CLINICAL USE OF ANTIBIOTICS IN DENTAL PRACTICE

Inappropriate use of antibiotics by clinicians leads to development of antibiotic resistance. For the most part, antibiotics are prescribed in dental practice for prophylactic and therapeutic reasons. Prophylac tic antibiotics are prescribed to prevent diseases caused by members o f the oral flora introduced to distant sites in a host at risk or intr oduced to a local compromised site in a host at risk. In most cases, p rophylaxis is used for prevention of endocarditis. Therapeutic antibio tics are prescribed, in most cases, to treat diseases of hard and soft tissues in the oral cavity after local debridement has failed. Antibi otics used for prophylaxis must: (1) be active against the major patho gens; and (2) achieve a tissue loading dose before the bacteria are in troduced. Antibiotics used for therapy are required in cases where the infection is already present and thus the agent must reach the site o f infection at a high enough level for a long enough time to produce t he desired effect. For an exogenous agent the goal is to eliminate the agent from the site of infection. In the case of an endogenous agent the antibiotic must suppress the organism at the site of infection. Re cent evidence underscores the important role of antibiotics in the tre atment and prevention of diseases initiated in the oral cavity that ha ve the potential to spread to distant organs in the body. (C) 1998 Els evier Science B.V. All rights reserved.