When Do I Need To Premedicate For My Dental Work?

As a dentist, I meet patients every day who are not familiar with the regulations of antibiotic prophylaxis.  Patients do not know if premedication with antibiotics is necessary for them due to a medical condition or procedure they had done.  I hope to shed some light on the most up-to-date indications for antibiotic prophylaxis as they have changed considerably by the American Dental Association, American Association of Orthopedic Surgeons and American Heart Association (or by the corresponding national associations).

Antibiotic prophylaxis (or premedication) is the act of taking antibiotics one-hour before certain dental procedures like cleanings, extractions, and root canals.  The bacteria we naturally have occurring in our mouths can enter our bloodstream due to everyday things we do like eating, brushing, flossing along with dental treatments mentioned earlier.  For the healthy immune system, this bacteria will not cause harm; however, it can pose a risk to those immune-compromised individuals.  For these reasons, patients have been told to take an antibiotic before their dental treatment.

Recommendations have changed for those who need to take antibiotics before their appointment.  Two types of patients who are to follow the premedication guidelines are people with prosthetic joints/orthopedic implants and those with heart conditions.

Prosthetic Joints/Orthopedic Implants:

 In the past years premedication was necessary for any patient with prosthetic joints, however as of January 2015, The American Dental Association’s Council on Scientific Affairs have decided to discourage antibiotic premedication for most patients with artificial joint implants.  You read that correctly, if you have a prosthetic joint or implant, you do not have to take antibiotics before your future dental visits!

Something to pay attention to here is, if you do have a prosthetic implant, you might still be a candidate to premedicate based on your medical status.  You may have an increased risk of infection if you also have a compromised immune system due to diabetes, rheumatoid arthritis, cancer, chemotherapy, chronic steroid use.

 Heart Conditions:

The AHA, does recommend antibiotic prophylaxis, for patients with certain heart conditions:

Artificial heart valves.
A history of an infection of the lining of the heart or heart valves known as infective endocarditis.
A heart transplant in which a problem develops with one of the valves inside the heart.
Heart conditions that are present at birth, such as:
Unrepaired cyanotic congenital heart disease, including people with palliative shunts and conduit.
Defects repaired with prosthetic material or device—whether placed by surgery or catheter intervention—during the first six months following
Cases in which a heart defect has been repaired, but a residual defect remains at the site or adjacent to the location of the prosthetic patch or prosthetic device used for the repair.
It is imperative to talk to your physician well before your dental visit to ensure you are following their most recent recommendations.  Your doctor can provide you with a note for your dental team, or you may have them complete our form.  This way you can avoid interrupting your necessary dental care, and you can be ready for your upcoming visit.

by Laura Sharbash, DDS


Sources:

http://www.mouthhealthy.org/en/az-topics/a/joint-replacement

http://www.mouthhealthy.org/en/az-topics/a/premedication-or-antibiotics