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Dentists Are Prescribing Far Too Many Antibiotics

The B.C. Dental Association says increasingly complex work could be why antibiotics are overprescribed
While antibiotic prescribing by doctors is dropping, the opposite is true in the field of dentistry.

The B.C. Centre for Disease Control says dentists are prescribing too many antibiotics — and it wants patients to help solve that problem.

A new poster campaign launched  by the BCCDC and the B.C. Dental Association is asking people to consider how they use antibiotics.

The posters, posted prominently on SkyTrains, picture the open mouth of a dental patient with the caption, “Just say ‘nahhh’ to antibiotics.”

“Whether your patient leaves your office pissed off or happy with your decision not to prescribe, that’s going to affect your likelihood to do that again,” David Patrick, the centre’s medical epidemiologist and lead for antimicrobial resistance, told On The Coast host Gloria Macarenko.

“That’s very clear in all the behavioural literature.”

Posters similar to this are being run on SkyTrains in Vancouver and other locations. (

That, Patrick says, is why patients need to be part of the effort, even though it is the dentist who writes the prescription.

Lower costs, fewer infections

Concerns that overprescribing antibiotics is leading to drug resistant infections are not new.

Reducing unnecessary antibiotic use has been a focus of professional medical bodies.

Patrick said a similar patient-focused efforts in B.C. to reduce antibiotic use by doctors has seen prescribing go down by 30 per cent over 20 years.

He said doctors in B.C. prescribe the least amount of antibiotics in Canada while the province is also seeing fewer serious infections, saving $50 to $80 million each year in antibiotic costs.

Dentists’ use of antibiotics, conversely, has gone up 30 per cent in the same time frame.

Dentist education also ongoing

BCDA president Dr. Raymon Grewal is working with the BCCDC on the campaign.

He said much of the overprescribing by dentists is due to an increasing number of complicated procedures, especially when it comes to implants like tooth replacements.

Older research has advised prescribing antibiotics before and after those procedures but a growing body of literature suggests only prescribing antibiotics before.

“Some of it is patient-driven,” Grewal added. “Sometimes, patients ask for antibiotics, particularly if it’s a toothache or what seems to be a localized infection that has to do with a tooth.

“Historically, antibiotics would have been given but the true treatment of choice would be removal of the infection which… would be the removal of the tooth or a root canal.

Grewal said while patient education on better use of antibiotics is the goal of the poster campaign, education of dentists is also ongoing.

Listen to the full interview with David Patrick:


Which Antibiotics ACTUALLY DO Treat Tooth Infections?


A tooth infection, sometimes called an abscessed tooth, causes a pocket of pus to form in your mouth due to a bacterial infection. It’s usually caused by:

Tooth infections can cause:

  • pain
  • sensitivity
  • swelling

Left untreated, they can also spread to nearby areas, including your brain.

If you have a tooth infection, see a dentist as soon as possible to prevent the infection from spreading. You’ll want to be careful with any infection in your head, especially in your mouth since it’s close to your brain. Your dentist will likely prescribe an antibiotic to help kill the bacteria causing your tooth infection.

Read on to learn more about the types of antibiotics used to treat tooth infections and over-the-counter options for pain relief.

Which antibiotics work best for a tooth infection?

Not all tooth infections require antibiotics. In some cases, your dentist may be able to drain the abscess. Other cases might require a root canal or removal of the infected tooth.

Antibiotics are generally used when:

  • your infection is severe
  • your infection has spread
  • you have a weakened immune system

The type of antibiotic you’ll need depends on the type of bacteria causing the infection. Different classes of antibiotics have different ways of attacking bacteria. Your dentist will want to choose an antibiotic that can effectively eliminate your infection.

Antibiotics of the penicillin class, such as penicillin and amoxicillin, are most commonly used to help treat tooth infections.

An antibiotic called metronidazole may be given for some types of bacterial infections. It’s sometimes prescribed with penicillin in order to cover a larger variety of bacterial species.

While penicillin antibiotics are common used for tooth infections, many people are allergic to them. Make sure to tell your dentist about any allergic reactions you’ve had in the past to medications.

If you’re allergic to penicillin, your dentist might a different antibiotic, such as clindamycin or erythromycin.

How much should I take and for how long?

If you have a tooth infection that requires antibiotics, you’ll need to take them for about one week. Depending on the type of antibiotic, you’ll need to take a dose two to four times a day.

You should receive instructions from your pharmacy detailing exactly how to take the antibiotic. You can ask the pharmacist if you’re not sure about how to take a medication.

Keep in mind that you might have to take a few courses of antibiotics before they get into your system and begin acting on the infection.

Always take the entire course of antibiotics prescribed by your dentist, even if your symptoms seem to disappear. If you don’t take the entire course, some bacteria may survive, making it harder to treat the infection.

Are there any over-the-counter remedies?

You should always see your dentist if you have a tooth infection. Your teeth are very close to your brain and a tooth infection can quickly spread to nearby areas and organs.

Antibiotics aren’t available without a prescription, but there are a few things you can do at home for relief before your appointment, such as:

  • taking over-the-counter pain relievers, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol)
  • gently rinsing your mouth with warm salt water
  • avoiding hot or cold foods whenever possible
  • trying to chew with the opposite side of your mouth
  • brushing with a soft toothbrush around the affected tooth

You can also try these 10 home remedies for an abscessed tooth.

The bottom line

If you’re having symptoms of a tooth infection, such as persistent throbbing pain, swelling, and sensitivity to temperature or pressure, see a doctor or dentist as soon as possible.

If your dentist prescribes antibiotics, follow the instructions carefully and finish the prescription. Even if the infection seems mild, it can quickly become serious without proper treatment.

Liam Britten – Digital journalist – CBC Digital Columbia

Medically reviewed by Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT on June 19, 2018 — Written by Jill Seladi-Schulman, PhD

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