Antibiotics may be recommended before certain dental procedures and other surgeries too. The suggestion is made to those at higher risk of serious problems. Dental or surgical procedures might allow bacteria to enter the bloodstream, causing infection.
For instance, some people have had previous damage to the heart valves or lining. In rare instances, introducing bacteria into the bloodstream could inflame those areas. This would cause an infection called infective endocarditis. Taking a preventive dosage of a particular antibiotic before certain dental and surgical procedures can help avoid infection. The hope is that the antibiotic will prevent a possible inflammatory process. The term for this preventive action is antibiotic prophylaxis.
Those who have certain health conditions, or had joint replacements done, may also take antibiotics to prevent infection.
Bacteria, fungi or other organisms can cause infective endocarditis (IE) infection. Bacteria is introduced into the blood stream, and circulates through the body. It can stick to previously damaged heart valves or to the lining of the chambers of the heart. Next, the bacteria might grow to form small masses called vegetations. This will also damage that part of the heart.
Although the evidence is not absolutely conclusive, antibiotic prophylaxis may prevent serious infections. Those at high risk are routinely given antibiotics before surgery or dental procedures.
Over the years, the list of heart concerns thought to put someone at risk has become much smaller. As a result, fewer people now need preventative antibiotics. People with certain conditions are at high risk, so antibiotics are prescribed for them. The conditions include:
At one time, antibiotics would have been prescribed. However, research suggests that they were not effective in controlling or preventing heart infection. As it is important not to expose people to medications that they do not need, these conditions no longer require antibiotics.
Antibiotics have never been recommended for some low risk conditions. For instance, an innocent heart valve murmur would not need this type of treatment. Pacemakers or defibrillators are not thought to place a person at risk either.
You may be wondering whether you should take an antibiotic before your dental visit. Talk with your dentist or doctor, and ask for an explanation of your situation. In some cases, a specialist may be involved in making the decision about antibiotics. As with all complex situations, a one-size-fits-all approach does not cover all cases. Your situation may be unique and require coordinated, specific care.
The American Heart Association has published guidelines every five to seven years since the mid-1950s. The most recent guidelines were published in 2007. The Canadian and the American Dental Associations review these, and publish their own guidelines for dental care. Your dentist follows these suggestions.
Whenever possible, antibiotic use is kept to a minimum. Allergic reactions or side effects are always possible. In the world right now, the concern is that overuse of antibiotics allows bacteria to become resistant to particular antibiotics. No one wishes to contribute to the development of ‘superbugs’ by giving these drugs to people who do not need them.
Specific dental procedures are most likely to cause bleeding. Preventative antibiotics should be prescribed for those who require them. The list includes:
Other routine dental procedures do not warrant coverage with antibiotics. They include:
Today, more people have artificial hips and knees. The infection process here is the same as with infections of the heart. Certain bacteria in the mouth can be carried in the blood to the site of the artificial part. The bacteria can lodge there or on nearby bone, causing serious infection. Infections of prosthetic joints are difficult to treat using antibiotics. Sometimes the artificial hip or knee may fail as a result. Surgery is required to remove the infected implant. The joint must be replaced all over again.
Much debate and some controversy exist about who needs preventive antibiotics, and for how long after the artificial hip or knee has been placed. The risks are very serious for those who do become infected. As there is so much uncertainty, many surgeons do recommend antibiotics for anyone with a prosthetic joint.
It is better to prevent an infection than to treat one. If possible, all dental treatment should be done before the joint replacement takes place. Preventative antibiotics are generally used for two years after the joint replacement surgery. Antibiotic coverage is similar to that required for heart-related inflammation. Guidelines from the American Association of Orthopaedic Surgeons are used. The American Dental Association and the Canadian Dental Association also publish specific guidelines. The debate about antibiotic coverage continues. Talk with your orthopedic surgeon and dentist about your specific situation.
With certain medical conditions, everyone agrees that antibiotic coverage is always required, no matter how long ago the joint replacement surgery occurred. These are people with any of the following conditions:
Other types of orthopedic surgeries use pins, plates or screws. No recommendations for antibiotics exist in these cases.
Canadian Dental Association
Heart and Stroke Foundation of Canada
(search ‘antibiotics and
American Heart Association
Several other health conditions may warrant antibiotic coverage before dental visits. This applies to people who have:
This area of infection prevention is complex, and every situation is unique. If you think you might need preventative antibiotics, talk with your dentist, physician or other health care provider.
The bottom line — an ounce of prevention is worth a pound of cure.
Your dentist and dental hygienist have the knowledge and skill needed to help you maintain good oral health. If you are at high risk, you may return more frequently for tooth cleaning and monitoring. Consistent daily brushing, flossing, and in some cases, using special oral rinses will promote better oral health and improve general health for all people.