Do I need an antibiotic?

This is a question I get pretty routinely and the answer is almost always no.  Antibiotics are obviously used to treat bodily infections of a systemic nature and are truly one of modern science’s greatest achievements.  When infections affect the throat, gut, urinary tract, or other internal tissues there’s really no good way to scrub these areas clean.  So we rely on chemistry to do the work for us and as little as a week of penicillin or azithromycin provides a magical cure!


For infections of the oral cavity, mechanically removing the source of the infection is usually the preferred and sometimes only effective treatment.  Bacterial infections of the mouth are very common and include periodontal disease and abscessed teeth.  Unfortunately, antibiotics will only provide temporary relief of symptoms for a week to a month.  In periodontal cases such as tartar build up under the gums, no amount of chemicals can remove the source of the infections.  The same is true for infected or necrotic tissue inside of an individual tooth.  For periodontal disease, simply cleaning the teeth and gums thoroughly at our office cures what ails you.  Teeth with abscesses require a root canal to clean and disinfect the internal anatomy.  I’ll explain in a later post why root canals no longer live up to their bad reputation and are now a non-event.  Finally, there are times that the best treatment for a badly infected tooth is extraction and replacement with a dental implant.


I do prescribe antibiotics though.  Fever and obvious swelling are the two signs I’m most worried about.  These infections will look like a ping pong ball in the cheek or a swelling that causes the lower eyelid or fold of the nose to bulge.  I also look to see if the infection has a way to drain.  Draining is gross but beneficial.  Signs that the infection is spreading aren’t good either and require antibiotic therapy.


One more note on antibiotics.  These incredible drugs are becoming less and less effective every day.  You see, every time you take a round of antibiotics, nearly all bacteria bugs are killed.  The survivors though are the ones that repopulate your body and can be slightly less susceptible to the drugs.  Over time this results in bacterial resistance (MRSA for example) yet new antibiotics aren’t being developed as quickly.  So it’s very important to take all of the antibiotics prescribed and take them at intervals as directed.  Definitely don’t tell me you had some old amoxicillin and you took a couple of those!


I hope this helps you understand the rationale for antibiotic prescriptions in dentistry.  Do you have any other questions you’d like answered?  Did you find this article interesting or provoking?  I’d love to hear in the comments below.


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