Antibiotic Use for Dental Surgeries
Michael Jennings, VMD, DAVDC, Board-Certified Dentist & Oral Surgeon
Veterinary Specialty & Emergency Center
One common question I often discuss with other veterinarians is when to use antibiotics with dental surgeries. The cases that warrant it are quite rare. A recent panel discussion at the Veterinary Dental Forum in Nashville1 also tackled the topic, and there are some important points impacting our use of antibiotics that are worth sharing:
- While much of the focus of antibiotic use in veterinary medicine has focused on food animals, recently there has been more attention on antibiotic use in companion animals.
- Transfer of drug-resistant bacteria from companion animals to pet owners and the impact on the wider community is being studied and acknowledged as a potential threat to public health.
- One of the biggest issues is inappropriate prescribing of antibiotics. Reasons are multiple and include demand from patients/patient owners, time pressure on physicians/veterinarians, and diagnostic uncertainty.
- Unfortunately, there is a tendency to use antibiotics as part of the management of any animal with periodontal disease or other oral condition, although there is no justification for this.
- It is imperative to review periodontal treatment strategies and determine whether systemic antibiotics have a role to play in the management of periodontal disease.
Periodontal disease is the most common oral condition we treat, and the process in dogs and cats is the same as in humans. Plaque accumulates > minerals in our saliva bind and convert it to calculus > mineralized layers of bacteria accumulate against and underneath the gumline > gingivitis develops > untreated gingivitis results in bone loss and periodontal pockets. Many of our animals – especially those without regular anesthetized cleanings and daily home care – will develop advanced periodontal disease, requiring surgery and extractions to remove the source of infection and inflammation.
Sixteen year-old Teddy did not receive antibiotics before, during or after his dental surgery
With cases of advanced periodontal disease, are antibiotics necessary pre-op? Animals with severe disease have been living daily with their infection, often for years. If they are otherwise healthy, although their immune system has been in overdrive responding to the disease, it is able to maintain the animal’s health. Treatment of the disease with thorough cleanings and extraction of diseased teeth is the best way to reduce the bacterial load and give the immune system a break.
What about intra-op doses? Transient bacteremia does occur during dental surgeries. However, again, the immune system is there to quickly and efficiently clear the bloodstream and it is not just surgery that causes bacteremia. Studies have also shown that humans with advanced disease will have significantly higher levels of circulating bacteria after brushing their teeth!2
Post-op? After the disease is treated, the body’s healing process is ready to take over. Due to its great vascularity, the oral cavity heals relatively quickly and efficiently, especially after the bacterial load has been decreased. Closing the extraction sites also promotes faster healing.
What if surgery isn’t an option? There are some cases when other systemic severe disease is present that precludes moving forward with a dental surgery. These cases are also rare. Contrary to previous recommendations, patients with heart murmurs or valve disease do not need prophylactic antibiotics. As we know that age is not a disease, don’t miss the chance to make your senior patient’s golden years a bit brighter with a healthier mouth. Some of my most rewarding cases have been older animals who are more alert, energetic and comfortable following treatment of their dental disease.
Are their cases when antibiotics should be used? Again, the number of cases are rare. Examples include animals with compromised immune systems (ex: uncontrolled diabetics, uncontrolled Cushing’s disease, patients receiving chemotherapy). In most of these cases, the underlying uncontrolled disease would likely warrant treatment priority over a dental procedure.
We must also manage the owners’ expectations. Many are surprised their pet is not prescribed an antibiotic following dental surgery. Antibiotics come with their own set of issues (side effects: nausea, vomiting, diarrhea) in addition to the larger public health threat. After an explanation of the cons of prescribing most often outweighing the pros, most are happy to forego trying to give another medication (in addition to pain control) following dental surgery.
Questions about antibiotic use or other dental issues? Contact me at firstname.lastname@example.org.
Dr. Michael Jennings is a Board-Certified Dentist & Oral Surgeon at the Veterinary Specialty & Emergency Center. The Veterinary Specialty & Emergency Center operates state-of the-art emergency and specialty veterinary hospitals that are open 24/7/365 in Levittown PA, Philadelphia PA and Conshohocken PA. For more information about our world-class emergency and specialty care, please visit VSEC on the web at www.VSECVET.com.
- Reiter A, Harvey C et al. “Antibiotic panel.” Proceedings of the Veterinary Dental Forum. Sept. 2017, Nashville, TN.
- Tomas I, Diz P, Tobias A et al. “Periodontal health status and bacteraemia from daily oral activities: systematic review/meta-analysis.” J Clin Periodontol. 2012 Mar; 39(3); 213-28.