Below is an article from the owner and founding dentist of Brighter Smiles Dental – Dr. Sylvia Irwin. This article discusses the usage of antibiotics prior to obtaining dental treatment. Dr. Irwin and her dedicated staff have been treating patients and transforming smiles, in her Nutley, NJ dental office for over 31 years. The article below is meant to be used as a reference and a means of generating thoughtful discussion regarding your medical treatment. It should not replace the medical advice given by your physician.
Medical guidelines are often re-evaluated to ascertain that they are based on the most current scientific evidence available. Two groups of patients are currently advised to take antibiotics prior to dental treatment: those with severe heart conditions that may place them at greater risk of developing infectious endocarditis, and those with total joint replacements.
The guidelines for cardiac patients were revised in 2007, and now other guidelines have been revised as well. The American Dental Association and the American Academy of Orthopedic Surgeons issued new guidelines for patients with total joint replacements at the end of 2012.
These guidelines indicate that there is insufficient evidence that patients with total joint replacements routinely require antibiotics prior to dental treatment. This conclusion was reached because no direct evidence has been found linking dental procedures and infections of prosthetic joints. Therefore, the risks of taking antibiotics (the potential of developing resistant organisms, stomach upset, allergic reactions, etc) outweigh the benefits of their use. However, these findings are only guidelines, and each person must still be considered individually.
Patients with other risk factors, such as diabetes, cancer, a compromised immune system, or other systemic diseases may still require antibiotics prior to dental treatment.
Many orthopedic surgeons feel that even a small risk of infection is too great a risk. They feel that the side effects of a single dose of antibiotics are justified even if there is only a possible risk of total joint infection. Furthermore, some orthopedic surgeons feel that this potential for joint infection is always present, and does not decrease over time.
I therefore urge those of you with total joint replacements to discuss this subject of the need for antibiotics prior to dental treatment with your orthopedic surgeon, and to be guided by their advice. The full guideline and all supporting documentation for antibiotic prophylaxis of patients with total joint replacement is available on the ADA website and on the AAOS website.
Even if antibiotics are advised. There is uniform consensus that they are not needed for all treatment. Dental procedures for which antibiotics are required include those that may involve the gums, such as cleanings, restorations, extractions, and root canal therapy.
Procedures not requiring antibiotics include routine local anesthesia, x-rays, placement and adjustment of removable appliances, and restorations that are not near the gumline.
If antibiotics are required, it is only a single dose with no follow-up after dental treatment. The approved oral antibiotic regimens are as follows:
- For those not allergic to Penicillin: Amoxicillin: 2g for adults or 50mg/kg for children OR Cephazoline OR Cephtriaxone 1g for adults or 50mg/kg for children. The entire dose is to be taken one hour prior to dental appointment.
- For those allergic to Penicillin: 2g Cephalexin for adults or 50mg/kg for children OR Clindamycin 600mg for adults or 20mg/kg for children OR Azithromycin or Clarithromycin 500mg for adults or 15mg/kg for children. The entire dose is to be taken one hour prior to dental appointment.
Intravenous and intramuscular administration of theses antibiotics is also acceptable.
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According to the guidelines issued by the American Heart association in conjunction with the American Dental Association, this regimen is also suitable for those cardiac patients who are at the highest risk of developing infective endocarditis. These patients include those with a prior history of endocarditis, prosthetic heart valves, unrepaired or recently repaired cyanotic congenital heart disease, repairs with residual defects, and those patients with cardiac transplants who have valvular disease. It is to be noted that patients with heart murmurs including mitral valve prolapse, rheumatic heart disease, and congenital heart defects are not longer advised to take antibiotics prior to dental treatment.
As with the above recommendations for patients with joint replacements, if there are any questions, the patient is always advised to speak to their cardiologist or cardiac surgeon prior to dental treatment. And remember: Good oral hygiene is a key to good health!
Brighter Smiles Dental is the practice of Dr. Sylvia Irwin. For over 31 years, Dr. Irwin and her staff have been providing patients with expert dental care in a calm and relaxing setting. For more information or to schedule an appointment please click here or call our Nutley, NJ dental practice at: 973.667.1567.
