A source of confusion in Dentistry for several years has been the use of antibiotic prophylaxis prior to certain dental procedures. We have devoted this issue of our Office Newsletter to review the latest recommendations and protocols in the use of antibiotic premedication prior to dental treatment. Antibiotic prophylaxis has historically been recommended for certain at risk patients prior to dental treatment.
Procedures that could potentially involve bleeding of the gums; such as cleanings, extractions, root canals, and most restorative procedures have required antibiotic premedication in the past. The individual best equipped to determine whether you require antibiotic premedication before your dental treatment is your Cardiologist or Orthopedic Surgeon. They are the most knowledgeable of your actual diagnosis and risk factors.
There are guidelines in place in case your Cardiologist or Orthopedist has not specifically spelled out your particular needs. Antibiotic prophylaxis recommendations exist for two groups of patients:
- Those with heart conditions that may predispose them to Infective Endocarditis (infection of the lining around the heart);
- Those who have prosthetic joints and may be at risk for developing secondary infections at the site of the prosthetic.
- Prevention of Infective Endocarditis
The most current guidelines (2008) support premedication for a much smaller group than noted in previous years. This change was based on the review of scientific evidence, which showed that the risk of adverse reactions to antibiotics outweigh the benefits of antibiotic coverage for most patients. Patient Selection The current guidelines state that the use of preventive antibiotics before certain procedures is reasonable for patients with:
- Prosthetic heart valves or prosthetic material used for heart valve repair
- A history of Infective Endocarditis
- A cardiac transplant that develops cardiac valvulopathy
- Certain congenital (present since birth) heart conditions or disease:
- Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits
- Completely repaired congenital heart defect with prosthetic material or device during the first six months after the procedure
- Any repaired congenital heart defect with residual defect at the site
- It is very important to obtain your specific diagnosis from your Cardiologist, if you wish to avoid taking antibiotics.
Prevention of Prosthetic Joint Infection The most current guidelines (2014) concluded that prophylactic or preventive antibiotics given prior to dental procedures are no longer recommended for patients with prosthetic joint implants. For patients with a history of complications associated with their joint replacement surgery who are undergoing dental procedures that may induce bleeding, prophylactic antibiotics should only be considered after consultation with the patient and Orthopedic Surgeon. Clinical Reasoning for the Change in Recommendation
- There is clinical evidence that dental procedures are not associated with prosthetic joint implant infections.
- Evidence is lacking that antibiotics provided before dental treatment actually prevent prosthetic joint implant infections.
- There are potential harms of antibiotics including risk for allergic reactions, antibiotic resistance or opportunistic infections.
- The benefits of antibiotic prophylaxis may not exceed the risk of harms for most patients.
- Each individual patient’s circumstances and preferences should be considered when deciding whether to prescribe prophylactic antibiotics prior to dental procedures.
There are far fewer medical conditions which dictate the routine use of prophylactic antibiotics prior to dental treatment. Please consult with your Physician if you are unsure of your specific diagnosis or condition.
Because of the number of years that antibiotics were routinely administered prior to dental treatment for certain cardiac & orthopedic conditions; it may take a few years to re-educate the public about these updated changes.
Sources & Additional Resources www.agd.org (Academy of General Dentistry maintained website and the Oral Health Fact Sheets) www.ada.org (American Dental Association maintained website)