We routinely prescribe antibiotics following oral surgery procedures such as removal of wisdom teeth or placement of dental implants. (JADA 2017:148(12):878-886). The mouth is a naturally dirty place and it is not possible to “sterilize” it prior to treatment. In fact, it is common that the structures that we are treating are infected such as abscessed teeth or gum disease. Our patient population is by in large intolerant of complicating factors such as infections that can be avoided.

The studied infection rates without antibiotics are low, but still too high for patient expectations. Because of this, as I present the alternatives and risks to patients, they will select taking the antibiotics as long as they tolerate them well physically. Anecdotally, when we do not use antibiotics due to allergy or personal patient preference, we see a higher rate than I might expect. You might suggest that it is our technique or contamination, but believe me – we are psycho in our approach to this. The fact remains that the mouth is a dirty place with a lot of naturally occurring germs. And these are naturally contaminating our surgical sites.

Because of the concerns with resistance and over prescribing, we continue to fine tune our therapies and techniques to look for ways to reduce antibiotic prescribing. But for now we continue to prescribe for most of our procedures.