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opinion: antibiotics aren't the answer to most toothaches
3 minute read
tooth pain deserves timely, appropriate care. in most cases, this means finding the best way to ease discomfort, not filling an antibiotic prescription.
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toothache discomfort is real, and so is the need for relief. often patients leave a dentist, walk-in clinic or doctor’s office with an antibiotic prescription for a quick fix. but in most cases, this can do more harm than good.
most tooth pain can be managed with a dental procedure, pain relief medication or sometimes a combination of both. antibiotics do not address the cause of most dental pain, which may be caused by cavities, infection or a damaged tooth.
despite this, antibiotics continue to be widely prescribed for tooth pain. studies show antibiotics are often given as a precaution in dental care, even though up to 80 per cent of these prescriptions are unneeded.
so why are antibiotics still being prescribed for a toothache? if a patient is in pain, prescribing antibiotics can feel like a quick and safe decision. and if dental care is delayed or unavailable, antibiotics may seem like the only option.
but relying on antibiotics to relieve pain comes with unintended consequences—that affect everyone. for the individual patient, these medications can cause unwanted side effects such as nausea, upset stomach, diarrhea or more serious complications.
the growing concern is that, over time, unnecessary use, especially in treating common infections, also contributes to antimicrobial resistance, which means these medications, even the most powerful available, may be less effective when any of us truly needs them.
dentists are responsible for nearly 10 per cent of all antibiotic use in canada. this puts them in a key position to help patients understand when antibiotics are needed and when they are not. it starts with having clear conversations about what is causing the pain and whether antibiotics are the answer.
there is often confusion about when antibiotics are needed before a dental procedure. in some cases, such as for people with heart valve replacements, or a history of heart valve infection, antibiotics may help prevent bacteria from causing serious complications. but for other heart conditions, like a minor heart murmur, antibiotics are not helpful and can lead to unnecessary side effects.
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the same misunderstanding applies to joint replacements. many believe that having a hip, knee or shoulder implant means antibiotics are always needed before dental treatment. current evidence shows that in most cases, they are not.
to support the effort to reduce unnecessary antibiotic use in dental procedures, experts developed a national toolkit with guidance for dentists and other providers. created by choosing wisely canada and supported by the canadian dental association, the toolkit includes resources such as a dental prescription pad that explains ways to relieve pain without antibiotics. the toolkit also provides answers to common questions for providers and patients.
patients also play a role. seeking dental care early—especially now that dental care is available to more canadians, through the federal dental care program or otherwise, asking whether antibiotics are necessary, and learning how to safely manage symptoms all help. good brushing, a healthy diet and regular dental examinations can also prevent toothaches from happening in the first place.
although antibiotics may seem like a quick fix for pain, they are not always the right choice. a more informed discussion between patients and healthcare providers means safer care, fewer side effects and preserving antibiotics for when they are truly necessary.
tooth pain deserves timely, appropriate care. in most cases, this means finding the best way to ease discomfort, not filling an antibiotic prescription.
dr. louann visconti is an orthodontist in timmins, ontario and choosing wisely canada society lead for the canadian dental association.
dr. susan sutherland is choosing wisely canada society co-lead for the canadian association of hospital dentists and associate professor at university of toronto.
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