If you've recently had joint surgery, such as a hip or knee implant, or been implanted with an artificial heart valve, your surgeon may recommend antibiotic prophylaxis before dental procedures. Recent evidence-based guidelines published by the American Dental Association (ADA) outline what specific medical conditions may require this precaution.
An Extra Level of Protection
The word "prophylaxis" means a preventive measure. While antibiotics are often prescribed after the first sign of an infection elsewhere in the body, they can also be taken to prevent an infection.
During dental treatment, any bacteria introduced to or already present in the mouth can easily be transmitted to the bloodstream. An antibiotic taken before a dental hygiene cleaning or procedure helps protect a vulnerable patient from infection.
Who Needs Antibiotic Prophylaxis?
Before the ADA put out its new guidelines, nearly all patients who had undergone joint implant surgery were covered with antibiotics prior to any dental treatment. The organization now recommends that the orthopedic surgeon who placed the prosthesis decide whether or not medication is required on a case-by-case basis. Commonly, patients who need prophylaxis are those who need to undergo gum tissue surgery or another kind of incision in the oral tissue.
The majority of the patients who need antibiotic coverage are those who have cardiac conditions where bacteria could infect structures in and around the heart. Recent heart transplants, valves and surgical shunts are all common reasons to prescribe pre-appointment medication.
Many other cardiac devices, such as stents, are now coated with infection-fighting drugs before they are implanted, notes theEuropean Journal of Vascular and Endovascular Surgery. Other advances mean that devices, such as pacemakers, that are implanted in the chest wall no longer pose a threat for infection.
Commonly Prescribed Antibiotics
Amoxicillin is the most commonly prescribed drug for oral antibiotic prophylaxis, explains the journal Open Forum Infectious Diseases. If you are unable to take oral medication, your doctor will prescribe an intramuscular (IM) shot or intravenous (IV) infusion of another kind of antibiotic, such as ampicillin or cefazolin. If you are allergic to certain antibiotics, your surgeon might give you a dose of clindamycin instead.
Dosing Requirements and Side Effects
Your dosage will depend on your age, size and the antibiotic your doctor prescribes. Oral antibiotics should usually be taken one hour before the dental procedure. They can also be taken up to a few hours after the procedure if you forgot to take the medication prior to coming into the office, but it's best to follow your surgeon's instructions and arrive at your dental appointment fully prepared.
Most antibiotics are best taken with a small amount of food. Conferring with your doctor, pharmacist or dentist is always recommended since different antibiotics have different effects.
Relatively few patients need to take antibiotics before seeing a dentist, so it's unlikely you will have to build taking a pill into your routine on appointment days. If you've recently undergone joint or heart surgery, talk to your medical team about the possibility of antibiotic prophylaxis.