Why didn’t I get antibiotics to treat a dental infection?

A double-edged sword: Ever since the discovery of penicillin, antibiotics have benefited humankind greatly; however, overuse of antibiotics has resulted in the development of many resistant strains of bacteria in the environment. Although penicillin is still an inexpensive, safe and effective antibiotic used to treat certain bacterial infections, more and more patients are getting infections from bacteria against which penicillin does not work. Strains of bacteria, such as methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE), are developing in the environment that are resistant to even “stronger” antibiotics (1). The number of antibiotics available to treat resistant bacterial strains is limited, particularly for those patients allergic to certain types of antibiotics (like penicillins). To help prevent the development and breeding of resistant bacterial strains, healthcare professionals have a responsibility to prescribe antibiotics only when a patient truly needs it (2). Additionally, let's not forget that medications are rarely without side-effects. Certain antibiotics are known to cause gastro-intestinal distress, yeast infections, and serious adverse drug interactions, to name a few.

Treatment of dental infections: The fact is that the normal, healthy human body has an excellent natural immune system capable of handling many low-grade infections on a daily basis. Simple mechanical removal of most of the bacteria via decay excavation followed by a filling, deep cleaning of tooth and root surfaces, extraction or root canal therapy of contaminated teeth is often sufficient in treating certain dental infections without the use of antibiotics. In fact, most of the time antibiotics alone will not completely cure dental infections; you'll need the corrective procedure too.  Feel free to ask your dentist about the appropriateness of use of antibiotics in your situation, but do not be surprised if your dentist does not write a prescription

1. ADA Council on Scientific Affairs. Combating antibiotic resistance. J Am Dent Assoc 2004;135:484.
2. Sweeney LC, Jayshree D, Chambers PA, Heritage J. Antibiotic resistance in general dental practice—a cause for concern. J Antimicrobial Chemotherapy 2004;53:567.