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Antibiotic stewardship is the effort to measure antibiotic prescribing; to improve antibiotic prescribing by clinicians and use by patients so that antibiotics are only prescribed and used when needed; to minimize misdiagnoses or delayed diagnoses leading to underuse of antibiotics; and to ensure that the right drug, dose, and duration are selected when an antibiotic is needed.

Inappropriate antibiotic use contributes to the spread of antibiotic resistance (meaning that drugs may be less likely to work in the future). Inappropriate antibiotic use also contributes to increased health care costs, adverse drug reactions, and health care and community-associated Clostridium difficile infections (a potentially deadly form of diarrhea). Annually in the United States, approximately two million people develop infections from antibiotic-resistant bacteria, and 23,000 people die as a result of these infections according to the CDC.

The American Dental Association (ADA) Council on Scientific Affairs provides a set of clinical guidelines that should be used as a resource when prescribing antibiotics. The ADA also provides guidance for antibiotic prophylaxis prior to dental procedures, focused on prevention of prosthetic joint infection and infective endocarditis. In 2015, ADA released the following clinical recommendation for management of patients with prosthetic joints undergoing dental procedures: “In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection. For patients with a history of complications associated with their joint replacement surgery who are undergoing dental procedures that include gingival manipulation or mucosal incision, prophylactic antibiotics should only be considered after consultation with the patient and orthopedic surgeon. To assess a patient’s medical status, a complete health history is always recommended when making final decisions regarding the need for antibiotic prophylaxis.”

What other resources are available for those interested in knowing more about antibiotic stewardship?

To learn more about antibiotic stewardship, please click on the following link: https://www.cdc.gov/oralhealth/infectioncontrol/faqs/antibiotic-stewardship.html

A visible spray is created during the use of rotary dental and surgical instruments (e.g., handpieces, ultrasonic scalers) and air-water syringes. This spray contains primarily a large-particle spatter of water, saliva, blood, microorganisms, and other debris. This spatter travels only a short distance and settles out quickly, landing either on the floor, nearby operatory surfaces, the dental health care personnel providing care, or the patient. This spatter can commonly be seen on face shields, protective eyewear, and other surfaces immediately after the dental procedure, but after a short time it may dry clear and not be easily detected. The spray may also contain some aerosol. Aerosols take considerable energy to generate, consist of particles less than 10 microns in diameter, and are not typically visible to the naked eye. Aerosols can remain airborne for extended periods of time and may be inhaled. Aerosols should not be confused with the large-particle spatter that makes up the bulk of the spray from handpieces and ultrasonic scalers. To prevent contact with splashes and spatter, dental health care personnel should position patients properly and make appropriate use of barriers (e.g., faceshields, surgical masks, gowns), rubber dams, and high-volume evacuators.

Although it is known that bloodborne pathogens can be transmitted through mucous membrane exposure, there are no known instances of a bloodborne pathogen being transmitted by an aerosol in a clinical setting. In studies conducted in dental operatories and hemodialysis centers, hepatitis B surface antigen could not be detected in the air during the treatment of hepatitis B carriers, including during procedures known to generate aerosols. This suggests that detection of HIV in aerosols would also be uncommon, since the concentration of HIV in blood is generally lower that that of HBV. Finally, detection of HIV in an aerosol would not necessarily mean that HIV is readily transmissible by this route. In the health care setting, the major risks of HIV infection are blood contact due to percutaneous injuries and, to a lesser extent, mucous membrane and skin contact. The possibility that HIV may be transmitted via aerosolized blood must be considered theoretical at this time.