Chapter 8

Antiinfective Agents

Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Antiinfective Agents

Types of Dental Infections

Caries
Caries are produced by Streptococcus mutans.
Antibiotics are not used to treat or prevent caries.
Periodontal Disease
Many different bacteria are involved in causing
periodontal disease.
Treatments include the use of local or systemic
antibiotics.

Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Antiinfective Agents

Types of Dental Infections

Localized Dental Infections

Most localized dental infections are an extension of
periodontic or endodontic-related sources.
Drainage is the normal course of therapy.
Antibiotics are used if the patient is
immunocompromised.
The choice of antibiotic depends on the infecting
organism.

Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Antiinfective Agents

Types of Dental Infections

Systemic Infections
These infections produce systemic symptoms such
as fever, malaise, and tachycardia.
Infections need to be treated with antibiotics.

Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Antiinfective Agents

Indications for Antiinfective Drugs

Most dental infections do not require

antibiotics.
Patients that are immunocompromised may
require antibiotic therapy.
Drainage is usually sufficient for localized
infections.
Systemic infections may require antibiotics.
The choice of antiinfective therapy depends on
the infecting organism.

Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Antiinfective Agents

Indications for Antiinfective Drugs

Antibiotics are most often used in dentistry as

prophylaxis before a dental procedure.
Antibiotic prophylaxis is used when there is a
history of rheumatic or congenital heart
disease or the presence of a heart valve
prosthesis.

Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Antiinfective Agents

Antibiotic Prophylaxis

Antibiotic prophylaxis is used to prevent infective

endocarditis.
Antibiotic prophylaxis depends on the specific
dental procedure being performed, the cardiac
and medical condition of the patient, and the
drug and dose necessary.
Always check the most current guidelines of the
American Heart Association and the American
Dental Association regarding antibiotic
prophylaxis.
Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Antiinfective Agents

Many different antiinfective drugs are

available to treat infections.
All antiinfective drugs share several
different adverse reactions and drug
interactions.
Review each antiinfective to determine
whether it has an adverse reaction or drug
interaction that is not shared by all.

Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Antiinfective Agents

General Adverse Reactions

Superinfection
All antiinfectives can produce an overgrowth of
organisms that is different from the infecting
organism.
The wider the spectrum of the antibiotic, the higher
the risk for superinfection.
This adverse effect can be minimized by giving the
most narrow spectrum antibiotic as possible.

Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Antiinfective Agents

General Adverse Reactions

Allergic Reaction
All antiinfective drugs have the potential to cause an
allergic reaction.
Allergic reactions can range from a mild rash to
anaphylaxis.
Penicillin-type antibiotics are more allergenic than
other antibiotics.

Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

10

Antiinfective Agents

General Adverse Reactions

Gastrointestinal Complaints
All antiinfective drugs produce a variety of GI complaints.
GI effects include stomach pain, increased motility, and
diarrhea.

Chewable and Liquid Dose Forms

Chewable and liquid dose forms contain sugar as a sweetener.
Children or adults that use these dose forms should brush and
floss their teeth after each dose.
Long-term administration of antibiotics may increase the risk for
caries.

Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

11

Antiinfective Agents

General Drug Interactions

Oral Contraceptives
Antibiotics can increase the clearance of oral
contraceptives from the body, which makes the oral
contraceptive less effective.
Women taking oral contraceptives should use an
additional method of contraception while receiving
systemic antibiotic therapy.

Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

12

Antiinfective Agents

General Drug Interactions

Oral Anticoagulants
Antibiotics can potentiate the effects of oral
anticoagulants.
Antibiotics reduce the bacterial flora that produce
vitamin K.
Vitamin K is the bodys natural clotting factor.
Oral anticoagulants are vitamin K inhibitors.

Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

13

Antiinfective Agents

Antibiotics Most Commonly Used in Dental

Health Care

Penicillins
Cephalosporins
Macrolides
Azithromycin
Clarithromycin
Tetracycline
Clindamycin
Metronidazole
Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

14

Antiinfective Agents

All the antibiotics used in dental health

care share similar adverse effects and
drug interactions.
Several antibiotics have adverse effects
that have significant concerns to a dental
healthcare practitioner.

Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

15

Antiinfective Agents

Dental Concerns of Selected Antibiotics

Tetracycline
Tetracycline is absorbed into calcifying structures

including unerupted teeth.

Tetracycline can cause permanent discoloration of the
teeth and enamel hypoplasia.
Tetracycline should not be used in children until they
have all of their adult teeth.
Tetracycline crosses the placenta and into breast milk
and affects the primary teeth.
Tetracycline should not be given to women who are
pregnant or nursing.

Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

16

Antiinfective Agents

Dental Concerns of Selected Antibiotics

Metronidazole
If alcohol is ingested while a person is taking metronidazole, the

person will experience a mild form of a reaction that occurs with

alcohol and disulfiram.
Symptoms include nausea, abdominal cramps, flushing, vomiting,
and headache. The reaction can happen if the patient ingests any
form of alcohol including foods, drinks, and mouth rinses containing
alcohol.
Some people have experienced the symptoms if they smell alcohol,
apply it to their bodies (e.g., perfumes, colognes, aftershave).
Alcohol should not be consumed during metronidazole therapy and
one day after finishing therapy.
Other oral adverse effects include dry mouth, unpleasant or sharp
metallic taste, glossitis, stomatitis, and a black-furred tongue.

Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

17

Antiinfective Agents

Other Antiinfectives
Many other agents are available for nondental
uses.
Vancomycin
Aminoglycosides
Chloramphenicol
Sulfonamides
Nitrofurantoin
Quinolones
These antiinfectives share many of the same
adverse effects as other antibiotics manifest.

Mosby items and derived items 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

18