Clinical Applications and Resistance of Antibiotics in Oral Surgery

Combination of Antibiotics

Used when there is a mixed infection, or for the following reasons:

• Where the infectious organism is not known.
• Where the two antibiotics can produce a greater effect (synergism) than one alone.
• To prevent the development of resistance to one antibiotic.

Indications for Antibiotics

Curative Treatment

The primary aim when:

1. Infection cannot be treated with surgery.
2. As supplements to surgery (adjunctive therapy).
3. In cases of osteomyelitis and actinomycosis.

Prophylactic Treatment

Starting approximately one hour before surgery.

Absolute Indications

• Prevention of subacute bacterial endocarditis before surgical procedures.
• Diabetic patients undergoing major oral surgery.
• Immunocompromised patients.
• Oral surgery in patients previously subjected to radiation treatment in the head and neck region.
• Patients with rheumatic fever.
• Patients with congenital or acquired heart disease.

Conditional Indications

• Generally debilitated patients.
• Treatment of complicated jaw fractures.
• Surgical intervention causing large bone cavities.
• Extensive soft tissue lesions.
• Tooth transplantation and reattachment procedures.

Contraindications of Antibiotics

• Allergy (Hypersensitivity)
• Renal failure
• Gastrointestinal disorders
• Hepatic failure

Diagnostic Aids for Maxillary Sinus

1. History taking.
2. Clinical examination (percussion and palpation, transillumination).
3. Radiographic examination (intraoral, extraoral, computed tomography - CT).
4. Sinoscopy.

Acute Maxillary Sinusitis: Clinical Features (CF)

• Pain referred to the cheek side.
• Interference with smell (hyposmia/anosmia).
• Dental pain.
• Foul-smelling nasal discharge.
• Constitutional symptoms (fever, malaise).
• In case of oro-antral fistula.

Treatment of Acute Maxillary Sinusitis

• Antibiotics
• Decongestants
• Analgesics
• In case of oro-antral fistula: irrigation and closure.

Chronic Maxillary Sinusitis: Clinical Features (CF)

• Dull, diffuse pain and headache.
• Impaired smell sensation.
• In case of oro-antral fistula, a soft tissue lump may be present.

Treatment of Chronic Maxillary Sinusitis

• Conservative treatments (similar to acute conditions).
• Caldwell-Luc operation if the case is irreversible.

Antimicrobial Resistance (AMR)

Definition

The ability of a microorganism to withstand the effect of an antibiotic.

Mechanism of Resistance

• Some bacteria acquire resistance traits.
• These traits may arise as new mutations.
• Resistance occurs if a bacterium carries several resistance genes.
• Resistance to drugs happens due to mutation (often related to insufficient dosage or prolonged use).

Patients at High Risk for Antibiotic Resistance

Patients most likely to develop antibiotic resistance include those who are:

• Very ill.
• In intensive care units (ICUs).
• On a long course of antibiotics.
• Recovering from major surgery.
• Being treated with invasive devices.
• Spending a long time in the hospital.