Do I need to take antibiotics before my dental visit?

Physicians and dentists may recommend that a patient takes antibiotics prior to certain dental procedures. This is called “antibiotic prophylaxis”. But why do physicians and dentists at times recommend antibiotic prophylaxis?

All of us have bacteria in our mouths, and many dental procedures allow bacteria to enter the blood stream. This is known as bacteremia. For most of us, this does not pose a problem. A healthy immune system typically prevents the bacteria from causing any harm.There is a concern, however, that for some people, bacteremia could potentially cause an infection elsewhere in the body.

Who is at risk?

Antibiotic prophylaxis is recommended for people who have specific heart conditions. In 2008, the American Heart Association released new guidelines identifying people who need to take antibiotics prior to dental care. Antibiotic prophylaxis should be considered for people with:

• Artificial heart Valves
• A history of endocarditis
• A heart transplant with abnormal heart valve function

Certain congenital heart defects including:

• • Unrepaired cyanotic congenital heart disease, including people with palliative shunts and conduit

• • Defects repaired with prosthetic material or a device for the first six months after the repair procedure
  • Repaired congenital heart disease with residual defects, such as persisting leaks or abnormal flow at or adjacent to a prosthetic patch or prosthetic device

The guidelines prior to 2008 suggested use of antibiotics for many additional conditions. Conditions for which antibiotic prophylaxis is no longer recommended include:

• Mitral valve prolapse or heart murmur
• Rheumatic heart disease
• Bicuspid valve disease
• Calcified aortic stenosis
• Any heart condition present from birth that is not listed above

Antibiotic prophylaxis guidelines were also developed for those who have orthopedic implants, such as artificial joints. In the past, antibiotics were recommended for two years post artificial joint placement. And in rare occasions, more than two years. In 2012, the American Dental Association and the American Association of Orthopedic Surgeons updated these recommendations.

The new guidelines do not recommend routinely prescribing antibiotics for people with artificial joints. Due to these changes, dentists and physicians rely more on case-by-case assessments and consultation with patients to determine when antibiotics are appropriate with orthopedic implants. For example, antibiotic prophylaxis might be used for the patients that also have a compromised immune system which might increase the risk of orthopedic implant infection.

If you have a heart condition or an orthopedic implant, talk with your dentist or physician about whether antibiotic prophylaxis is necessary.

Sources:

https://www.heart.org/en/health-topics/infective-endocarditis

http://www.ada.org/~/media/ADA/Member%20Center/Files/PT ED Page Antibiotics 2.ashx