Who Should Receive Antibiotic Prophylaxis To Prevent Infectious Endocarditis
People who are at highest risk for infective endocarditis should take one dose of an antibiotic by mouth one hour before certain dental, oral, or upper respiratory tract procedures a second dose is not necessary.
People with the following conditions are considered to be at the highest risk of developing infectious endocarditis. Preventive antibiotics are generally recommended for people with the following conditions before certain procedures:
- A prosthetic heart valve
- Valve repair with prosthetic material
- A prior history of infectious endocarditis
- Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits
- Completely repaired congenital heart defects with prosthetic material or device during the first six months after the procedure
- Repaired congenital heart disease with residual defects at the site or adjacent to the site of the prosthetic patch or prosthetic device.
Controlling Bacteria In The Mouth
Bacteria thrives off remnants of food and drink that enter the mouth. Normally, a healthy body is able to handle constant bacteria in your mouth. Most bacteria are relatively harmless as long as you regularly floss and brush your teeth.
Unfortunately, this isnt the case for everyone. Sometimes, there are bacteria present in someone with a weakened immune system. Infection can occur when the bacteria enter the bloodstream.
Our mouths are far more vulnerable to bacteria entering the bloodstream during dental work. Because of this, your dentist may suggest antibiotics before any dental treatment commences. Basically, Antibiotic prophylaxis before dental treatment is to prevent rather than cure.
How To Prevent Antibiotic Resistance
Some dentists frequently prescribe antibiotics to their patients, even for diseases that can’t be treated with antibiotics.
To stop the spread of drug-resistant bacterial strains, dentists should only prescribe antibiotics to control known local infections, and not just when some inflammation is visible. Additionally, prophylactic use should be limited and only in cases when there are infections.
Patients also have a role to play to stop antibiotic resistance. A couple of things patients should do include:
- Ask questions: Ask your dentist or doctor about the antibiotics they are giving you and why you need it for your treatment.
- Don’t demand antibiotics: Never demand antibiotics from your doctor if they say they aren’t necessary.
- Don’t use old antibiotics: Don’t share or use old or leftover antibiotics only take them when prescribed by your doctor.
In the video below, Dr. Tamisha Denis talks all about the dental antibiotics for tooth infection and in dentistry, including when they should be prescribed, and when they shouldn’t.
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Taking Antibiotics Before Dental Visits May Cause Serious Side Effects 80% Prescribed Unnecessarily Study Shows
AT A GLANCE
WASHINGTON, D.C. Not only are antibiotics vastly overprescribed before most dental visits, using them for even a day or two increases the risk of serious side effects such as an allergic reaction or Clostridioides difficile infection, according to a large national study being presented at IDWeek 2019.
Antibiotics are often prescribed for a day or two before dental visits to prevent infections in certain people, such as those who have had hip or knee replacements, but current American Dental Association and American Heart Association guidelines no longer recommend this in most cases. The study of nearly 170,000 dental visits determined 80% of antibiotics prescribed before dental visits to prevent infection are unnecessary.
In addition to Drs. Gross and Suda, co-authors of the study are: Jifang Zhou, MD, MPH, Gregory Calip, PharmD, MPH, PhD, Susan A. Rowan, DDS, Ronald Hershow, MD, Rose Perez, Charlesnika T. Evans, PhD, MPH, Jessina C. McGregor, PhD, FSHEA.
How To Get Antibiotics For A Tooth Infection
You can get antibiotics for a tooth infection from your dentist or doctor, although dentists are preferable due to their experience with tooth infections. Antibiotics are not available over the counter you must have a doctor’s prescription.
Depending on your condition, you may be able to get prescriptions through an online dental consultation.
If you have antibiotics leftover in your medicine cabinet from an old infection, you should not use them. To properly dispose of your antibiotics, take them to your nearest pharmacy.
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Antibiotic Premedication Is Only Necessary For Certain Dental Procedures
If you have a condition above that requires antibiotic prophylactic premedication, you dont necessarily need to take antibiotics before going to the dentist. It all depends on what procedure you are having done at the dental office.
You only need to take an antibiotic premedication if the dentist will be doing a procedure that involves manipulation of the gingival tissue or the periapical region of teeth or perforation of the oral mucosa. The American Academy of Orthopaedic Surgeons came out with a more specific list in their guidelines from 2003, but did not include it in their most recent update.
Heres the list from the American Academy of Orthopaedic Surgeons of dental procedures where antibiotic premedication is required:
- Dental extractions
- Periodontal procedures including:
- Subgingival placement of antibiotic fibers/strips
- Scaling and root planing
- Periodontal probing
- Periodontal recall maintenance
Heres a list from the Amerian Heart Association of dental procedures that do NOT require antibiotic premedication:
Commonly Used Antibiotics In Dentistry
If you are required to take premedication, the patient will take the antibiotic orally one hour prior to the dental appointment. The antibiotic will work to fight germs that may enter the patient’s system through the gum tissue and into the blood stream during the dental procedure.
The Journal of the California Dental Association recommends 2 grams of amoxicillin for adults or 50 milligrams per kilogram of weight for children. If the patient has an allergy to amoxicillin, their healthcare provider may prescribe other antibiotics, such as clindamycin, cephalexin or azithromycin. The benefits that antibiotics provide are they are easy to take, fast-acting and kill bacteria that may cause an infection in the body. Antibiotics are generally taken with food to prevent side effects, such as an upset stomach, nausea, diarrhea and may build a resistance to bacteria according to Medical News Today. There are risks associated with any medication your dentist or healthcare provider will prescribe the patient – if they believe the potential benefits outweigh any potential risks.
Heart Problems That Call For Antibiotics In Dental Procedures
Virtually all guideline committees around the world recommend antibiotic prophylaxis for those individuals at high risk of an adverse outcome from infective endocarditis and who are undergoing invasive dental procedures. Today, the AHA only recommends antibiotics before dental procedures for patients with the highest risk of infection, those who have:
If youre not sure about the guidelines for your heart condition, check with your heart specialist. If you have one of these conditions, always tell your dentist. Also, alert your dentist if – you are allergic to any antibiotics or other medications.
Antibiotic Prophylaxis And Joint Surgery
In the past, people who have had a joint replacement, such as a hip or a knee replacement, were often prescribed antibiotic prophylaxis before invasive dental procedures. While this still may be necessary for some individuals, in general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended routinely prior to dental procedures to prevent prosthetic joint infection.
Based on careful review of the scientific literature, the American Dental Association found that dental procedures are not associated with prosthetic joint implant infections, and that antibiotics given before dental procedures do not prevent such infections. The American Dental Association has found it is no longer necessary for most dental patients with orthopedic implants to have antibiotic prophylaxis to prevent infection.
A joint expert group of the American Dental Association and the American Academy of Orthopaedic Surgeons found moderate strength evidence that dental procedures are unrelated to implant infection and that antibiotic prophylaxis prior to dental procedures does not reduce the risk of subsequent implant infection. The group stated that practitioners might consider discontinuing the practice of routinely prescribing prophylactic antibiotics for patients with hip and knee prosthetic joint implants undergoing dental procedures.
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Oral Biofilm Entering The Bloodstream
The reason why a dental patient may need to take an antibiotic before their treatment is primarily due to the risk of oral biofilm entering the blood supply through the mouth, as its being disrupted by the dentist or hygienist.
For medically compromised individuals, there is a risk of the biofilm transferring itself into the blood vessels, heart, or elsewhere in the body. As such, it can lead to significant cardiovascular complications
Taking the antibiotic as directed will temporarily reduce the potency of the biofilm inside of the mouth, minimizing the risk of it spreading into the cardiovascular system and helping the patients immunity fight it off if it does.
When In Doubt Ask Your Medical Provider
Dentists follow recommended medical guidelines when it comes to prescribing a prophylactic antibiotic for specific treatments. But if youre still uncertain whether its necessary, call your family physician or medical specialist. If he or she says its not necessary, ask to have your dentist speak to them directly or bring a doctors note to your dental office.
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What Are The Guidelines On Antibiotic Prophylaxis For Dental Procedures
Prophylaxis controversy continues regarding who should have antibiotic prophylaxis for dental procedures and which antibiotics to use.
Current recommendations by the American Heart Association 2007 for dental, oral, respiratory tract, or esophageal procedures, if the patient has one of the following conditions:
Prosthetic cardiac valve
Congenital heart disease
Unrepaired cyanotic CHD, including palliative shunts and conduits
Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure
Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device
Cardiac transplantation recipients who develop cardiac valvulopathy
Recommendations for dental, oral, respiratory tract, and esophageal procedures for patients with one of the conditions listed above include the following:
Prophylactic regimens are for patients with prosthetic heart valves, previous bacterial endocarditis, congenital cyanotic heart disease, pulmonary shunt placement, cardiac myopathies, acquired valvular disease, and mitral prolapse with regurgitation.
Only 25% of patients who should receive prophylactic antibiotics actually receive them.
With 100% compliance, estimates suggest that the incidence of bacterial endocarditis would be reduced 3-6%.
What Is The Best Antibiotic For Gum Infection
A gum infection left untreated can lead to all sorts of problems such as:
- Adult tooth loss
- Soft tissue damage
- Weakening of your jaw bone
Amoxicillin is the best antibiotic for a gum infection. However, if you have an allergy, other antibiotics for gum infection include erythromycin, tetracycline, or metronidazole.
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Why You Might Need To Premedicate With Antibiotics Before You See Your Dentist
During my first few weeks as a student-dentist in the clinic at dental school, I had a new patient assigned to me. She arrived late, and we were both in a hurry to get the oral examination and treatment planning finished so we could start working on her teeth.
Without going into too much detail, she had a history of heart problems as a child. After mentally running through the guidelines for determining which patients need antibiotics, I didnt think she needed to be premedicated. I went ahead and did a screening procedure to check the health of her gums which made her bleed slightly. When the dentist in charge came to review what I had done, he told me that this patient should have been premedicated with antibiotics for the procedure. He had me immediately go over to the appropriate department and get 2 grams of amoxicillin for my patient.
I explained everything to the patient and she was very understandable. However, with her particular condition, I still didnt think she needed to take the antibiotics. But I did what my professor told me to do.
At the end of the appointment, I told my professor that I felt like an idiot.
He replied, You should. Then he told me that it wasnt a big deal because her condition wasnt too risky, and since we got her the antibiotics within two hours of the procedure, no harm was done.
How Long Does It Take For Antibiotics To Reduce Swelling From Tooth Infection
You can start feeling the effects of antibiotics on a tooth infection in as little as a day. But just because your pain and swelling have gone away doesn’t mean your infection is entirely cured!
Your antibiotics won’t completely take care of the infection until you’ve taken them over a course of 7 to 10 days, and always for the complete amount of time your dentist has prescribed.
It’s extremely important that you take all of the antibiotics that your dentist has prescribed, exactly as prescribed. If not, you could just make bacteria resistant to the antibiotics and make your infection ultimately more difficult to treat.
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Why Do Some Dental Patients Need Antibiotic Prophylaxis
We have billions of bacteria living on and inside our body. However, our blood is usually kept free of bacteria as a result of our hard-working immune system. If bacteria enters our bloodstream, it is known as a bacteremia.
When a dentist extracts a decayed tooth that is infected with millions of bacteria, some of those bacteria could enter the bloodstream.
So, lets say that a patient needs a tooth extracted and he just had a plastic heart valve inserted into his heart. The bacteria in that patients mouth have the ability to attach to the plastic heart valve in that persons heart. This could lead to a very serious condition known as infective endocarditis.
After seeing the patient I mentioned above, I went online to research which exact conditions require premedication. I have summarized the information I gathered below.
Evolution Of Prophylaxis Guidelines
Since the 1950s there has been a progressive reduction in the use of antibiotics in the prevention of endocarditis following dental therapy . Different countries have made different recommendations. The changes in the USA in 2007 limited prophylaxis to patients with conditions including prosthetic cardiac valves or valves repaired with prosthetic material, previous infective endocarditis, unrepaired and repaired congenital cardiac defects and cardiac transplants with subsequent valvulopathy. Patients with mitral valve prolapse, even with severe regurgitation, no longer required prophylaxis.18
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Do You Need Antibiotics Before Your Dental Visit
Antibiotics treat bacterial infections. Antibiotic prophylaxis is the taking of antibiotics before a surgery or other procedure that may release large numbers of bacteria into your bloodstream to decrease the chance of infection in another part of your body. During dental procedures that may cause bleeding, such as tooth extractions, large numbers of bacteria from the mouth can enter the bloodstream. In persons at high risk of infection or with certain heart conditions, there is concern that these bacteria may cause infection in other parts of the body . The immune system normally kills these bacteria, but antibiotic prophylaxis may offer these people extra protection. The American Heart Association recommends that antibiotics be used prior to some dental procedures for persons with certain heart conditions, who may be at risk for developing an infection of the heart.
Numerous studies have pointed out that blood bacteria may occur during normal daily activities, such as chewing, tooth brushing and flossing. It is likely that these daily activities induce many more bacteremias than typical dental procedures. While studies do show a strong association between certain dental procedures and bacteremia, they dont show good evidence that there is a direct link between dental procedure associated bacteremia and infections in the heart or prosthetic joints.
Heres what the experts say.
Antibiotic Prophylaxis For Patients Allergic To Penicillin
Clindamycin or azithromycin or clarithromycin taken orally one hour before the procedure.
If the patient cannot take oral medicationsClindamycin IV within 30 minutes of the procedure x 1 dose.
If the penicillin allergy was not associated with anaphylaxis, angioedema, or urticaria, the patient may take:Cephalexin taken orally x 1 dose, orCefazolin IM or IV x 1 dose.
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Antibiotic Prophylaxis To Treat Local Infection
There are various surgical procedures and medical conditions that are routinely covered by systemic antimicrobials which include impacted third molars, orthognathic surgery, implant surgery, periapical surgery, benign tumorsurgery and immunocompromised patients. The service of antibiotics in endodontics should be indicated for patients with signs of local infection and fever. Evidence shows prescribing antibiotics after removal of impacted third molars reduce the severity of postoperative pain,. Abu-Taa et al compared the benefits of pre- and post-operative antibiotics in patients undergoing periodontal surgery. Pertaining to the post operative antibiotics, remarkable reduction in the post operative discomfort was noticed. Amoxicillin 2 000 mg for five days at a suitable dose and interval helps to cover the treatment requirements after third molar surgery. Studies show a decrease in postoperative infection, following the use of antibiotics after orthognathic surgery,. Danda et al evaluated the prophylactic value of single-dose antibiotic prophylaxis on postoperative infection in patients undergoing orthognathic surgery, compared to single-day antibiotics. The documented results were clinically significant.