Antimicrobial Drugs and Dental Health

Antimicrobial Drugs

Summary

Antimicrobial medications are drugs prescribed by physicians, dentists and periodontists to either kill or prevent the formation of bacteria and other harmful organisms such as parasites, fungi and viruses in a person’s mouth and/or body. Localized and systemic infections may be treated with these drugs. Antimicrobial medications are sometimes also prescribed as a preventative measure for certain at-risk patients prior to dental visits.

Antibiotics are among the most frequently prescribed antimicrobial medications. They are usually used to treat dental conditions such as dental abscesses and periodontal disease. They may also be prescribed to prevent illness that can result when bacteria in the mouth enters the bloodstream during dental work. Preventative use of antibiotics is often recommended for patients who have certain pre-existing heart conditions or compromised immune systems.

Antifungal, antiviral and antiseptic drugs are other examples of antimicrobial medications prescribed to treat or prevent illness associated with dental work. For example, antifungal drugs are used to treat thrush, an infection of the mouth’s mucous membrane caused by the Candida albicans fungus. Antiviral drugs may be used to treat herpes simplex virus, an infection that causes cold sores. Finally, dentists may prescribe antiseptic drugs, which kill or inhibit the growth of organisms on body surfaces as a preventative measure to reduce the risk of developing periodontal disease.

Antimicrobial medications may be applied locally to a specific region of the mouth or taken internally as a pill, a lozenge (e.g., some antifungal medications), a mouth rinse or a liquid or injectable form. 

Allergic reaction is the most significant side effect associated with the use of antimicrobial medications. Patients may also experience signs of allergic reaction such as rashes, itchiness, facial swelling and watery eyes. In extreme cases, they may experience difficulty breathing, wheezing, light headedness and drowsiness. In addition, some antimicrobial medications may cause increased sensitivity to sunlight.

In some cases, antimicrobial drugs have been shown to interact poorly with or decrease the effectiveness of certain medications, such as anticoagulants (drugs that help prevent blood clots) and oral contraceptives (birth control pills).

Patients who undergo treatment with antimicrobial medications are urged to practice good oral hygiene in the form of daily brushing and flossing. However, patients who receive a dose of antibiotics in a specific area (e.g., the gum) are typically urged to avoid flossing the treated teeth so that the medication does not become dislodged.

About antimicrobial medications

Antimicrobial medications are drugs that either kill or inhibit the growth of bacteria and other harmful organisms. Dentists commonly prescribe these medications to treat dental infection, periodontal disease, and localized and systemic infections. In addition, healthy patients who nonetheless are at high risk for certain illnesses may be urged to take these drugs as a preventative measure.

Dentists prescribe a variety of antimicrobial medications, but antibiotic drugs, which specifically target bacteria, are among the most often prescribed. In dentistry, antibiotics are usually used to treat dental infections and periodontal disease. These drugs are most often administered orally – in either in pill or liquid form. A course of antibiotics generally lasts for 7 to 10 days.

Antibiotic drugs may also be administered locally so that just one part of the body is treated. Methods of local delivery include:

  • Chip. A chip containing the medication chlorhexidine is placed under the gums, where it dissolves over a period of seven to 10 days.
  • Gel. A gel containing the medication doxycycline is injected under the gums, and the area is covered with a bandage called a periodontal pack. After seven to 10 days, the dentist removes the bandage.
  • Powder. A powder containing the medication minocycline is squirted under the gums, where it dissolves over a period of three weeks.

In some cases, a sample of bacteria or culture will be obtained from the patient’s mouth and grown in a lab to help determine which type of antibiotic will be most effective in treating the condition. A dentist will prescribe just enough of a medication to kill the harmful microorganism without also killing the microorganisms (flora) that normally inhabit a bodily organ or part and that are essential to good health. In addition, the dentist will closely review the patient’s health and medication histories to ensure that the patient can safely use the medications.

Patients who take a pill form of antibiotic must complete the full medication regimen by taking all the medicine prescribed. This lowers the risk that bacteria will survive and become resistant to the medication. Antibiotic resistance is a growing problem. As more and more bacteria become resistant to antibiotics, bacteria infections become increasingly difficult to treat.

About two to three months after the completion of therapy, patients will be asked to return to their dentist or periodontist for a full examination. If the periodontal disease has not been cured, the patient may be asked to try another medicine. Or, a more extensive therapy such as periodontal surgery may be planned.

Antifungal and antiviral drugs are other examples of antimicrobial medications that are prescribed to treat dental conditions. Finally, dentists may prescribe antiseptic drugs as a preventative measure to reduce the likelihood of developing periodontal disease. These drugs are typically composed of diluted disinfectant and are administered in the form of an oral solution. Antiseptics kill or inhibit the growth of microorganisms on body surfaces (e.g., skin, mouth). Common antiseptics include alcohol, iodine and hydrogen peroxide. In contrast, antibiotics kill or inhibit the growth of microorganisms by acting systemically through the bloodstream. Common antibiotics include penicillin, erythromycin and clindamycin.

Types and differences

There are various types of antimicrobial medications that a dentist or physician uses to treat or prevent oral conditions. The medication may be applied locally to a specific region or come in a pill form, a lozenge (e.g., some antifungal medications) or a mouth rinse.  

Antibiotics that often are prescribed include:

TypeGeneric NameBrand Name(s)
Natural penicillinspenicillin G
penicillin V
nafcillin
oxacillin
cloxacillin
dicloxacillin
Pentids
Pen Vee K,
V-Cillin K
Unipen, Nafcil
Prostaphlin, Bactocil
Tegopen, Cloxapen
Dynapen, Dycill
Amino penicillinsampicillin
amoxicillin
Polycillin, Omnipen
Amoxil
Extended spectrumcarbenicillinGeocillin, Geopen
Cephalosporincephalexin
cephradine
cefadroxil
cefaclor
cefuroxime
cefprozil
cefpodoxime
loracarbef
cefixime
Keflex
Velosef
Duricef
Ceclor
Ceftin, Kefurox, Zinacef
Cefzil
Vantin
Lorabid
Suprax
Macrolide antibioticserythromycin
erythromycin estolate
erythromycin ethylsuccinate
erythromycin stearate
dirithromycin
clarithromycin
azithromycin

E-Mycin, ERYC, Ery-Tab, PCE Dispertab
Ilosone
E.E.S., EryPed
Erythrocin
Dynabac
Biaxin
Zithromax
Tetracycline antibioticstetracycline
doxycycline
minocycline
Achromycin V, Sumycin
Vibramycin, Doryx
Minocin
TypeGeneric NameBrand name(s)
Antifungal medicationnystatin
clotrimazole
ketoconazole
itraconazole
fluconazole
Mycostatin, Nilstat
Mycelex
Nizoral
Sporanox
Diflucan

Antiviral drugs that are often prescribed include acyclovir (Zovirax).

Conditions treated

Generally, oral infections fall into one of two main categories. The first is an infection that starts when decay and bacteria enters the pulp or nerve of the tooth, causing the nerve to deteriorate or die. This generally causes a toothache. Left untreated, the bacteria can spread to the surrounding tissues and cause swelling inside the mouth or on the face. This condition is called a dental abscess.

The second category is an infection that has its origins from the gums and is broadly referred to as periodontal disease. In a severe form, it can lead to swelling of the gums and loosening of the teeth, resulting in a periodontal abscess. Whenever possible, dentists and periodontists prefer to treat periodontal disease without using antibiotics, as overuse of antibiotics can lead to bacteria becoming resistant to the medication.

However, antibiotics may be needed to treat more significant cases of periodontal disease. For example, antibiotics are frequently prescribed to treat acute infections in the gums (abscess). Antibiotics may also be used to treat periodontal disease that is aggressive (include necrotizing ulcerative gingivitis) or that does not respond to other treatments. Patients may also receive antibiotics if they have periodontal disease along with weakened immune systems or other serious medical conditions.

Antibiotics are often used as a supplement to scaling and root planing when treating periodontal disease. This combined approach is often successful, although in some cases more extensive treatment – including surgery – may be necessary to successfully treat periodontal disease.

Less commonly, antimicrobial medications may be used to treat fungal and viral infections. For example, antifungal drugs are used to treat thrush, an infection of the mouth’s mucous membrane caused by the Candida albicans fungus. Antiviral drugs may be used to treat herpes simplex virus, an infection that causes cold sores.

In some cases, antimicrobial drugs may be prescribed prior to dental procedures to protect patients from becoming sick in the first place. Patients in certain high-risk categories may be asked to take antibiotic medications such as amoxicillin, clindamycin or erythromycin shortly before dental procedures where bleeding may occur (e.g., extractions, gum surgery). This helps to protect patients from illness that occurs when bacteria in the mouth enter the bloodstream.

Preventative use of antimicrobial drugs is commonly recommended for patients who have various heart conditions.  In certain cases, patients may be required to pre-medicate or take antibiotics one hour prior to certain dental procedures. Dental procedures that cause bleeding may lead to bacteria entering the patient’s bloodstream. When this occurs, the patient may develop bacterial endocarditis, in which the heart valves or tissues become seriously inflamed as a result of bacteria originating from the mouth nesting there. Antibiotics can reduce this risk.

Patients who have a past or present heart condition are urged to inform their dentist of this fact. Those who have had heart or vascular surgery within the previous six months may be required to take antibiotics prior to dental appointments. Patients with the following conditions or the presence of the following artificial heart devices may require treatment with antibiotics before certain dental procedures:

  • Abnormal or damaged heart valves
  • Acquired valvular dysfunction
  • Congenital heart malformations
  • History of bacterial endocarditis
  • Hypertrophic cardiomyopathy (heart disease that causes thick heart muscles)
  • Mitral valve prolapse (heart murmur) with valvular regurgitation
  • Pacemaker
  • Prosthetic heart valves
  • Rheumatic heart disease

In addition, some patients with conditions unrelated to the heart may also be advised to take antimicrobial medications prior to dental visits. This includes patients who are taking steroids on a long-term basis or other medications that may compromise the patient’s immune system. Patients who have had a joint replacement may also need to take antimicrobial drugs prior to dental visits, as bacteria that travels from the mouth into the bloodstream can settle in the artificial joint.

Patients with the following illnesses may also be urged to take antimicrobial medications prior to all dental appointments:

  • Cancer
  • Conditions that compromise the immune system (e.g., rheumatoid arthritis, systemic lupus, HIV infection)
  • Hemophilia
  • Immunosuppression caused by drug or radiation treatment
  • Malnourishment
  • Type 1 diabetes

Potential side effects

Allergic reaction is the most significant side effect associated with use of antimicrobial medications. This usually appears as a rash, hives or upset stomach. However, in rare, severe cases it may develop into anaphylactic shock, a potentially life-threatening, whole-body reaction to the medication. Patients who experience any adverse reaction to their medications should promptly notify a physician.

Other potential complications associated with using antimicrobial medications include:

  • Abdominal pain and diarrhea
  • Bone marrow depression
  • Dizziness or lightheadedness
  • Dry mouth (xerostomia)
  • Hemolytic anemia
  • Inflammation of a vein (thrombophlebitis)
  • Inflammation of the tongue (glossitis)
  • Kidney or liver damage
  • Nausea with or without vomiting
  • Seizures

Patients who use antibiotics excessively or inappropriately are at risk of allowing the bacteria in their bodies to become resistant to the medication. For this reason, patients are urged to strictly follow their dentist’s recommendations while taking antibiotics.

Some antimicrobial medications may cause drowsiness that prohibits the patient from driving or engaging in activities that require deep concentration. In addition, some antimicrobial medications may cause increased sensitivity to sunlight, requiring patients to stay out of the sun or to wear sunscreen lotion.

In some rare cases, use of antimicrobial medications can result in superinfection, an indirect reaction that occurs when organisms not affected by the antibiotic produce another infection which is usually prevented by other bacteria or fungi.

Drug or other interactions

Patients should consult their dentists or physicians before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications. In some cases, antimicrobial drugs have been shown to interact poorly with or decrease the effectiveness of certain drugs. Such drugs include anticoagulants (drugs that help prevent blood clots) and oral contraceptives (birth control pills).

Lifestyle considerations

Patients who undergo treatment with antimicrobial medications are urged to practice good oral hygiene in the form of regular brushing and flossing.

Patients who receive a local dose of antibiotics at the affected gum area are typically urged to avoid flossing the treated teeth so that the medication is not dislodged. About 10 days after the treatment, the patient’s dentist or periodontist will remove the medication pack and clean up any traces of the antibiotic. At this point, the patient will be allowed to return to regular brushing and flossing.

Questions for your doctor

Preparing questions in advance can help patients to have more meaningful discussions with their dentists regarding their conditions. Patients may wish to ask their doctor the following questions related to antimicrobial medications:

  1. Which antimicrobial drug is most appropriate for me?

  2. Why do I need to use an antimicrobial drug? Do I have other options?

  3. What side effects are associated with this drug?

  4. How long will I need to take this drug?

  5. Should I avoid flossing certain areas while I’m on this drug?

  6. Should I look for any signs that indicate the drug is working?

  7. What happens if my treatment with this drug is not successful?

  8. Should I take an antimicrobial drug as a preventative measure before appointments?

  9. What risks do I face if I don’t take these drugs?

  10. By taking these drugs, am I at risk of allowing bacteria to become resistant to the medication?
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