Antibiotics in container

Using Prophylactic Antibiotics Prior to Dental Procedures

The AAOS Board of Directors and the American Dental Association published reports linking evidence that dental patients with prosthetic joints or cardiac problems should pre-medicate with antibiotics prior to dental procedures to reduce the risk of infection. These guidelines were to include procedures such as routine dental cleanings, scaling and root planing, crowns, root canals, dental extractions, and implants.

Many patients are asking why their dentists were telling them that they needed to take an antibiotic before having a dental procedure. They were told this:

A panel of experts from the American Dental Association along with the American Academy of Orthopaedic Surgeons and American Heart Association published their reviews and guidelines of preventing infection for these types of patients when having dental procedures. Their comprehensive research defined criteria that dental procedures were indeed risk factors for hip and knee implant patients and infective endocarditis recipients.

Studies determined that the association between having bacteria from the mouth enter the bloodstream during a dental procedure could easily occur due to certain factors. The most commonly known is by simply cleaning the teeth which can cause the gums to bleed. Even though this is usually a small amount of blood, it can allow slight amounts of bacteria to enter the blood stream. Studies show that bacteria can travel to the site of a prosthetic device like a hip or knee implant or heart valve and lead to an infection.

Because of this, medical professionals set out guidelines for prophylactic antibiotics prior to dental procedures to ensure their safety and lower the risk of complications of these types of patients, and determined that it is better to prevent a potential infection.

This is what they concluded:

  • There is evidence that dental procedures are not associated with prosthetic join implant infections
  • There is evidence that antibiotics provided before oral care do not prevent prosthetic joint implant infections
  • There are potential harms of antibiotics including risk for anaphylaxis, antibiotic resistance, and opportunistic infections like Clostridium difficile
  • The benefits of antibiotics for prophylaxis may not exceed the harms for most patients
  • The individual patient’s circumstances and preferences should be considered when deciding whether to prescribe prophylactic antibiotics prior to dental procedures

Dentists have been accepting these guidelines for all of these at-risk patients, but as time went on as this issue was continually reviewed for results, the effectiveness for antibiotic prophylaxis has not proven as effective as once thought, and the annual cost of the amoxicillin administered to these patients was exceeding $50 million dollars. The revision came about in 2014 suggesting that prophylaxis may prevent a small number of cases, but antibiotic-associated adverse events were exceeding the benefits of antibiotic therapy. That is when the “guidelines” became an “information statement” for dental patients.

Antibiotics are still highly recommended for all dental procedures that involve a disruption of the gingival tissue or perforation of the oral mucosa for these at-risk patients. Patients and practitioners should review the AHA guidelines which can be found at http://circ.ahajournals.org.

So, it is still a good idea to talk with your dentist about your health conditions in detail to determine whether you are a likely candidate for this type of prophylactic antibiotics prior to dental procedures.

Using Prophylactic Antibiotics Prior to Dental Procedures