An Early Bite with Dr. John Paul: “Why Won’t You Give Me an Antibiotic?”

By Dr. John Paul, FDA Editor

Have any of you heard this today?

“Doc, I’m calling you at home after hours because I’ve got this toothache again. This time it’s been hurting about a month and it’s just killing me. You’ve got to call me in an antibiotic.”

Here’s my answer:

“Mrs. Gruntbuns, back when Mr. Fleming found penicillin, antibiotics seemed like magic. You give people a pill and their problems went away. While that was the net effect, what really happened was the drug killed enough of the infection that your body could heal itself. The drugs were so new that they wiped out every bacteria they came in contact with. It’s important to remember over time that changes. The more often bacteria contacts a drug that does not completely wipe them out, the more they develop resistance to the drug until that drug becomes harmless to the bacteria.

“We’ve talked about this before. That antibiotic I gave you last time was to help you get by until you got a real treatment. Once a tooth is infected enough that you have symptoms, there is no way for your body to heal it after a little help from a drug. You’ll need a real treatment like a root canal or an extraction to remove the source of the infection before you can heal. The more times you get a drug without the real treatment, the more the bugs get a chance to become resistant.

“Tomorrow morning I can get you an appointment with an endodontist or an oral surgeon. Which would you prefer?”

Have a question you have a tough time answering? Send it to Dr. Paul at jpaul@bot.floridadental.org.

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