Dental Antibiotic Premedication: 10 Common Questions
Many dental procedures cause bleeding in the mouth, which can allow the bacteria in the mouth to enter into the persons bloodstream. Certain people are more susceptible to bacterial infections in their bloodstream than others. In order to prevent bacteria from living in your bloodstream and infecting certain high risk areas of your body, it is important for certain people to take antibiotics before having many dental procedures. This is known as antibiotic premedication or antibiotic prophylaxis.
Many people have questions regarding antibiotic premedication and dental work. Heres a list of ten common questions and their answers. If you have any other questions about antibiotic premedication that I dont cover in the following article, feel free to leave a comment down at the bottom.
Antibiotic Prophylaxis Vs Treatment
The type and amount of antibiotic that youre prescribed will depend on the specific dental situation that youre dealing with. If its a prophylactic treatment to prevent an infection during your dental procedure, youll probably only have to take the medication on the day of the appointment.
But if you already have a chronic or severe dental infection that you need treatment for and youre in pain your dentist may give you an antibiotic to take for about a week, with your procedure schedule at the completion or near the middle of the medication duration.
Reviewing Your Health History With A Dentist
Its not uncommon for some people to compartmentalize their mouth separate from the rest of their body. They often think things like, Why do I need to tell the dentist if I am being treated for ___? In reality, the oral-systemic health connection is very strong. Failing to disclose specific health conditions or medications that youre taking to your dentist isnt just a mistake, it could be deadly.
Rest assured that like medical providers, dentists abide by the same confidentiality laws and restrictions that your doctors office does. Sharing that youve been diagnosed with or treated for a specific health concern can better help your dentist care for you and possibly diagnose other conditions that may have yet to be discovered.
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Antibiotics For Dental Work
Certain types of dental work can cause infections elsewhere in the body. There are many different types of bacteria in the mouth. Depending on the patient, the bacteria can cause an infection in different organ systems. For example, some patients can become bacteremic, meaning they develop a bacterial infection in their blood. Others may develop pneumonia, cardiovascular infections, or inflammatory conditions. Different patients have different risk factors.
Dental Antibiotics After Tkr
I have read that many of you take antibiotics before any dental work. I want to get back to my dental cleanings, I’m 4 months post-op from bilateral. My OS said he doesn’t believe in prescribing antibiotics for dental work, but my dentist said it’s the first he’s heard of a DR not prescribing and would want my OS to put that in writing for him before he would do any work. Now I’m wondering what’s the harm of taking them before dental work? An ounce of preventionthanks for any replies to this.
Interested in more discussions like this? Go to the Joint Replacements group.
I had a partial replacement and needed to wait 6 months after surgery before I could go to the dentist for a cleaning, and needed to do antibiotics prior.
I had a partial replacement and needed to wait 6 months after surgery before I could go to the dentist for a cleaning, and needed to do antibiotics prior.
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The Usual Occasions For Antibiotics
Antibiotics may be used in cases of an abscess or periodontaldisease . Its usually a necessary part of such procedures astooth extraction, root canal therapy or deep cleaning of the gums.
In other cases, antibiotics may be prescribed to prevent aninfection. This type of application is referred to as premedication.
Heart Problems That Dont Call For The Use Of Antibiotics In Dental Procedures
For years, the AHA recommended that people with most heart problems, including murmurs, take a short-term course of antibiotics before visiting the dentist. The goal was to reduce the risk for infective endocarditis, an infection of the hearts lining or valves that could be caused by oral bacteria. However, those at risk are exposed to oral bacteria on a daily basis during brushing and flossing and do not develop infective endocarditis. Also, research has shown that antibiotics offer little protection against infective endocarditis for most people. Therefore, the AHA guidelines have significantly reduced the number of individuals and procedures where AP is recommended.
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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.
When Should You Take Antibiotics For Dental Work
September 30, 2016 by Dr. Jessica Barron, D.M.D.
Antibiotics, discovered in 1928, have saved millions of people from untimely deaths due to bacterial infections. In fact, a life expectancy jump of eight years between the mid-1940s and early 1970s is credited to the introduction of antibiotics.
This wonder drug, however, has resulted in resistance as new strains of disease have surfaced. While, on one hand, its a great medication to use when infection is present, on the other its hard to know when its warranted to ward off potential infection in high-risk situations.
Everyone has bacteria in our mouths, and some dental treatments can allow bacteria to enter the bloodstream. For the majority of patients, this isnt a problem as a healthy immune system stops the bacteria from causing harm. In a small number of cases, we may suggest antibiotics before a dental treatment to reduce the chance of infection.
While guidelines have altered over the years, medical associations have worked to define when taking a precautionary antibiotic before a dentist visit is warranted. While patients should ensure they are heeding the latest guidelines, current recommendations state:
Whether taking antibiotics is necessary before a visit to the dentist, there are two other key aspects that all patients should understand when looking after their dental health.
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Antibiotics Of Choice For Prophylaxis
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. Take it 30 minutes before the procedure if it is taken parenterally.
Amoxicillin is the drug of choice for prophylaxis.Amoxicillin taken orally one hour before the procedure x 1 dose.
For patients who cant take oral medicationsAmpicillin IM or IV within 30 minutes of the procedure x 1 dose.
Ada And Orthopedic Society Antibiotic Recommendations
The American Dental Association is the professional society for dentists. The ADAs official recommendations are as follows: For patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection. They recommend abstaining from prophylactic antibiotics because they assert that there is no evidence that dental procedures are associated with PJIs. They also argue that there is no evidence to suggest that giving patients prophylactic antibiotics before dental procedures prevents PJIs. The ADA asserts that antibiotic resistance is a major concern, and the theoretical benefits are not enough to make up for this concern. However, they state that each patient should be considered individually, taking into account their personal risk factors.
American Academy of Orthopedic Surgeons
Just as the ADA is the professional society for American dentists, the AAOS is the professional society for orthopedic surgeons. They have released their own guidelines for surgeons when considering prophylactic antibiotics for dental procedures.
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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.
Are Antibiotics Necessary After Dental Surgery
As in general medicine, antibiotics are sometimes prescribed in dentistry. In this article, we offer a brief summary of when dental surgery requires antibiotics, and when it doesnt. For the purpose of this blog post, our working definition of dental surgery includes invasive dental procedures, such as a tooth extraction, fillings and repairs, root canal therapy, dental crowns, gum disease treatment, and dental implants.
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How Implant Infection Occurs
The most common route of a bacterial infection into the body is through broken skin. While normal tissue can typically defend itself against the invading bacteria, the inorganic materials of a prosthesis cannot. It is there that an infection can seed and cause damage to surrounding bone and tissue.
Another possible route involves oral infections and certain types of dental work. During a dental procedure , bacteria can often enter the bloodstream if the tissue is broken.
With little immune protection, any infection of a knee replacement and hip replacement can quickly turn serious, increasing the risk of complications and disability.
To avoid this, healthcare providers will often recommend a course of antibiotics before any invasive procedure. In this way, the natural bacteria on the skin or in the mouth will be dramatically suppressed.
While this would certainly be recommended in advance of major surgery, persons undergoing certain dental procedures may also be asked to take antibiotics before a procedure.
What Is The Best Antibiotic For A Toothache
A toothache caused by infection can be treated in various ways depending on the severity, location, and general health of the patient. In cases of severe infections that can’t be treated by root canal or tooth extraction alone, your dentist may prescribe an antibioticusually amoxicillin, or metronidazole in the case of a penicillin allergy.
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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.
Can You Take Doxycycline For A Toothache
Doxycycline is part of the tetracycline class of antibiotics. It isn’t typically a first-choice antibiotic rather, it is reserved for more serious infections.
Therefore, doxycycline should only be taken for a toothache if that toothache is caused by a severe infection and your dentist has prescribed it to you.
Doxycycline can also be used to help prevent the breakdown of gum tissue and help with the reduction of gum pockets in patients who have gum disease. At that dosage, however, it won’t treat bacterial infections.
Doxycycline for a tooth infection is not recommended in children under 12 because antibiotics from the tetracycline class can cause permanent tooth staining in children. It’s also not suitable for pregnant women.
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Postoperative Antibiotic Prophylaxis For Dental Patients Provincial Hip And Knee Committees Weigh In
ABJHI Archive
In 1997, the American Dental Association and the American Academy of Orthopaedic Surgeons published the first advisory statement on antibiotic prophylaxis for dental patients with prosthetic joints. This advisory statement was updated in 2003 with new information and concluded that AP is not routinely indicated for most patients with total joint arthroplasty who undergo dental procedures, and that, although bacteremia can cause hematogenous seeding of total joints, there is no evidence linking dental procedures to prosthetic joint infection. These advisory statements were fairly specific concerning which patient populations the clinician might choose to give AP, including the period of time following joint implantation, dental procedures of concern, antibiotic protocols, and alternatives, and there was discussion of the benefits and risks from this practice. In 2009, the AAOS released a new statement: Given the potential adverse outcomes and cost of treating an infected joint replacement, the AAOS recommends that clinicians consider AP for all total joint replacement patients prior to any invasive procedure that may cause bacteremia.1-5
To summarize:
In Alberta, some patients will receive AP prior to dental work at the individual surgeons discretion. The Provincial Hip and Knee Care Path has been updated to reflect this decision, reading:
References
If You Are One Of A Small Group Of People Who Have A Specific Heart Condition
For a small group of people, theres concern that bacteria in their bloodstream can cause an infection of their heart lining or valves. This infection is called infective endocarditis .
The American Heart Association only recommends preventive antibiotics for people who would be in the most danger if they developed a heart infection. This affects a very small and specific type of person with a heart condition.
If you have one of these heart conditions, we or physician/cardiologist may recommend that you take an antibiotic before dental treatment:
- artificial heart valves
- a history of infective endocarditis
- certain specific, serious congenital heart conditions, including:
- unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
- a 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
- any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device
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If You Had Complications With Your Joint Replacement Surgery Or If You Are At Increased Risk Of Infection
You may be taking antibiotics to prevent joint implant infections or because you experienced complications from a joint replacement surgery. Or, you may take antibiotics if you are at increased risk of infection because of other drugs or diseases.
Talk to your orthopedic surgeon before any dental treatment. They can best determine if you need to keep taking antibiotics before you see your dentist for planned treatment.
Too Few Heart Patients Take Antibiotics Before Dental Work
July 5, 2000 — Last year, 52-year-old Richard Collett was diagnosed with a heart condition called mitral valve prolapse and regurgitation.
Whenever he goes to the dentist, he is reminded of his condition, in which one of the heart valves is leaky and allows some blood to flow backward between beats. “My heart doctor recommended that I take antibiotics whenever I have dental work, so I always take the antibiotics as prescribed by my dentist,” says Collett, a real estate manager from Tampa, Fla.
Like many Americans, he needs to take antibiotics before having dental work to prevent a potentially fatal heart infection. “I hate taking pills,” Collett says. “But when it comes to my heart, I’m not taking any chances.”
But too many of these people are taking chances, according to a study published in the Journal of the American Medical Association. Many who need antibiotics before having dental work aren’t taking them, and other dental patients are taking antibiotics needlessly.
“The bottom line of our study is that about 40% of patients who need preventive antibiotics for dental work and similar procedures aren’t taking them, and that 25% of patients who don’t need them are taking them,” researcher Warren J. Manning, MD, tells WebMD. Manning is an associate professor of medicine and radiology at Harvard Medical School.
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Only Certain Patients Require Antibiotics
The problem of unnecessary dental antibiotic use mainly involves certain patients for whom antibiotic prophylaxis was once recommended. Under previous guidelines from the American Academy of Orthopaedic Surgeons , one dose of antibiotics before dental procedures was recommended for certain patients with prosthetic joints, like a knee implants. But that recommendation was removed when the guidelines were updated in 2013.
Similarly, previous guidelines from the American Heart Association recommended that patients with cardiac conditions who are at risk for adverse outcomes from infective endocarditis should receive an antibiotic before invasive dental procedures, such as a tooth extraction. But the recommendation was narrowed in 2007. Under the current guidelines, antibiotics are recommended only for patients with cardiac conditions that are associated with the highest risk of adverse outcomes from infective endocarditis.
Suda and her colleagues theorize that providers who care for patients with conditions not requiring the drugs may still be recommending antibiotic prophylaxis before dental procedures. In their earlier study, they looked at data from a large national health claims database and found that, under the current AAOS, AHA, and American Dental Association guidelines, 80.9% of the antibiotics prescribed before 168,420 dental visits from 2011 through 2015 were unnecessary. Patients with prosthetic joint devices were the most likely to receive unnecessary antibiotics.
