’ adherence to prescriptions, the antimicrobial resistance phenomenon in dentistry, and the evidence supporting and recommending appropriate antibiotic use in dental care. Eligible systematic reviews and original studies in humans published in the English language from January 2000 to 26 January 2023 were considered. A total of 78 studies, 47 on the epidemiology of antibiotic use and prescription in dentistry, 6 on antibiotic therapy in dentistry, 12 on antibiotic prophylaxis in dentistry, 0 on adherence of dental patients to antibiotic prescription, and 13 on antimicrobial resistance in dentistry, were presently considered. Retrieved evidence revealed that antibiotics are frequently overused and misused in dental practice, dental patients frequently do not adhere to prescriptions, and antimicrobial resistance in dentistry is a still rising phenomenon also secondary to improper oral antiseptics use. The present findings highlighted the need to establish more evidence-based and accurate antibiotic prescriptions to sensitize dentists and dental patients to minimize and rationalize the use of antibiotics only when it is indicated and necessary, improve patients’ adherence, and enhance knowledge and awareness of the antimicrobial resistance in dentistry.

Pulp regeneration treatment using different bioactive materials in permanent teeth of pediatric subjects

“…[ 90 ] Combining agents such as triple or double antibiotic paste could nevertheless bring side effects. [ 15 ] The antimicrobial combination can indeed increase the risk of antibiotic resistance[ 91 ] or allergic reaction, as the root canal could act like a systemic sensitization pathway. [ 92 ] The use of triple antibiotic paste has been recommended by AAE.…”

Rational Antibiotic Prescribing Is Underpinned by Dental Ethics Principles: Survey on Postgraduate and Undergraduate Dental Students’ Perceptions

“…However, as far as inappropriate antibiotic use is concerned, dentists often describe it as a "gray area": decision making under uncertainty, ethical challenges associated with the clinical judgement varying from patient to patient, depending on their vulnerability and risk population they are in, and clinical decisions that depend on the moral judgment of individual prescribers, varying in their antibiotic-prescribing approach [4,5]. So far, there is a huge number of articles proposing that a lack of adherence to the recommended prescribing protocol, based on choice of antibiotic appropriate for suspected pathogen, site of infection, dosing regimen, and duration of antibiotic therapy, represents the main obstacle for antibiotic stewardship in dentistry [6][7][8]. However, even when dentists follow guidelines, the overuse or misuse of antibiotics due to unresolved ethical issues can occur, and this is the problem that has not been addressed so far.…”