Dental News - Interview: Antibiotics are often overprescribed in an arbitrary manner in dentistry

Franziska Beier, Dental Tribune International

Tue. 9. July 2019

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The use of antibiotics remains a controversial topic. A recent study investigated the necessity of antibiotics for the prevention of dental implant infections. Lead author Dr. Ismael Khouly, Associate Director of Periodontology and Implant Dentistry at Bluestone Center for Clinical Research at the New York University College of Dentistry, U.S., and his colleagues found that the prophylactic use of antibiotics has no influence on the prevalence of post-surgical dental implant complications in patients who are healthy overall. Khouly was so kind as to answer DTI’s questions on the topic.

Dr. Khouly, why did you focus on this topic for your study?
We decided to focus our systematic review on this topic because of the absence of current clinical guidelines for antibiotic prophylaxis in dental implant placement procedures, the misuse and overuse of antibiotics, and the risks associated with their prescription.

While reviewing the medical literature, I noticed that existing guidelines on antibiotic prophylaxis in surgery, such as hip and knee arthroplasty, are often based on postoperative infection. Therefore, we decided to focus our systematic review on antibiotic prophylaxis to prevent surgical wound infection in dental implant surgeries rather than to prevent implant failure only.

Furthermore, we investigated whether any specific antibiotic regimens with regard to antibiotic compound, dosage and dosing schedule were justified for specific evidence-based clinical guidelines. Our goal was to obtain more information and help clinicians to identify when to use antibiotics, responsibly, in dental implant placement procedures, to identify those clinical situations where antibiotics are recommended, as well as to choose the right antibiotic at the right dose and for the right duration.

Would you say that antibiotics are generally prescribed too often?
Unfortunately, antibiotics are often overprescribed in an arbitrary manner and mostly unnecessarily in dentistry, according to a recent study published in JAMA Network Open. This is important because around 10% of the antibiotics used in the U.S. are prescribed by dentists. Therefore, we must develop clinical guidelines for the rational use of antibiotics based on evidence and reduce the misuse of antibiotics.

How can dentists be made aware of this situation?
Every clinician involved in dental implant surgery procedures should take care not to overlook confounding variables while prescribing antibiotics in dental implant placement surgeries. Clinicians should understand that postoperative complications in implant dentistry, such as postoperative infection and implant failure, are most likely multifactorial and involve different risk factors which could be related to the clinician, the environment or the patient. Moreover, early implant failure may be caused by reasons other than postoperative infection, such as confounders from the surgical procedure as stated in a study by the International Team for Implantology Antibiotic Study Group.

What would you recommend to dentists regarding antibiotic prescriptions for future implant surgeries?
Bearing in mind the limitations of our systematic review, it seems that antibiotic prophylaxis may not prevent postoperative infections after dental implant placement procedures. However, and as stated in our study, “It is our recommendation that until such evidence becomes available, clinicians evaluate the benefits (or lack thereof) of antibiotic prophylaxis for each patient given medical history and surgical complexity and seriously consider results of the present paper for overall healthy patients as well as risks associated with administration of antibiotics.”

Editorial note: The study, titled “Antibiotic prophylaxis may not be indicated for prevention of dental implant infections in healthy patients. A systematic review and meta-analysis,” was published in the April 2019 issue of Clinical Oral Investigations.