Listen to this alarm bell in the current issue of the British Dental Journal:

Current prescribing data by general dentists in England and Scotland demonstrates that approximately 60% and 52%, respectively, of the total metronidazole prescribed in primary care is for dental infections.8,9 It is difficult to understand why metronidazole is so widely prescribed in dental practice because the first line of treatment for acute dental infections should be infection source control, that is, surgical treatment (extraction, endodontics, incision and drainage, debridement etc). If required then the first line antimicrobial agent is a beta-lactam (penicillin, amoxicillin).10 The dental team should become more aware of the importance of antimicrobial stewardship to conserve metronidazole.

My mentor, Dr. Walter Loesche of the University of Michigan, pioneered metronidazole’s use in avoiding periodontal surgery. It is very effective, very affordable, seemingly safe but now has an overriding concern called microbial resistance. Metronidazole has more important medical uses such as managing C. difficile.

As reported in this blog last year, medicine is reducing its use of antibiotics. The opposite is the case for dentistry.

A post-antibiotic world is a big challenge for how we go about delivering oral health services.


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