Do I Need Antibiotics Before My Dental Appointment?
There is a long-standing protocol that certain patients should take a large dose of antibiotics immediately prior to dental procedures. This approach is changing, and the ADA no longer recommends preventative antibiotics for most joint and heart patients.
Older guidelines that recommended these antibiotics were not based on studies that indicated a dental procedure would put such a joint at risk. In addition, no studies have indicated that a single dose of antibiotics before an appointment would protect these joints. *111 The premedication dose of antibiotics just seemed like a good idea at the time.
Physicians are becoming concerned that “prophylactic antibiotics” may be contributing to both patient intolerance and bacterial resistance, preventing antibiotics from working when you actually need them the most. For these reasons, the American Dental Association no longer recommends routinely taking these large doses prior to having a dental procedure for the majority of patients.
More recent guidelines, by both the ADA and the American Academy of Orthopaedic surgeons, support this approach. It is recommend that only patients with relatively specific and severe conditions take these antibiotics. *1, 11 These are outlined below, and are intended as a guideline for both the dentist and the physician. Typical patients with a healthy artificial joint, simple heart murmur, cardiac stents, are NOT RECOMMENDED to take the typical 2,000 mg dose of Amoxicillin prior to their dental appointment.
In order to comply with the ADA and AAOS guidelines, Ashtabula Dental Associates will no longer be providing prophylactic antibiotics for most joint replacements and medical conditions, with a few exceptions. These exceptions are outlined below, and generally involve complex heart problems, severe autoimmune conditions, or a documented history of heart or joint infections. In these patient populations, it is expected that the benefit of taking these antibiotics outweighs the potential risks *1v We will be enforcing this policy beginning in 2022, to give us enough time to visit with many of our joint patients and explain this transition chairside.
If you have had an artificial joint placed, your particular surgeon may still require you to take antibiotics before dental procedures. We ask those patients to follow up with their surgeon and follow the protocol that they recommend. In these cases, your particular surgeon’s office should be your source for those prescriptions. Our office protocol is to follow the current ADA recommendations, which does not recommend preventative antibiotics for typical joint patients, but it is the patient’s responsibility to follow any special guidelines set forth by their surgeon.
Please have a conversation with your dentist and physician to determine if you would benefit by taking antibiotic premedication before your dental procedures.
prosthetic cardiac valves, including transcatheter-implanted prostheses and homografts;
prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords;
a history of infective endocarditis;
a cardiac transplant with valve regurgitation due to a structurally abnormal valve;
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
Cardiac Conditions still requiring premedication
(ADA 2015 Guidelines)
Works cited
1 https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis
11 https://www.aaos.org/globalassets/quality-and-practice-resources/dental/pudp_guideline.pdf
1v https://www.ada.org/en/member-center/oral-health-topics/antibiotic-stewardship