Over time a major concern has arisen about overusing antibiotics in dentistry. Each year, in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics. And at least 23,000 people die each year as a direct result of these infections,” according to the CDC. The Centers for Disease Control (CDC) is the government agency responsible for tracking and studying infectious diseases and educating Americans about risks and prevention. You’ve likely seen the news reports in which an infection kills often healthy individuals in a matter of days. These infections, which can be contracted in a hospital, doctor’s office, contaminated water among others, are antibiotic resistant bacteria, nicknamed “super bugs”. Government officials from across the world met just last September to discuss the global threat.
Why are dentists rethinking the way they prescribe antibiotics?
Since the discovery of penicillin in 1928, the world of medicine — and dental care — has changed dramatically. Prior to antibiotics, bacterial infections that we would today consider “harmless” greatly impacted the life expectancy of those living at the time. Statistics from the CDC state that the life expectancy of those born in 1900 was 47 while those born in 2015 have a projected expectancy of nearly 79.
Wider availability of food, improvements in shelter from the elements and transportation have contributed. One major reason for this massive increase is the discovery and utilization of antibiotics. Prior to antibiotics a small infection undeterred by the “host’s” immune system could kill in weeks.
The existence of antibiotics to treat infections is a relatively new discovery. Fewer than 100 years ago, when someone contracted a bacterial infection, the options for treatment were very limited. Doctors would often recommend amputation of an affected limb to prevent the bacteria from spreading to the brain or other vital organs. When this was not an option, infections that we would consider harmless today could kill quickly and spread to others rapidly.
In 1928, the discovery of Penicillin, which is derived from a fungus that “kills” bacteria by weakening its cell walls, revolutionized healthcare. Soon it was followed in 1934 by Sulfa, which prevents the ability of bacteria to use the essential nutrient folate. These could be considered the greatest medical advancement in history. They helped turn the tides on our fight against bacteria.
According to data gathered by the CDC ( Centers for Disease Control ), the expected lifespan of those born in 1900 was 47 while those born in 2015 have a projected life expectancy of nearly 79. This dramatic increase in life expectancy can be largely attributed to the discovery, availability, and use of antibiotics.
With the great benefits of the systematic antibiotic usage around the world, saving life and limb, also came the development, adaptation, and spread of bacteria that were resistant to our methods of fighting bacteria.
Over the past 70 years, we’ve been careless because we did not know of the outcome of over-prescription.
- Doctors have prescribed antibiotics to patients before diagnosis could be obtained to determine if antibiotics were the best course of treatment. For example, when you have a cold or Flu, which is a virus, doctors prescribed antibiotics, which might treat a sinus infection( bacteria), but have no power over viruses. This was a “just in case” approach.
- Furthering the “just in case” approach, antibiotics were prescribed after surgeries, which take place in a very sterile (clean) environment. Again, this was the “just in case” approach because most bacterial infections are resolved by a relatively healthy person’s own immune system.
- We, as patients, prescribed antibiotics, did not complete the course of treatment once “we” felt better, leaving some of the bacteria alive and resistant to antibiotics. Or we tried to “finish off” the rest of our antibiotics when we were sick again. Most of us are probably guilty of one or both of these. In the same way to vaccines are made of very low doses of the illness that they protect you from so that your body develops an immunity to it, so do bacteria develop an immunity if exposed to inappropriate low doses of antibiotics.
- The livestock industry regularly gave antibiotics to animals who were not yet sick to avoid illness.
Over time, the over-usage and misusage of the “miracle drug” led to more and more bacteria becoming immune to antibiotics.
How Did These Bacteria Develop?
After the discovery of this medical “miracle,” the medical community’s response was to prevent and treat bacteria where ever it might be found. This overuse, often when harmful bacteria were not even a real concern, led to the rapid development of mutations. Some bacteria were only exposed to small amounts of antibiotics. Or they were exposed for a short period. Through this, the bacteria were able to survive. This is similar to the way that vaccines include small amounts of the virus from which they protect us so that our bodies can learn to fight the virus in a harmless and controlled environment.
The Bacteria Life Cycle
In the case of the bacteria, the minute exposure led to their better understanding of how to fight back against antibiotics. Bacteria, much like humans, contain DNA, which they pass down to their “offspring”. Similarly to a human mother to child, passing on immune intelligence, so do these bacteria spread this knowledge during bacterial cell division, basically, a bacterium’s method of giving birth.
The Strain of antibiotic-resistant bacteria
Staphylococcus aureus (Staph), a very common bacteria, which is present (and typically harmless) on the human skin, hair, noses, and throats, demonstrates resistance to important antibacterials, such as vancomycin ( common IV antibiotic ). And it has become the most frequent medical facility-acquired pathogen. The term “pathogen” is a catch-all for bacteria, virus and other microorganisms that cause illness.
Despite the similarities, between humans and bacteria, the bacteria life cycle is very different from the human life cycle. The resistant bacteria can reproduce quickly and many times in a short period, which allows them to adapt very, very quickly. This has led to a striking increase in death and serious illness from pathogens that are contracted after — and not before — a person is admitted into a medical facility, such as a hospital.
The Cost to Patients
These types of infections are incredibly costly. According to JAMA, a well-respected medical journal, the direct cost of these infections is $9.8 billion per year, with infections developing on the surgery site accounting for 1/3 of these infections. In individual cost, which is a bit easier for us to relate to, this amounts to about $46,000 per affected patient. That’s more than most people make annually in most regions of the country.
Despite great measures taken to prohibit the spread of these infections in facilities, the individuals who develop these infections in facilities are then able to spread the infection to hospital staff and other patients. These infections then leak out into the general community as visitors, staff and discharged patients go about their lives.
But in a “Catch 22”, these facilities through their usage of antimicrobials, antibacterials and other prevention measures, are furthering the development of new resistant bacteria.
What is the solution for antibiotic-resistant bacteria?
Almost, as soon as a pharmaceutical company can develop a new effective antibiotic, the bacteria adapt and become resistant. Significant time and money go into the development of new drugs. So this quick adaptation has made the development of antibiotics not only not profitable, but a losing proposition as research investments cannot be recouped. Because pharmaceutical companies must make profits to exist, many companies can no longer afford to research antibiotics.
Now that the problem has been identified, across industries, we are working to reduce antibiotic usage. A report from Aker University in Oslo, Norway suggests that it is possible to reverse the problem of antibiotic-resistant bacteria simply by reducing the prescription rate of antibiotics.
- You may have noticed the wider availability of meats that say “no antibiotics” as the industry and consumers have become more aware.
- Your doctor may no longer give you antibiotics when you show up with what is likely the Flu.
- Hospital-acquired infections have become some of the most prevalent. These can affect patients at a hospital, spread within the close quarters. For this reason, the medical industry, insurance companies and private enterprise are looking for more effective ways to treat individuals in outpatient and even home settings to reduce possibility for exposure.
We are simply getting smarter with the way we use antibiotics as we work to reverse the damage done. This does not mean leaving patients who need antibiotics out in the cold. Antibiotics are still highly effective on most bacteria. So once it’s verified that the bacteria are present and that a certain antibiotic will be the effective course of treatment, prescriptions are written.
This relatively new concern changes the way the medical community responds to infection. The idea of “let’s prescribe just in case” has been cast aside for a more balanced “wait and see” approach. This helps avoid the prescribing of antibiotics to illnesses that are caused by viruses over which antibiotics have no power or for infections that our healthy immune systems would “kill” naturally.
As it turns out, this results in improved patient care. The prior method of treatment may have involved sending someone home with high-dosage and potentially addictive pain killers and antibiotics that may not even be needed. The new approach is keeping an eye on the patient, suggesting Ibuprofen (Advil), Acetaminophen (Tylenol) or Naproxen (Aleve) for fever and the mild pain normally experienced post-surgery.
This change can come as a surprise to patients who may not have had a procedure in the past 5 years or so. It is important that patients understand exactly how antibiotics do and do not work.
- Antibiotics are not a cure. Rather, they re-establish the proper balance of defenses in the body. And can even cause side effects of yeast infections and poor digestion as they kill the “good” bacteria (probiotics) that are found naturally in and on our bodies.
- They are seldom an appropriate substitution for more attentive patient care.
- All antibiotics are a little different. Some work more effectively on certain bacteria. So until your doctor determines what bacteria is present, they are best not to prescribe.
- Antibiotics do not have any power over viral infections. These must be treated differently or handled by our immune systems.
When a patient is visiting a doctor or dentist, patients and their guardians should be aware that they will likely not receive antibiotics. The “wait and see” approach is for the benefit of yourself and the good of the world at large.
While antibiotics have been around for nearly 100 years, they are still being studied, and medical research is always advancing. This may lead to future changes. But when it comes to antibiotics, sometimes, less really is more—especially when dealing with a complex organism like a bacteria.
Who to Blame
While we can look to the medical community responsible for managing antibiotics, we all hold a bit of the blame for the spread of antibiotic-resistant bacteria.
- Medical Professionals, including Dental, for many years, prescribed antibiotics as a “just in case” measure rather than waiting to see if an infection developed against which antibiotics would be effective and the which the patient’s immune system would not simply destroy. If a patient had a root canal, they might be prescribed antibiotics just in case an infection developed.
- Ordinary people did not finish their course of antibiotics after they felt better. This led to some bacteria surviving and being adapted. Most of us have done this at some point in our lives, completely unaware of the consequences.
- Patients who went to a doctor for a viral infection — over which antibiotics have no control — were given seemingly harmless antibiotics, as a “placebo,” so they would “feel better” when it was their immune systems making them better. If you have ever received antibiotics for the Flu or a Cold, both viruses, you have seen this first hand.
- The meat industry, to produce cheaper meat, treated animals with antibiotics to prevent infections before they could develop that might add to the cost of treating animals who became sick.
- Over-commercialization of antibacterial products for everyday use, when there is no proof that they are any more effective than hand-washing with regular soap and water.
This is a worldwide challenge. The British Society of Antimicrobial Chemotherapy concluded in a review that dental professionals contributed to this spread as well. The American Dental Association, in a survey completed, identified among licensed dentists, a widespread:
- misunderstanding about best prescribing practices
- gross inappropriate prescribing, dosage, usage
- use of antibiotics as a bacteria preventative
Is There Hope?
Research completed in Oslo, Norway is promising. It does indicate that the adoption of “smarter” usage guidelines can reverse the direction that we are going. While the majority of the world was increasing usage, Norway was decreasing usage of antibiotics. And as a result, they have little to no existence of the “superbugs” present throughout the rest of the antibiotic using world.
The US Medical Community’s Response
Based upon newer research, and an uphill battle against bacteria, the medical/dental community has revised its method for fighting bacteria to a “wait and see” approach.
The ADA (American Dental Association) issued its official stance that antibiotics are only to be used as a treatment when necessary and not as a preventative.
It is important to understand that antibiotics do not cure patients. They only help our immune systems more effectively battle the infections by weakening the bacteria in such ways as those described above in the case of penicillin and sulfa.
Antibiotics are very rarely a substitute for removal of an infected area through surgery ( i.e., removal of the affected tooth, drainage of an abscess, scraping/removing necrotic flesh, etc.). 60% of infections can be resolved by the patient’s immune system once the source of the infection is removed. If the infection has spread beyond a source that can be safely surgically removed, the two methods (minor surgery and antibacterials) may be used together.
It should be noted, that antibiotics do not prevent bacterial infection. In fact, they can even weaken your natural defenses. They destroy our bodies natural balance of microorganisms, primarily, “probiotics”, a “good” bacteria that live in the gut and help us properly break down and absorb nutrients. Without these vital nutrients, our immune systems are weakened, making the patient more susceptible not less.
What to Expect When You Visit Your Dentist
When you visit your dentist with symptoms of a bacterial infection, your dentist will:
- Examine the infection to determine if it is bacterial in nature.
- Evaluate the source of the infection to determine the best course of treatment, which may be allowing your immune system to do its job. Or, if treatment is needed, then your doctor may drain, extract or cut away infected flesh to allow the healthy flesh to take over.
- Consider if antibiotics are needed for the infection either as a stand-alone or in conjunction with surgical intervention.
- Wait and see if needed.
Your dentist will not:
- Give you antibiotics as a preventative after a procedure or otherwise.
- Give you antibiotics, so you can “feel better”.
- Give you antibiotics if a minor surgery is a better and safer option for your type of infection.
- Give you antibiotics before your condition can be properly and extensively evaluated.
- Give you antibiotics for infections that your immune system should be able to handle effectively without intervention.
Through re-evaluating how antibiotics are used, we can work together to stop the effects of years of antibiotic misuse. Learning about antibiotic-resistance and educating others about the risks will help support the worldwide efforts to reverse this dangerous trend toward ineffectual tools to fight bacteria. Together we can save lives. If you have any question or concern call us or make an appointment to talk to one of our dental specialists.
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