Antibiotics and tooth extractions

At South Kansas City Emergency Dental, located in Pleasant Hill, Missouri just outside of Lee's Summit, Missouri our most frequently performed treatment is the extraction of a tooth or multiple teeth. One of the most common questions patients ask us at their emergency dental appointment where a tooth will be extracted is, “do I need antibiotics”?  In general, the answer to this questions is, “not usually.”  Since the discovery of the antibiotic penicillin in the 1920’s, the drug is estimated to have saved over 500 million lives.  Antibiotics are effective at killing off the bacteria responsible for infections, but in many instances the body’s endogenous immune response is adequate to eradicate the infection.  Studies show that dentists frequently over-prescribe antibiotics, leading to increased antibiotic resistant and undesirable side-effects.

The discovery of penicillin on September 28, 1928 by Scottish physician-scientist Alexander Fleming, earned him the 1945 Nobel Prize in physiology/medicine.  Ironically, penicillin was discovered by accident, when Fleming left some Petri dishes with bacterial growths in it next to an open window where mold spores were in the air. He noticed that all of the bacteria died in the Petri dishes contaminated with the mold spores. The scientist then identified the mold as a member of the Penicillin genus, and he named the "mold juice" (as he called it) penicillin. Fleming would later comment, “When I woke up just after dawn on September 28, 1928, I certainly didn’t plan to revolutionize all medicine by discovering the world’s first antibiotic, or bacteria killer.  But I suppose that was exactly what I did.

Teeth require extraction for a variety of reasons including tooth fractures, dental caries (cavities), and periodontal infections.  Traditionally, many dentists generously prescribed antibiotics in an effort to reduce the frequency of complications such as post-operative infections.  However, the effectiveness of the practice has been called into question. In a 2021 study by the Cochrane Oral Health Group called Antibiotics to prevent complications following tooth extractions, researchers found low-certainty evidence that antibiotics reduced the risk of infection and dry socket following 3rd molar extractions when compared to those patients who took placebo (essentially a sugar pill with no medicine).  The study found that prescribing antibiotics after a tooth extraction is often unnecessary and can lead to unwanted side effects and increased antibiotic resistance in the population in general. Also, no evidence was discovered which suggested that antibiotics prevent pain, fever, swelling or difficulty with opening post-extraction. So when your emergency dentist tells you you don't need antibiotics, this isn't just the dentist's personal opinion, rather the treatment recommendation is consistent with the current literature.

While the trend is increasingly to prescribe antibiotics less frequently, certain medical conditions do warrant the administration of antibiotics prior to most dental procedures, so-called, “antibiotic prophylaxis.”  Antibiotic prophylaxis in the dental world refers to prescribing antibiotics for the patient to take PRIOR to the dental procedure in an effort to prevent another medical side effect.

These medical conditions include certain heart conditions, and in the past many patients with artificial joints were prescribed antibiotics prior to dental treatment.  However in 2014, the American Dental Association changed its guidelines regarding antibiotic prophylaxis in patients with artificial joints, stating, “[I]n general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection.”  A potentially fatal infection of the heart caused by harmful bacteria in the bloodstream which accumulate in a heart valve, the heart lining or a blood vessel, is what is known as infective endocarditis.  The American Dental Association now recommends antibiotic prophylaxis only for those patients who have a substantial risk of a serious adverse cardiac outcome associated with dental work.

As stated above, in recent years, physicians have begun to prescribe antibiotics less frequently due to concerns that bacteria will become increasing resistant to the antibiotics if they are prescribed in cases where they are not actually needed.  Unfortunately, many people are of the mindset that every sickness needs a medication, and that illnesses such as the flu, common cold and other viruses will improve with antibiotic therapy.  It is important to realize that antibiotics have no effect on the flu, because antibiotics kill bacteria, not generally most viruses.  Consequently, practitioners are often pressured by patients with the flu to over-prescribe antibiotics because the patient is convinced the treatment will benefit them.  When the patient’s symptoms improve several days later (as the body naturally recovers), the patient incorrectly contributes the improvement to the antibiotics and further cements the incorrect mindset.

According to the National Foundation for Infectious Diseases, the over-prescribing of antibiotics can lead to antibiotic resistance, where bacteria evolve defenses against the antibiotics, rendering them infective against infection.  When an infection in someone becomes resistant to antibiotics, more aggressive antibiotics (with more serious side-effects) are required.  In severe infections, antibiotic resistance can become so advanced that no antibiotic is effective, often leading to fatal consequences.  A new philosophy regarding the prescribing of antibiotics in general is called antibiotic stewardship.  In this more conservative approach to prescribing, practitioners are urged to prescribe antibiotics exclusively when they are absolutely needed.  This is our approach at South Kansas City Emergency Dental.

In additional to antibiotic resistance, practitioners now prescribe antibiotics with less frequency because often the potential benefits of the medication is out-weighed by the potential for side effects. The most common side-effects of antibiotics are upset stomach, diarrhea and other gastrointestinal conditions.  Within our digestive system, in particular the digestive tract, reside a plethora of beneficial bacteria which aide in our proper digestion of food.  Antibiotics can disrupt the normal digestive process by killing the beneficial bacteria in our gut leading to discomfort, constipation or diarrhea.

Another, although rare, risk of taking antibiotics is the possibility of an allergic reaction.  An allergic reaction to an antibiotic most commonly manifests itself as a raised, itchy skin rashes known as hives. Yet in even less frequent cases, the allergic reaction can trigger a potentially life-threatening condition known as anaphylaxis.  Anaphylaxis has been known to start within seconds to minutes of when the body is confronted with something it is allergic to.  Physiologically speaking, an anaphylactic reaction occurs when the body releases into the bloodstream chemicals forcing the body into shock, with a sharp drop in blood pressure, as well as narrowing and closure of the airway.  Anaphylaxis should be treated immediately with the drug epinephrine, which is essentially adrenaline which dilates the airway and blood vessels. It is for this reason all schools and medical emergency kits contain an Epipen.

In 2019, the American Dental Association published guidelines for the administration of antibiotics for dental pain and swelling. Essentially, practitioners are urged not to prescribe antibiotics as a preventative treatment, but only when symptoms of a serious infection are present, and/or the patient is unable to seek dental treatment in a timely manner.

With the majority of extractions performed at South Kansas City Emergency Dental, antibiotics are not prescribed because they simply are not needed.  We occasionally do have a patient with a post-operative infection following an extraction, and these patients can be properly and effectively treated with antibiotics.   There are rare circumstances, such as severe swelling or the inability to open the mouth, which make extracting a tooth challenging.  In these cases, antibiotics are recommended before treatment is performed.  If you have an infection with noticeable swelling on the outside of your face, or anywhere near your throat, you need to see an emergency dentist immediately.  If no emergency dentist is available, go to your local emergency room.

With over 17 years of experience, the dentist at is qualified to treat your dental emergency in the most effective manner.  If you believe you have an infected tooth, please call our office at 816-601-1817 or contact us on our website at www.southkcemergencydental.com.  We offer convenient hours on Friday, Saturday and Sunday to help those with dental emergencies. We are Kansas City’s emergency dentist.