Antibiotic resistant bacteria are a major problem in today’s world. Responsible and judicious use of antibiotics in both people and animals is imperative. Antibiotics are often not necessary for veterinary dentistry and should be used cautiously.
It is common for veterinary practices to use antibiotics in conjunction with periodontal disease, dental prophylaxis and extractions. A scenario we often encounter is an animal that is showing acute signs of oral pain or inflammation and they are put on a course of antibiotics, hopefully, only until they can get in for a dentistry procedure and oral surgery. Many animals are also put on antibiotics during and after the dentistry procedure to prevent further infection and complications.
In a world where antibiotic resistant bacterial infections are becoming more common, it is imperative that we scrutinize use of antibiotics and when they are necessary. According to the CDC’s 2019 Antibiotic Resistance Threats Report, there are 2.8 million antibiotic resistant infections annually and 35,000 deaths as a result. Overuse and misuse of antibiotics in both people and animals can contribute to these antibiotic resistant bacterial populations.
While periodontal disease is partly related to a shift in the bacterial population in the mouth, it is also caused by the host’s (animal’s) response to that shift. Inflammatory cells populate the area and are the cause of tissue destruction and result in periodontal pockets, bone loss, and oral pain. Antibiotics may temporarily alleviate some symptoms but often do not penetrate the protective biofilm the bacteria inhabit and only result in temporary relief. Additionally, antibiotics disrupt the normal symbiotic bacteria population in the mouth and the entire body. For these reasons, antibiotics are never the solution to periodontal disease and further treatment with a comprehensive oral health assessment and treatment (COHAT) is necessary. Aside from severe oral infections, such as osteomyelitis, alternative forms of treatment prior to a COHAT may include anti-inflammatories and pain control instead.
Concerns about post-operative infections including extraction site infection and dehiscence, systemic infection and endocarditis often drive decisions about peri and post-operative antibiotics for dentistry. While all can be risks during the post-operative period, they are thankfully not common. Pet parent’s should be informed that infection is a possible risk and what to look for if this should happen. There is a small subset of high-risk patients that may require peri-operative antibiotics, but most do not require post-operative antibiotics. The risks associated with using antibiotics prophylactically, including antibiotic resistance and disrupting normal bacteria flora, far outweigh the risks of post-operative infection.
It can sometimes be difficult to decide if an animal needs antibiotics and the pet parents’ concerns about infection can often be misleading. There are also different opinions among clinicians about antibiotic use that can be confusing. While high level data for animals is lacking, thankfully, there are some guidelines that can help. The AVMA has produced several resources in the last few years to help guide veterinarians and pet parents and they can be found on their website. The 2022 AAFP/AAHA Antimicrobial Stewardship Guidelines state, “Systemic antimicrobials are usually not indicated for routine dental prophylaxis or after tooth extractions. In cases of periodontitis, systemic antimicrobials are not a substitute for surgical treatment. In most cases of periapical tooth root abscesses, debridement of infective tissue is sufficient to control infection.”
The bottom line is, while antibiotics have a place in treating bacterial infections, they should be considered only one tool in the toolbox and avoided when other means of treating infection are available. This includes periodontal disease where scaling, root planing and/or extractions alone can treat inflammation and infection. Additionally, the use of prophylactic antibiotics to prevent infection should be highly scrutinized and perioperative antibiotics should only be used for very high-risk patients. More work is needed to define high risk patients in veterinary medicine, but these cases are rare. Here at Mainely Veterinary Dentistry we take antibiotic use very seriously. Please talk to your technician about antibiotic use in your pet.
