For patients with certain heart conditions, prosthetic heart valves, or a history of infective endocarditis, taking antibiotics before certain invasive dental procedure serves as a preventive measure to reduce the risk of bacterial infection. For these susceptible patients, the prophylactic antibiotics help safeguard their oral health and overall well-being. For most other patients though, antibiotic premedication before dental treatment is generally NOT recommended.
In this blog post, we will discuss what antibiotic prophylaxis is, what are the current guidelines for it and when it may be recommended before dental appointments.
What is Antibiotic Prophylaxis?
Antibiotic prophylaxis, also known as premedication, is the administration of antibiotics before certain medical or dental procedures to prevent the occurrence of bacterial infections.
Dental procedures such as teeth cleaning, scaling and root planning, tooth extractions, root canal treatments, and dental implants create opportunities for bacteria in the mouth to enter the bloodstream, potentially causing severe infections somewhere else in the body. Antibiotic prophylaxis acts as a protective shield, reducing the risk of infection.
Who Needs Antibiotic Prophylaxis Prior To Dental Procedures?
Most people are protected by their immune system from bacteria from the mouth that may enter the bloodstream. Others who have pre-existing medical conditions, such as patients with different cardiac conditions or weakened immune systems, may need additional protection with antibiotics.
When is infective endocarditis prophylaxis before dental treatments recommended?
In 2007, the American Heart Association (AHA) published updated evidence-based guidelines on the recommended use of antibiotic prophylaxis to prevent infective endocarditis (IE) in cardiac patients undergoing invasive procedures . These guidelines significantly scaled back the underlying conditions for which antibiotic prophylaxis was recommended, leaving only 4 categories thought to have the highest risk of adverse outcome:
- Prosthetic cardiac valve;
- History of infective endocarditis;
- Cardiac transplant patients with valve regurgitation due to a structurally abnormal valve;
- Congenital Heart Disease (CHD):
- unrepaired cyanotic congenital heart disease, including palliative shunts and conduits
- any repaired congenital heart defect with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or a prosthetic device
No premedication with antibiotics is recommended for heart conditions other than listed above.
What are the guidelines regarding premedication to prevent joint infection?
Based on guidance from the American Academy of Orthopedic Surgeons (AAOS), and the latest clinical practice guideline from American Dental Association (ADA), in general, for patients with prosthetic joint implants, prophylactic antibiotics are NOT recommended prior to dental procedures to prevent prosthetic joint infection. There is evidence that dental procedures are not associated with prosthetic joint implant infections and that antibiotics provided before oral care do not prevent these infections.
For patients with a history of complications associated with their joint replacement surgery, and in cases where antibiotics may be deemed necessary, it is most appropriate for the orthopedic surgeon to recommend the appropriate antibiotic regimen and, when reasonable, write the prescription.
What dental procedures may require antibiotic prophylaxis?
- All dental procedures that involve manipulation of the gingival tissue, like gum surgeries, teeth cleaning, deep scaling and root planning.
- Root canal treatment
- Manipulation of the periapical region of teeth, teeth extractions, apicoectomies
- Perforation of the oral mucosa, incisions, oral surgery including dental implant placement, etc.
Antibiotic prophylaxis is not recommended for routine local anesthesia injection through non-infected tissue, or while taking dental radiographs, impressions or scans of the teeth, or for placements of removable denture, orthodontic appliances, or other non-invasive dental procedures.
What are the downsides of antibiotic use before dental treatment?
• There are potential harms of using antibiotics including risk of anaphylaxis, antibiotic resistance, and opportunistic infections like Clostridium Difficile associated colitis.
• For most patients, the benefit of antibiotic prophylaxis may not exceed the harms.
• The individual patient’s circumstances and preference should be considered when deciding whether to prescribe prophylactic regimen prior to dental procedures.
How can laser bacterial reduction help minimize infection risk and protect susceptible patients?
Laser bacterial reduction or laser decontamination is the use of dental laser to minimize the bacterial load present in your mouth and gums and to reduce pathogens, minimize aerosols, and reduce bacteremia during dental procedures.
This means that when a dental laser is used on the tissues before a dental procedure, the laser beam selectively destroys bacteria can potentially escape into the blood stream and disseminate onto weakened sites such and the heart valves or the joints in susceptible patients.
Minimizing oral pathogens would be useful for any patient, but it is especially recommended for immuno-compromised, elderly, or patients who need to premedicate with antibiotics before their dental visits. Laser bacterial reduction, however, is not a substitute, but a supplement to antibiotic prophylaxis for the category of cardiac patients outlined by the AHA guidelines from 2007.
The procedure takes about 5-10 minutes to complete and requires no local anesthesia.
Key Points To Remember
Antibiotic prophylaxis is the preventative administration of antibiotics to protect susceptible patients from developing bacterial infections.
The American Heart Association and the American Dental Association are two prominent professional organizations that offer comprehensive guidelines and recommendations for antibiotic prophylaxis. In the context of dental appointments, the most recent guidelines recommend that antibiotic prophylaxis should be limited to specific patient populations and dental procedures. The guidelines have evolved, and the focus has shifted towards a more targeted and individualized approach, taking into account the specific medical history and risk factors for the patient.
In general, antibiotic prophylaxis is recommended for patients with the highest risk of infective endocarditis, including those with prosthetic heart valves, previous infective endocarditis, specific congenital heart defects, and cardiac transplants.
For most other patients, antibiotic prophylaxis is NOT recommended for dental procedures.
Unsure If You Need Antibiotics Before Dental Work?
If you have questions or if you are wondering whether you need to use antibiotics before a dental treatment with us, then please discuss your concerns with Dr. Tufa before your appointment. Based on your medical history and the type of dental procedure being performed, she can help you determine if you have a high risk of infection that may require the use of antibiotics for preventative reasons.