DR.

FAHAD QIAM
BDS, FCPS, MOMSRCSEd
DEPARTMENT OF ORAL & MAXILLOFACIAL
SURGERY
KHYBER COLLEGE OF DENTISTRY
WHAT IS THE INFECTION
RATE IN THE ORAL
CAVITY
 Infection rate in the oral cavity is 3%

 Infection rate for removing impacted

third molars is 10%

 Infection rate for removing impacted

third molars among immuno-
compromised patients is 25%
 PRINCIPLES OF
PRESCRIPTION
 Writing legibly

 State the date, name and age

 Write names of approved drugs only

 State the dispensed form

 State the dose and dose frequency

 State the quantity to be supplied or
number of days of treatment

 For preparations to be used “as

required” specify a minimum dose
interval and the total quantity

 Sign the prescription legibly

WHAT TO PRESCRIBE
 Gram positive

 Gram negative

 Anaerobes

 Pain control
https://www.cochrane.org/CD003811/ORAL_antibiotics-to-prevent-
complications-following-tooth-extractions?
fbclid=IwAR0oCOGFIGe5iCyXEg2PeEt8o-
KjBhZoPXqb75Gse0kk4Gk3m94hp9sUUR0
 This review provides evidence that antibiotics
administered just before and/or just after
surgery reduce the risk of infection, pain and
dry socket after wisdom teeth are removed by
oral surgeons, but that using antibiotics also
causes more (generally brief and minor) side
effects for these patients.

 Additionally, there was no evidence that

antibiotics prevent fever, swelling or problems
with restricted mouth opening in patients who
have had wisdom teeth removed.
 There was no evidence to judge the effects of
preventative antibiotics for extractions of
severely decayed teeth, teeth in diseased
gums, or extractions in patients who are sick or
have low immunity to infection.

 Undertaking research in these groups of people

may not be possible or ethical.

 However, it is likely that in situations where

patients are at a higher risk of infection that
preventative antibiotics may be beneficial,
because infections in this group are likely to be
more frequent and more difficult to treat
 Another concern, which cannot be assessed
by clinical trials, is that widespread use of
antibiotics by people who do not have an
infection is likely to contribute to the
development of bacterial resistance.
Maxillofacial Surgery. 3rd Edition Volume 2 by Peter Brenan, GE
Ghali and Luke Cascarini. 2017
Applies for:

1- Acute apical abcess

2- Pericoronitis
3- Periodontal abcess
4- Perio endo abcess

Management of Acute Dental Problems: Guidance for

healthcare professionals by the Scottish Dental Clinical
Effectiveness Program published in March 2013
 Antibiotic prescribing practices by dentists: a review
Najla Saeed Dar-Odeh,1 Osama Abdalla Abu-Hammad,1 Mahmoud
Khaled Al-Omiri,1 Ameen Sameh Khraisat,1 and Asem Ata
Shehabi2

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909496/
 CONCLUSION

 The conclusion of this review is that

antibiotics given to healthy people to
prevent infections, may cause more harm
than benefit to both the individual patients
and the population as a whole.
 WHEN TO GIVE
PROPHYLAXIS AND WHEN
NOT
 Not indicated for extraction, frenectomy,
biopsy, alveoloplasty, tori reduction,
multiple extractions, severe periodontitis
& periapical infection

 Given in cellulitis/abcess, surgery lasting

for more than 4 hours, insertion of a
foreign body, immunocompromised
patient
Antianaerobic Antimicrobials: Spectrum and Susceptibility Testing. Itzhak
Brook ,Hannah M. Wexler, and Ellie J. C. Goldstein. Clin Microbiol Rev. 2013
Jul; 26(3): 526–546.
DOSING MODIFICATIONS
 Children: Avoid Tetracyclines,
Metronidazole, Quinolones

 Kidney diseases: Avoid

Aminoglycosides

 Liver diseases: Avoid Tetracyclines,

Aminoglycosides, Azithromycin
PREGNANCY
SAMPLE PRESCRIPTION?
 Name: XYZ Age: 21

 Procedure performed: Closed extraction 46

 Tab. Ibuprufen 400mg - 3 days then SOS

1+1+1

Signature
SAMPLE PRESCRIPTION?
 Name: XYZ Age: 21

 Procedure performed: Open extraction 46/ Closed

extraction in immunocompromised patient

 Tab. Amoxicillin + Clavulanic Acid 625mg - 7 days

1+1

 Tab. Ibuprufen 400mg - 3 days then SOS

1+1+1

Signature
HELPFUL APPS & BOOKS
 Medscape (Drug interaction checker,
Pregnancy and lactation rating)

 Pharmapedia Pakistan

 British National Formulary

 Pakistan Drug Index