At Smile Design Dentistry, your dentist will review your medical history and want to know of changes in your health every time you visit. A common question from patients is whether or not they should take antibiotics before dental procedures.
For some dental patients, antibiotics are prescribed to be taken one hour prior to dental procedures to combat bacteria that may enter the bloodstream. These are patients who are at high risk of bad outcomes from infective endocarditis, an infection of the heart’s inner lining or heart valves, or who are at high risk of bone infection after joint replacement. When antibiotics are recommended, doctors typically prescribe oral amoxicillin. There are alternatives for patients who are allergic to amoxicillin.
Heart Patients – What You Need to Know
The guidelines for taking antibiotics prior to dental procedures have been changing. Although some patients who took antibiotics in the past may no longer need to, each patient should follow the instructions of their physician. Your physician knows your health situation best and will make the judgment call about whether a short course of antibiotics is indicated for you.
The American Heart Association (AHA) now says that many patients who have taken preventive antibiotics regularly in the past no longer need them, including people with the following conditions:
- Mitral valve prolapse
- Rheumatic heart disease
- Bicuspid valve disease
- Calcified aortic stenosis
- Congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy. Your doctor may still prescribe antibiotics if you have:
- Artificial heart valves
- A history of an infection of the lining of the heart or heart valves known as infective endocarditis, an uncommon but life-threatening infection
- A heart transplant in which a problem develops with one of the valves inside the heart.
- Some heart conditions that are present from birth:
- Cyanotic congenital heart disease (birth defects with oxygen levels lower than normal), that has not been fully repaired, including children who have had a surgical shunts and conduits.
- A congenital heart defect that’s been completely repaired with prosthetic material or a device for the first six months after the repair procedure.
- Repaired congenital heart disease with residual defects, such as persisting leaks or abnormal flow at or adjacent to a prosthetic patch or prosthetic device.
Preventive antibiotics are no longer recommended by The American Heart Association for any other congenital heart disease. The American Heart Association guidelines are based on a growing body of scientific evidence that shows that the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks include adverse reactions to antibiotics and, more significantly, the development of drug-resistant bacteria.
According to the American Heart Association, a comprehensive review of published studies suggests that infective endocarditis is more likely to occur as a result of everyday activities than from a dental procedure. Scientists found no compelling evidence that taking antibiotics prior to a dental procedure prevents IE in patients who are at risk of developing a heart infection, as their hearts already are exposed to bacteria from the mouth, which can enter their bloodstream during basic daily activities such as brushing or flossing.
The American Heart Association also says that maintaining optimal oral health and optimal daily brushing and flossing are key to preventing harmful oral bacteria from entering your bloodstream. So, talk to your doctors, keep on brushing at least twice a day and flossing at least once a day, and regularly see your Smile Design Dentistry dentist.
Joint Replacement Patients – What You Need to Know
Individuals, who have undergone joint replacement surgery, are at risk for developing infections of their implanted joints. For many years now, doctors have prescribed antibiotics to be taken just prior to dental procedures. In 2012 the American Dental Association (ADA) and the American Academy of Orthopedic Surgeons (AAOS) jointly stated that antibiotics were not mandatory for joint implant patients undergoing routine dental work. In defending this statement, “both the AAOS and ADA stated that there was no evidence to suggest that the routine administration of antibiotics reduced the risk of joint implant infection.” The ADA’s updated review of the scientific literature in 2014 was published in 2015, and again reviewers found no association between dental procedures and prosthetic joint infections.
Despite this, your Smile Design Dentistry dentist and your physician may recommend you take antibiotics prior to dental procedures for two or more years after joint replacement. The American Dental Association states that in many cases, individuals with joint replacement are less able to fight the onset of infection and to combat it once it occurs. Those inherently at greatest risk are those with rheumatoid arthritis, lupus and other autoimmune disorders, insulin-dependent diabetics, and hemophiliacs, organ transplant recipients, those undergoing cancer therapy, those with advanced HIV infection, and those who have had previously had an infection of a joint implant.
If you are a heart or joint replacement patient, discuss this with your health providers.
Your medical history and current health status are of primary importance to all your healthcare providers. Tell your Smile Design Dentistry dentist about any changes in your health history. Comply with the recommendations of your dentist and physicians, as these recommendations are individualized for your health situation.
- Center for Scientific Information, ADA Science Institute. “Antibiotic Prophylaxis Prior to Dental Procedures.” Oral Health Topics. Updated June 25, 2018. https://www.verywellhealth.com/antibiotics-before-dental-work-2549523
- The American Heart Association, “Dental Procedures and Infective Endocarditis.” Health Topics. https://www.heart.org/en/health-topics/infective-endocarditis.
- The American Dental Association. “Antibiotic Prophylaxis for Heart Patients.” Mouth Healthy. https://www.mouthhealthy.org/en/az-topics/a/premedication-or-antibiotics
- Mark, Anita M. “What is antibiotic prophylaxis?” Journal of the American Dental Association. June 2016. https://jada.ada.org/article/S0002-8177(16)30298-7/abstract