Antibiotic prophylaxis in dentistry and oral surgery: use and misuse

Introduction: Antibiotic prophylaxis (AP) still represents a common but often misused procedure in dental practice, thus aggravating the risk for antimicrobial resistance and adverse effects occurrence. Aims and methods: Our primary objective is to review the available scientific evidence regarding AP in dentistry both among healthy subjects and medically compromised patients. Additionally, the latest available guidelines provided by some of the most authoritative associations are here discussed. Results and conclusions: AP is advisable only in a small percentage of patients where a risk of severe infective complications (i.e. infective endocarditis and prosthetic joint infection, septicaemia in severely immuno-compromised patients, bisphosphonate-related osteonecrosis of the jaw) exists. On the contrary, little or no scientific evidence exists for AP in subjects with other systemic diseases as well as in healthy individuals. This pioneering recommendation is strongly evidence-based, since a consistent association between any dental procedure and the development of local and distant infective complications is still lacking. In addition, the daily bacteraemia secondary to routine habits has been thought to be robustly associated with a greater risk of systemic disease bacterial-related than a single dental procedure exposure. Compliance of general dental or family practitioners to the current recommendations seems not to be optimal, thus, efforts to improve it should be planned and undertaken.