Prophylactic Antibiotics: Who Is a Candidate for Premedication?

Header Image

Bacterial infections are unpleasant to deal with at any time, and they can wreak havoc on your health and your immune system. For patients who are predisposed to contracting infections after a dental procedure, dentists may prescribe prophylactic antibiotics (also known as premedication) ahead of the procedure. Since 2012, however, the guidelines surrounding premedication have tightened and the practice is becoming less routine, according to the American Dental Association (ADA). Your dentist is an expert and will advise you if you are a candidate, but here's some background information about premedication, how it works and who benefits from it.

How Prophylaxis Works

Antibiotics are not only prescribed to treat existing infections, they are often recommended as a preventive measure in situations where infection has the potential to develop. Prophylactic antibiotics are administered before any activity that could result in infection, such as dental surgery or exposure to bacteria. While antibiotics aren't able to eradicate viruses, they work well to protect your body against infections caused by thriving bacteria.

Dental Prophylaxis

Even in a sterile environment, like a dental surgery clinic, microscopic bacteria manage to exist. Some of the resulting infections may cause long-term health conditions, such as infective endocarditis, so before any procedure the dentist will evaluate your risk level. According to the American Academy of Pediatric Dentistry, patients with a higher risk of infection include those with:

  • Underlying heart conditions, cancer or diabetes
  • Compromised immune system due to HIV, chemotherapy or radiation treatment
  • Autoimmune diseases such as arthritis, lupus or sickle cell anemia
  • Chronic steroid usage or bisphosphonate therapy
  • Prosthetic joint replacement within one to three years from surgery pending approval from orthopedic surgeon

The use of prophylactic antibiotics is usually recommended ahead of dental surgeries involving mucosal incision or manipulation of the gum tissue. Patients with prosthetic joint implants are not ideal candidates for premedication, though, because they are at risk of developing antibiotic resistance, according to the ADA. This risk outweighs the benefit of prophylaxis for the dental procedure.

Administering the Antibiotics

Antibiotics are usually given to the patient one hour prior to the procedure in the form of a tablet prescribed by the oral surgeon and dispensed by a pharmacy. In some instances, you could be required to take the antibiotics for several days before the surgery pending what your dentist or healthcare provider recommends. For patients unable to take oral medication, the surgeon might administer these through an intravenous tube during the procedure.

Potential Side Effects

The risk for side effects from prophylactic antibiotics are the same as those experienced when you use antibiotics to treat an infection. Tell your oral surgeon in advance if you're allergic to penicillin or any other antibiotics. Keep a close eye on your reaction to the premedication, and if you develop nausea, vomiting, diarrhea or skin rash speak with your surgeon or pharmacist immediately. If the antibiotics produce symptoms of anaphylactic shock, seek emergency medical care without delay.

Poor oral hygiene is a factor in developing bacterial infection after a dental procedure, so prior to your surgery it's important to floss once daily, brush twice a day and take extra care of your mouth. You can also reduce the bacteria present by swishing with a rinse like Colgate Total Mouthwash for Gum Health, which kills 99 percent of germs on contact and provides 12-hour protection against bacteria that cause gingivitis.

If you're facing oral surgery in the near future, discuss the option of premedication with your surgeon well ahead of time. Inform them of your entire medical history so they can determine your likelihood of infection and the potential benefits or risks of prophylactic therapy.