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 Gregory C. Dilger D.D.S.           General Dentist            1353 Edgewater St.          West Salem          (503) 378-0466   

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Their use in Dentistry and the consequences

One of the greatest discoveries in medicine was the discovery of antibiotics.  These have saved countless lives over the years.  Dental infections were once a significant health threat, but now are little more than an annoyance thanks to antibiotics.  However, there are precautions, concerns and consequences to using our modern antibiotics.

When do we use antibiotics?  Patients will often ask for antibiotics when they have a toothache, if we tell them a tooth is abscessed or even just for a cold.  Pain is not a valid reason for using antibiotics.  An antibiotic works throughout the body, so systemic involvement is our indication.  This would include fever (99 is not a fever, 101 is), malaise (general feeling of tiredness, just not right), increasing swelling, cellulitis (a severe infection where the skin is hard as a board) and unexplained trismus (stiffness in the jaw).  Persistent infections are referred to a specialist.

We coexist with trillions of bacteria, fungi and other microbes in our skin, nose, mouth, and the entire digestive tract.  Many are harmless, some beneficial, a few indispensible but some are harmful, especially if allowed to grow out of control.  This is called the human microbiome.  When we have an infection, ideally we would like to eliminate only the bugs that are causing the infection, leaving all the entire healthy bacteria in the stomach alone.  We do not have that ability yet, so we use antibiotics that are most commonly effective against the bugs that are in the mouth, but many of our good bacteria are also killed off.  Infections can be cultured to determine the most effective antibiotic, but these usually do not show any unusual bacteria, take too long and significantly increase the cost of treatment.  We usually have the infection well under control before we could get culture results back.

There are several choices of antibiotics for infections in the mouth, but the number one choice in Penicillin.  Penicillin is effective against over 80% of the bacteria in the mouth that have been found to cause infections, has the lowest incidence of side effects and is very cost effective (read cheap).  We sometimes use enhanced Penicillin class antibiotics such as Ampicillin or Amoxicillin, but these have a broader spectrum of effectiveness and kill more of our beneficial bacteria (especially in the stomach) and are more expensive.  They are also more difficult to manage in the case of allergic reaction, and that is the main reason we do not use Penicillin exclusively.  Many people have developed allergic reactions to Penicillin.  When we have this situation, we have to go to a secondary choice, and they are all compromises.  Erythromycin is often used, but is not as effective and causes more stomach upset.  The same is true for Tetracycline.  The Cephalosporin class of antibiotics (such as Keflex) and Clindamycin are much more expensive, have a broader spectrum of activity (kill more of beneficial bacteria, especially in the stomach) and also can cause stomach upset.

One of the most significant side effects of antibiotic use is stomach upset. This can be both nausea and diarrhea. Diarrhea can be a sign of the bacteria Clostridium Difficile causing Pseudo-Membranous Colitis (often referred to just as C. Diff). Clostridium Difficile is hard to kill and it over grows when other beneficial bacteria is killed by the antibiotics. Any antibiotic can cause this, but the stronger, broader spectrum antibiotics have a higher incidence. This can be a very serious condition, and should be evaluated by your medical doctor. Most of these cases resolve on their own, but some can be very persistent, lasting for months. Taking probiotics (in active culture yogurt, or ask your pharmacist) could possibly help restore the digestive tracts normal human microbiome, and decrease this incidence.


by Dr. Gregory C. Dilger - September 15, 2010

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Patient Testamonials


Dear Dr. Dilger:


It all started with my initial phone call to Dr. Dilger's office. I felt so comfortable from the start and after I came in for my first visit it's been all about what I want and what Dr. Dilger and his staff recommends for me. All around, it's been the best dental experience I've ever had.


Al P.




Going to the dentist used to be a nightmare experience for me. That's all changed when I came to Dr. Dilger. Dr. Dilger's office staff are so warm and welcoming. Visiting them is like going home. Dr. Dilger's calm and caring manner erased all my dental anxiety and for the first time in my life I found myself relaxed in a dental chair. Dr. Dilger and his staff really took the time to get to know me and my concerns. They talked with me about my fears and helped me address my anxiety. Now I visit the dentist and I'm not afraid. I can not express the difference Dr. Dilger has made in my dental life! Thanks so much Dr. D.


Molly F.




I love my new smile.  It was so easy too.  Nearly pain free.  I am considering my lower teeth at a later date.


Debbie E.