Do I Need to Take Antibiotics Before My Dental Appointment?

Almost every day, a patient will come into the office asking for a prescription for antibiotics to take prior to a scheduled dental appointment. However, the reality is that most people do not need to take antibiotics prior to their dental appointments. The original theory with regard to establishing an antibiotic regimen prior to dental treatment revolves around the concern that bacteria can enter the blood system—a condition called “bacteremia.” When a dental procedure is performed, whether a routine cleaning or something complex (such as a dental crown or extraction), blood flow from a patient’s gums is often common.  

            Bacteria in the mouth is very common and even normal. However, the concern has been that if that bacteria were transferred to another part of the body, particularly areas that happen to be in a “weakened” state (possibly caused by an artificial joint installment, heart murmur or otherwise), the bacteria could potentially damage, or further damage, that weakened area. Bacteria in the mouth could easily be transferred to another part of the body through the bloodstream as a result of bleeding gums, causing bacteremia, or infective endocarditis.

            Over the years, the American Heart Association (AHA) has actually lessened the regimens and recommendations regarding this subject. Still, many patients insist on taking some type of antibiotic prior to dental care. In addition, many physicians still insist on recommending antibiotic usage prior to dental care.

            New research by the AHA has changed the guidelines tremendously. Studies conclude that a patient actually has a greater risk of having an adverse reaction to antibiotics than to a joint or weakened heart resulting from a transient increase of bacteria in the body’s blood. In other words, an individual has a greater chance of having some sort of allergic reaction from taking antibiotics (ranging from a mild reaction, such as a rash, to a severe one, such as difficulty breathing or, in some cases, even death) than developing a bacterial infection resulting from bleeding gums. Moreover, simple brushing and flossing can often cause more bacterial exposure than an occasional dental visit! This, of course, does not mean that one shouldn’t brush and floss. The bottom line is that there is no concrete evidence showing that taking a dose, or even several doses, of antibiotics can definitively prevent infective endocarditis.

            According to the AHA, there are some cases in which a person should take antibiotics prior to dental care. These include patients with a past history of infective endocarditis; patients with artificial heart valves; patients with heart transplants, including a history of transplant damage; and those with unrepaired congenital heart valve problems. Patients with heart murmurs, a history of rheumatic fever or other valve problems usually do not need to take antibiotics prior to care. It is recommended that an individual consult a cardiologist (preferably their own if they have one) to get the best information and advice.

            For many years, orthopedic surgeons have provided antibiotics to patients with artificial joints—again, thinking that certain dental procedures introduce bacteria into the bloodstream, potentially causing infection in the prosthetic joint. A prosthetic joint infection is a very difficult complication to treat. Treatment may require the removal of the prosthetic joint and the installment of a new one, patient immobilization (sometimes for months), and intravenous antibiotics. It seemed reasonable and justified to provide antibiotics to help prevent such serious complications.

            The AHA has now, however, discontinued the recommendation to take antibiotics prior to dental treatment to prevent prosthetic joint infections. The recommendation from the American Dental Association now states, “In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infections.” Many orthopedic surgeons still recommend premedication following a joint replacement; however, there is no science to back this recommendation other than in the specific cases previously cited.

            The bottom line is you may not need to take antibiotics prior to dental care. It’s best to do your own research.

For more information, call The Art of Dentistry (located at 7505 St. Andrews Rd., in Irmo) at 803-781-1600.