Viewpoint: Oral care deserves your attention

February 19, 2007

Addressing the Cincinnati Dental Society back in 1883, dentist F. A. Hunter said, "Your patients will bless you; you become happy in consequence. They leave your office showering down upon you the highest encomiums, and never come back again." His subject: a new medicament to treat dental caries that was made up of a paste compounded from one pint of sorghum molasses mixed with one pound of English sparrow (yes, the bird) droppings! Small wonder the good doctor's patients never returned.

Growing up the son of a pharmacist who owned the lone store in a rural town with only one physician, one dentist, and no hospital, I became aware very early in my life that my dad was the individual who was the most knowledgeable healthcare provider in the community. Along with that knowledge, he held the highest levels of trust and confidence of his patients-people who relied on him on a daily basis to guide them on how best to treat their illnesses and understand what was, even then, an increasingly complex and confusing world of strange-sounding medications and unfamiliar regimens. Although he was "Dad" to me, he was "Doc" to most everyone else, and rightly so, for his vast familiarity with so many facets of medicine. We've all witnessed unprecedented changes in the healthcare system since the days when my father filled prescriptions and proffered advice, but even today that central role of pharmacist as caring, learned professional and health adviser remains intact.

Dental abscess from an infected tooth is an infection more akin to gangrene and requires root canal or extraction. These infections contain a mixed flora of bacteria but are populated mostly by anaerobes and need to be treated accordingly. Too often, uninformed dentists prescribe cephalexin to their patients as their antibiotic of choice, when clindamycin, amoxicillin/clavulanate, or metronidazole in combination with penicillin would be the far better option. As with the hapless Dr. Hunter, the rationale for treatment with topicals and inappropriate antibiotics may not be based on science but, rather, on alleged experience from the "it works for me" school of ignorance.