Patients undergo dental surgery for a number of reasons, and it can often be a stressful, expensive, and time-consuming endeavour. It’s essential that opportunities to maximise treatment success are taken, by both clinician and patient alike.
There is one consistent risk to post-surgical complications and failure, whether a patient is having a tooth extracted, an implant placed, or soft hard tissue treatment is provided – infection.
Luckily, there are actions both clinicians and patients can take to prevent this from occurring, and provide a greater chance at treatment success in the long term.
In the treatment room
Clinicians must take action to avoid the source of infection being the equipment or practice area used to deliver dental care. Health Technical Memorandum 01-05[i] is always a dental professional’s first port of call when making decisions on this subject.
It states that all dental practices should have an infection control policy in place, detailing everything from personal hygiene routines to the cleaning and sterilisation of instruments, and the maintenance of relevant dental equipment.
In the case of surgical instruments, ensuring they are sterilised between patients is fundamental. Following a cleaning and disinfection protocol, which is recommended to be performed with an automated washer disinfector as best practice, instruments will preferably be sterilised with saturated steam under pressure, delivered at a high temperature.i
Sterilised instruments must be stored safely with efforts made to prevent recontamination. They should be separated from the clinical environment, away from sunlight and water, in a dry and cool area. Instruments enclosed within sealable pouches or wrappings to further prevent recontamination must be clearly identifiable, with a sterilisation indicator that confirms they have been subjected to the appropriate processes.i
By taking steps like these, the dental team can confidently minimise the risk of causing infection at the point of care.
Appropriate antibiotics
Dental professionals can also have an impact on the occurrence of postoperative infection through the instructions and treatment adjuncts they provide to patients.
The use of antibiotics in particular must be judged appropriately. Unneeded antimicrobials contribute to antimicrobial resistance.[ii] Therefore, they must only be used where necessary, and clinicians and patients must realise that they do not replace, but support medical intervention or oral hygiene routines.[iii]
In dentistry, antibiotic prophylaxis is typically used as a preventative measure against infection.iii For periodontally healthy patients with straightforward implant procedures, antibiotic use has been reported to help prevent infection, but the number of individuals that needed to receive this treatment before a positive influence is seen is greater than 5, which is a problem for many clinicians. It is commonly not deemed sufficiently effective for routine use in healthy patients.ii, [iv]
In the case of tooth extraction, antimicrobial prophylaxis before the procedure has been seen to reduce the risk of bacteraemia by 50%.ii Yet, it is still commonly recommended to be avoided where possible. Antibiotic prophylaxis may be appropriate for a compromised patient (immunocompromised, or at high risk of endocarditis or osteonecrosis) or in high-difficulty extractions, especially those with long durations.iii
Exercising clinical judgement is essential. In some cases, antibiotic prophylaxis will seem like an obvious and sensible action to take, despite concerns about antimicrobial resistance.
Nothing beats oral hygiene
Patients can have a great impact on the success of their surgery through the oral hygiene routines they keep pre- and post-procedure.
Whilst the judgement for antibiotic prophylaxis has to be selective in order to be effective, great oral hygiene is a non-negotiable benefit for every dental surgery procedure.
Improved oral hygiene and removal of dental biofilm reduces the incidence of dry socket post extractions, decreases the bacterial contamination of an implant site, and is the first line of treatment for periodontal diseases. iii
Supporting your patients with good oral hygiene advice, including the need to brush twice a day and be delicate around surgical sites, is bettered by suggesting effective products that can improve their oral hygiene routines.
This includes solutions such as the Waterpik® Cordless Slide Water Flosser. With the ability to remove up to 99.9% of plaque biofilm,[v] it is an excellent addition to an oral hygiene routine for patients before or after surgery. The Cordless Slide can remove plaque and debris from interdental spaces and below the gumline, where brushing and traditional flossing can’t reach. For convenience, it is easily compactable to 50% of its size, making it excellent for simple storage or travel.
With effective infection control within the practice, the appropriate provision of antibiotics, and exceptional oral hygiene routines, patients stand a great chance at minimising the risk of infection and subsequent complications post-surgery. The actions of the clinician influence each of these, reinforcing the difference they can make on a day-to-day basis.
For more information on Waterpik® Water Flosser products visit www.waterpik.co.uk. Waterpik® products are available from Amazon, Costco UK, Argos, Boots, Superdrug and Tesco online and in stores across the UK and Ireland.
Join the 3,000+ dental teams who have already benefitted from a professional Waterpik® Lunch & Learn. Book your free session for 1 hour of verifiable CPD and a free Waterpik® Water Flosser – available either face to face or as a webinar – at www.waterpik.co.uk/professional/lunch-learn/
Margaret Black bio
I have more than 40 years’ experience in dentistry, qualifying as a dental nurse in 1982 and gaining a Diploma in Dental Hygiene in 1992.
I have experience in both NHS and private dental practice and spent time travelling Scotland as a Clinical Hygienist in Dental Research.
Presently, I split my working week between fixed and locum hygienist posts and was lucky to secure a role as an independent contractor for Church and Dwight in 2019.
Each role compliments the other and I enjoy meeting different practice teams.
In my personal life, I am married with an adult daughter and enjoy spending time with family and friends. I love travelling and am looking forward to a long-awaited post pandemic holiday.
[i] Department of Health, (2013). Health Technical Memorandum 01-05: Decontamination in primary care dental practices. (Online) Available at: https://www.england.nhs.uk/wp-content/uploads/2021/05/HTM_01-05_2013.pdf [Accessed March 2024]
[ii] Hollingshead, C. M., & Brizuela, M. (2022). Antibiotic prophylaxis in dental and oral surgery practice.
[iii] Buonavoglia, A., Leone, P., Solimando, A. G., Fasano, R., Malerba, E., Prete, M., … & Racanelli, V. (2021). Antibiotics or no antibiotics, that is the question: an update on efficient and effective use of antibiotics in dental practice. Antibiotics, 10(5), 550.
[iv] Torof, E., Morrissey, H., & Ball, P. A. (2023). Antibiotic Use in Dental Implant Procedures: A Systematic Review and Meta-Analysis. Medicina, 59(4), 713.
[v] Gorur, A., Lyle, D. M., Schaudinn, C., & Costerton, J. W. (2009). Biofilm removal with a dental water jet. Compendium, 30(1), 1.
