Antibiotics after tooth extraction - advice please

[RickG16]

I recently had 4 wisdom teeth out, and in the Thai tradition was offered a doggy bag of drugs to take home.... these included antibiotics, which I'm not sure are fully necessary....

 

Should I finish the course even though they were given as a protective measure?

 

They don't usually affect me too much, but with these I feel really drowsy and have dark circles under my eyes. Anyone else experienced this?

[Photoguy21]

If you have a bacterial infection then the antibiotics will work, if not they are of no value doctors have informed me.

[FritsSikkink]

If you started taking them you need to finish it otherwise the bacteria's get resisted.

[Lacessit]

Doctors and dentists issuing fistfuls of antibiotics is classic CYA in Thailand. If the practitioners have followed proper sterile procedures, post-operative infection should not be a problem.

My policy is to wait and see, if I start showing symptoms of infection, then it is time to use antibiotics.

Having said that, once a course of antibiotics is commenced, it should be completed. Anything less runs the risk of creating antibiotic-resistant strains of bacteria.

I only take antibiotics when absolutely  necessary, as they suppress the immune system.

[Lorry]

Dentists often give prophylactic antibiotics,  not only in Thailand.

Whether this is always necessary is sometimes debatable.

After pulling 4 wisdom teeth it doesn't sound unreasonable. 

 

BTW the existence of a "course " of antibiotics that has to be finished is a myth. Different situations require different duration of antibiotic treatment 

[soi3eddie]

9 hours ago, Lacessit said:

My policy is to wait and see, if I start showing symptoms of infection, then it is time to use antibiotics.

Having said that, once a course of antibiotics is commenced, it should be completed. Anything less runs the risk of creating antibiotic-resistant strains of bacteria.

I only take antibiotics when absolutely  necessary, as they suppress the immune system.

I had a tooth extraction in the UK in June this year. They gave me painkillers and antibiotics with instruction only to use them if infected and in pain. The course must be finished once started. 

 

[JackGats]

4 wisdom teeth extracted at one go is not trivial. I'd take the antibiotics.

 

I was once given Clindamycin after some procedure, an implant I think. I got catastrophic diarrhoea. That was about the only time in my life an antibiotic gave me diarrhoea.

[SidJames]

The inside of your mouth is the area of your body most vunerable to serious infection & your body will react quite violently if an infection is allowed to fester, any thing near the brain makes the body reaction rather quickly.

I don't like to take pills but on such an extraction I would & rinse with salt water gargles morning & night using clean not tap water unless boiled & allowed to cool.

[ChaiyaTH]

You can take the risk not taking the anti-biotics, to then revisit the dentist + pay additional, to cut open and suck out the dirt causing infections to happen. Or you can listen, and take the anti biotics, and limit pain killers which are all other pills, to the most.

[ChaiyaTH]

9 hours ago, Lacessit said:

Doctors and dentists issuing fistfuls of antibiotics is classic CYA in Thailand. If the practitioners have followed proper sterile procedures, post-operative infection should not be a problem.

BS has nothing to do with them not 'following proper sterile procedures'. It is just common to happen after treatments as the OP described, however, in the west we never give out such medicine upfront, only once it became a problem.

Here they do give them out upfront, one because they cost nearly nothing and 2, because people rather take cheap pills than having to come back with a tennis ball mouth caused by infection, to then need a paid procedure and still take the antibiotics. 

But yes, for many of the people they do heal naturally without any of that. The fact they hand it out does not mean you should take it as if it is candy, just to save you money and not make you need to come back, as a prep.

 

If something is not logical, look at the money costs and trails, there is your answer.

[HauptmannUK]

I had two tricky wisdom teeth extracted in a UK hospital. I was given antibiotics to take away and informed that wisdom tooth extraction is 'high risk' for infections...  

[Sheryl]

Best to continue the full course of the antibiotic. The other drugs in thd bag can probably be dispensed with unless needed for pain.  

 

It is unusual for an antibiotic to  cause drowsiness unless secondary to disturbed sleep. 

[Sheryl]

Best to continue the full course of the antibiotic. The other drugs in thd bag can probably be dispensed with unless needed for pain.  

 

It is unusual for an antibiotic to  cause drowsiness unless secondary to dsturbed sleep.  Which quinoline antibiotics in particular can cause.

[Lacessit]

3 hours ago, ChaiyaTH said:

BS has nothing to do with them not 'following proper sterile procedures'. It is just common to happen after treatments as the OP described, however, in the west we never give out such medicine upfront, only once it became a problem.

Here they do give them out upfront, one because they cost nearly nothing and 2, because people rather take cheap pills than having to come back with a tennis ball mouth caused by infection, to then need a paid procedure and still take the antibiotics. 

But yes, for many of the people they do heal naturally without any of that. The fact they hand it out does not mean you should take it as if it is candy, just to save you money and not make you need to come back, as a prep.

 

If something is not logical, look at the money costs and trails, there is your answer.

I have been having check cystoscopies for 16 years. Every six months. I have never had a post-operative UTI, either here or in Australia. I was never given antibiotics in Australia. Here, the antibiotic is part of the hospital package, not cheap at an itemized cost of 1000 baht. I assume you have heard hospitals do charge more for pharmacy medications.

I wait for three days, then throw the antibiotic out. I've been doing that for three years without incident. The same with tooth extractions, all I need is salt water.

I don't know why posters forget good manners when they disagree with another poster. I save myself further aggravation by putting them on my ignore list. Goodbye.

 

[RickG16]

11 hours ago, Sheryl said:

 

 

It is unusual for an antibiotic to  cause drowsiness unless secondary to disturbed sleep. 

Are dark circles normal? 

 

Before having the tooth extractions I was on holiday and drinking for about 10 days, that's why I'm thinking the antibiotics may not be good for my liver.....

[xylophone]

13 hours ago, JackGats said:

4 wisdom teeth extracted at one go is not trivial. I'd take the antibiotics.

Yes, you are quite right, having four wisdom teeth extracted at one go is not trivial and as you suggest, I believe he should take the antibiotics.

 

A dentist friend of mine in NZ gave me antibiotics at the same time as removing a very difficult and deep-rooted wisdom tooth, and this took over an hour!

 

Unfortunately there are quite a few bacteria that live in the mouth and one which is usually protective of teeth and environs, Streptococcus sanguinus, can be dangerous if it gets into the bloodstream, causing problems with heart valves.

 

No harm in taking the antibiotics if prescribed.
 

[Sheryl]

13 hours ago, RickG16 said:

Are dark circles normal? 

 

Before having the tooth extractions I was on holiday and drinking for about 10 days, that's why I'm thinking the antibiotics may not be good for my liver.....

Dark circles would result from inadequate/disturbed sleep as would the drowsiness. Some antibiotics, especially quinolones, have that effect in some people.

 

 

[RickG16]

18 hours ago, Sheryl said:

Dark circles would result from inadequate/disturbed sleep as would the drowsiness. Some antibiotics, especially quinolones, have that effect in some people.

 

 

It's amoxicillin 

[RickG16]

1 minute ago, RickG16 said:

It's amoxicillin 

With clavulanic acid

[Sheryl]

On 9/11/2022 at 9:36 AM, RickG16 said:

With clavulanic acid

It is uncommon but amox with clav does cause sleep disturbance in some people.

[crouchpeter]

On 9/10/2022 at 1:11 PM, xylophone said:

Yes, you are quite right, having four wisdom teeth extracted at one go is not trivial and as you suggest, I believe he should take the antibiotics.

 

A dentist friend of mine in NZ gave me antibiotics at the same time as removing a very difficult and deep-rooted wisdom tooth, and this took over an hour!

 

Unfortunately there are quite a few bacteria that live in the mouth and one which is usually protective of teeth and environs, Streptococcus sanguinus, can be dangerous if it gets into the bloodstream, causing problems with heart valves.

 

No harm in taking the antibiotics if prescribed.
 

The mind boggles reading these fairytales!

[xylophone]

11 hours ago, crouchpeter said:

The mind boggles reading these fairytales!

You may wish to stop your "mind boggling" and do some research...........

 

S. sanguinis may gain entrance to the bloodstream when opportunity presents (dental cleanings and surgeries) and colonize the heart valves, particularly the mitral and aortic valves, where it is the most common cause of subacute bacterial endocarditis. For this reason, oral surgeons often prescribe a short course of antibiotics to be taken a few days before to a few days after oral surgery. Once an infection has occurred, treatment is much more complicated and generally involves the administration of several weeks of penicillin and aminoglycoside antibiotics.

 

[tgw]

antibiotics after wisdom teeth removal is routine and advisable.

[cdemundo]

Oral infections can happen after oral surgery.

I had an infection after a root canal, I had a lot of swelling and pain.

I called the dentist and he thought I was making a big thing out of nothing, said just take the antibiotics.

 

Finally I insisted on an appointment and he nearly pooped himself when he saw how bad the swelling was.

He referred me to an oral surgeon who said, let's go to the hospital right now.

Oral surgeon said my airway was in jeopardy if the bacterial infection accelerated.

Had drain inserted that day and was hospitalized with IV antibiotics for 2 or 3 days.

 

This was in the US and luckily I had good insurance.

Probably close to worst case scenario but even still...

[crouchpeter]

On 9/12/2022 at 11:26 PM, xylophone said:

You may wish to stop your "mind boggling" and do some research...........

 

S. sanguinis may gain entrance to the bloodstream when opportunity presents (dental cleanings and surgeries) and colonize the heart valves, particularly the mitral and aortic valves, where it is the most common cause of subacute bacterial endocarditis. For this reason, oral surgeons often prescribe a short course of antibiotics to be taken a few days before to a few days after oral surgery. Once an infection has occurred, treatment is much more complicated and generally involves the administration of several weeks of penicillin and aminoglycoside antibiotics.

 

First of all; I'm a dentist. It's strep. viridans found in the mouth, and it can compromise damaged or artificial heart valves only! The bacteria do this by settling behind the flap of the damaged valve, where blood flow is hindered and form a colony. Similar to the little atrial appendage in the heart during AF where blood clots hide sometimes. So 1 hour before invasive dental work you take 3 gms. Amoycillin. This also applies to any prosthesis for 3 months after the op. Eg. Hip replacement. Of course, I've been retired for 7 years now, so might have forgotten some of the big words used to impress!

[xylophone]

53 minutes ago, crouchpeter said:

First of all; I'm a dentist. It's strep. viridans found in the mouth, and it can compromise damaged or artificial heart valves only! The bacteria do this by settling behind the flap of the damaged valve, where blood flow is hindered and form a colony. Similar to the little atrial appendage in the heart during AF where blood clots hide sometimes. So 1 hour before invasive dental work you take 3 gms. Amoycillin. This also applies to any prosthesis for 3 months after the op. Eg. Hip replacement. Of course, I've been retired for 7 years now, so might have forgotten some of the big words used to impress!

Well I was only quoting from published papers and from Wikipedia, and what I have also been told by a dentist friend of mine, and much to my dismay this particular bacteria found its way into my urinary system (it was cultured so was definitely this bacteria) and I had to have 14 days of intravenous carbapenem to get rid of it, which was extremely expensive. See below...................

 

Streptococcus sanguinis (S. sanguinis) is an abundant oral commensal which can cause disseminated human infection if it gains access to the bloodstream. The most important among these diseases is infective endocarditis (IE).

https://www.frontiersin.org/articles/10.3389/fmicb.2020.00010/full

 

S. sanguinis is a normal inhabitant of the healthy human mouth where it is particularly found in dental plaque, where it modifies the environment to make it less hospitable for other strains of Streptococcus that cause cavities, such as Streptococcus mutans.

 

S. sanguinis may gain entrance to the bloodstream when opportunity presents (dental cleanings and surgeries) and colonize the heart valves, particularly the mitral and aortic valves, where it is the most common cause of subacute bacterial endocarditis.

 https://en.wikipedia.org/wiki/Streptococcus_sanguinis

[crouchpeter]

17 hours ago, xylophone said:

Well I was only quoting from published papers and from Wikipedia, and what I have also been told by a dentist friend of mine, and much to my dismay this particular bacteria found its way into my urinary system (it was cultured so was definitely this bacteria) and I had to have 14 days of intravenous carbapenem to get rid of it, which was extremely expensive. See below...................

 

Streptococcus sanguinis (S. sanguinis) is an abundant oral commensal which can cause disseminated human infection if it gains access to the bloodstream. The most important among these diseases is infective endocarditis (IE).

https://www.frontiersin.org/articles/10.3389/fmicb.2020.00010/full

 

S. sanguinis is a normal inhabitant of the healthy human mouth where it is particularly found in dental plaque, where it modifies the environment to make it less hospitable for other strains of Streptococcus that cause cavities, such as Streptococcus mutans.

 

S. sanguinis may gain entrance to the bloodstream when opportunity presents (dental cleanings and surgeries) and colonize the heart valves, particularly the mitral and aortic valves, where it is the most common cause of subacute bacterial endocarditis.

 https://en.wikipedia.org/wiki/Streptococcus_sanguinis

The trouble is, everybody uses quotes from Google without having any in-depth understanding of the various and complicated mechanisms related to the workings of the human body. It's not black and white! Two properly conducted studies can come up with 2 different end results; and they're both right. This is because of biological subtleties and different interpretations. So contrary to what the media and shallow social media blogs tell you, there is no magic bullet; just boring protocols to hopefully get a positive result. And of course, the waters are muddied further by ignorant idiots such as King Charles III, who is a laughingstock to British doctors!

[crouchpeter]

5 minutes ago, crouchpeter said:

The trouble is, everybody uses quotes from Google without having any in-depth understanding of the various and complicated mechanisms related to the workings of the human body. It's not black and white! Two properly conducted studies can come up with 2 different end results; and they're both right. This is because of biological subtleties and different interpretations. So contrary to what the media and shallow social media blogs tell you, there is no magic bullet; just boring protocols to hopefully get a positive result. And of course, the waters are muddied further by ignorant idiots such as King Charles III, who is a laughingstock to British doctors!

Just an edit. Strep. are also found in the bowel, urinary tract, vagina etc. , so its unlikely oral bacteria would infect the urinary tract.

[xylophone]

1 hour ago, crouchpeter said:

The trouble is, everybody uses quotes from Google without having any in-depth understanding of the various and complicated mechanisms related to the workings of the human body. It's not black and white! Two properly conducted studies can come up with 2 different end results; and they're both right. This is because of biological subtleties and different interpretations. So contrary to what the media and shallow social media blogs tell you, there is no magic bullet; just boring protocols to hopefully get a positive result. And of course, the waters are muddied further by ignorant idiots such as King Charles III, who is a laughingstock to British doctors!

The quotes I used were from carefully controlled studies and not just any old "quotes from Google", and furthermore there is more information available on it, the deeper you wish to look; and I have been doing this research for decades now, and I have enough information and links in this research to prove my point.

I don't follow the media and "shallow social media blogs" when doing my research on prostatitis, but I do follow published papers and peer reviewed studies.

 

I'm not doubting your qualifications, however I am saying that you are mistaken on this particular point and my next point below further backs this up.

 

1 hour ago, crouchpeter said:

Just an edit. Strep. are also found in the bowel, urinary tract, vagina etc. , so its unlikely oral bacteria would infect the urinary tract.

Again, further research will show that streptococcus sanguinis has been found in the prostate and in my case it was found in the urinary tract, which was verified by culture tests done at Bangkok Phuket Hospital.

 

The article below will explain this and hopefully put paid to any doubts you may have about this particular bacteria...........

 

According to the classification criteria established by the U.S. National Institutes of Health (NIH), prostatitis is divided into the following four categories: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and asymptomatic prostatitis. CP/CPPS reportedly has a significant negative impact on the quality of life.1, 2 CP/CPPS accounts for 80% to 90% of prostatitis cases,3 but its etiology and pathogenesis remain poorly understood.

The pathogens isolated from global cases of acute and CP primarily include Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, Klebsiella, Proteus spp., Enterococcus spp., Pseudomonas aeruginosa, and Corynebacterium.4, 5 Chronic bacterial prostatitis may also be caused by anaerobic bacteria, the most common of which are Streptococcus sanguis and Bacteroides. Studies have also shown that sexually transmitted microorganisms, such as mycoplasma, Chlamydia trachomatis, Neisseria gonorrhoeae, human papillomavirus, and Trichomonas vaginalis, are among the most common pathogens of CP.3, 6

https://onlinelibrary.wiley.com/doi/full/10.1002/pros.23971
 

AND from another publtshed article:  Blood and urine cultures resulted positive for S. sanguinis. In this case, we report S. sanguinis causing urinary sepsis as a primary inciting event. Although S. sanguinis is an unusual cause of urinary tract pathology, treatment should be considered if the clinical picture is consistent with infection. Given the concern of dissemination, we recommend at least two weeks of antibiotics against S. sanguinis with repeated negative blood cultures prior to ureteral procedures.

 

For the record, my son is a medical professional in London and specialises in infectious diseases, and has published many papers. Perhaps the need to gain knowledge in this area is genetic!!!!!!!

[retiree]

20 hours ago, crouchpeter said:

First of all; I'm a dentist. It's strep. viridans found in the mouth, and it can compromise damaged or artificial heart valves only!

Gosh, it's almost as though you knew the American Heart Association evidence-based guidelines on the recommended use of antibiotic prophylaxis ???? 

 

We continue to recommend VGS IE prophylaxis only for categories of patients at highest risk for adverse outcome while emphasizing the critical role of good oral health and regular  access to dental care for all.  Randomized controlled studies to determine whether antibiotic
prophylaxis is effective against VGS IE are needed to further refine recommendations.

https://www.ahajournals.org/doi/10.1161/CIR.0000000000000969 

 

Fwiw, when I first read this thread I agreed with the "take the antibiotics" group -- it's what I've always gotten over the years. 

 

However, it turns out that thinking has changed in light of evidence, e.g. this Cochrane review from 2021.  After raising some concerns about the quality of evidence, it says: 

 

We concluded that antibiotics given to healthy people when they are having teeth extracted may help prevent infection, but the decision to use an antibiotic should be judged on an individual patient basis based on their state of health and possible complications of getting an infection.  ... On average, treating 19 healthy patients with prophylactic antibiotics may stop one person from getting an infection. 

https://www.cochrane.org/CD003811/ORAL_are-antibiotics-effective-way-prevent-infection-following-tooth-removal 

 

Interesting topic, 

-- Retiree