Antibiotic Prophylaxis Before Dental Appointments

Antibiotics have been a treasure for medicine in their ability to fight infection and stop harmful bacteria. For certain high-risk groups, antibiotics are administered before routine dental visits. Taking antibiotics helps reduce the chance of bacteria seeded to the blood stream from a dental procedure from infecting another part of the body. Historically, this was a very common recommendation for many heart conditions, organ donor recipients and those with joint replacements. The recommendations, made by the American Dental Association (ADA) and other professional organizations, have been revisited many times. Currently, there are very few patients who would require administration of antibiotics before a trip to the dentist.

The current guidelines recommend routine joint replacement recipients should not need antibiotic coverage before a dental visit. However, there are a few exceptions. If you have ever had an infection in a prosthetic joint or have severely compromised health or have had a recent prosthetic surgery, antibiotics may still be recommended. For many joint replacement recipients, the rules have changed since their surgeries. What was recommended five years ago is different today. Talk with your dentist if you are unsure. If the orthopedic doctor recommends antibiotic coverage that is outside clinical recommendations, your dentist may advise you to have them write your prescription, as the risk of adverse reactions outweighs the therapeutic potential of the antibiotic.

The American Heart Association has also changed its qualifying criteria for antibiotic prophylaxis. Only those patients with heart valve repair or replacement, congenital heart disease, heart transplant recipients, and those with previous infective endocarditis should receive antibiotic prophylaxis.

The guidelines for antibiotic prophylaxis have changed over the years, so expect them to change in the future. Conversations with your dentist, medical doctor and orthopedic physician can determine what is best for you. As more evidence accumulates and guidelines change, many people who have historically taken antibiotics before routine dental visits no longer need to do so.