The purpose of prescribing antibiotics prior to specific dental procedures is usually limited to a select group of patients. An antibiotic may be pre- scribed to reduce bacteria that could be introduced into the blood stream, and to help prevent the possibility of bacteria from colonizing on an artificial joint, heart valve, or congenital heart defect.
Since my graduation from dental school and ten years of practice, I have seen two revisions for the guidelines on taking antibiotics prior to dental
procedures. There are two main categories of patients where this recommendation was previously and may currently may still be made.
The first group of individuals are those who have undergone a total joint replacement such as knees or hip replacements. After a systematic review, piloted by The American Academy of Orthopedic Surgeons and the American Dental Association, a conclusion was made that most individuals in this group are no longer required to take the pre-medication of antibiotics. There was a lack of evidence that the antibiotics prevented colonization of the replaced joint. There are also concerns regarding increasing side effects associated with antibiotics. There are still a select few individuals that have had joint replacements, and due to extended health circumstances, still require an antibiotic pre-medication.
The second group of individuals requiring antibiotic pre-medication are those with ill-repaired congenital heart defects, heart valve replacement, or a history of infective endocarditis. The American Heart Association recommends that these individuals still use an antibiotic regiment the day dental procedures are performed.
Patients who have any total joint replacements or congenital heart issues should bring these conditions to the dentist’s attention at their first exam appointment, so a discussion can be made about whether or not a pre- medication is relevant. There are many times in my practice that I will also recommend a discussion with the orthopedic surgeon or cardiologist if necessary. Once a mutual decision is made by all practitioners and the patient, and if deemed necessary, then typically a single one-time dose of antibiotics is taken 1 hour prior to the dental appointment.