To Take or Not To Take…The Controversy Over Taking Antibiotics Prior to Dental Treatment


Updated Antibiotic Prophylaxis Guidelines Prior to Dental Treatment

Infective Endocarditis

In 2007 the American Heart Association’s (AHA) established its latest guidelines for antibiotic prophylaxis prior to dental procedures to prevent infective endocarditis. The guidelines were changed as a growing body of scientific evidence has shown that the risks of taking preventive antibiotics outweigh the benefits for most patients. These risks include adverse reactions to antibiotics ranging from mild to potentially severe and the development of drug-resistant bacteria.

The AHA guidelines emphasize the importance of achieving and maintaining excellent oral health and practising daily oral hygiene. For most patients, taking preventive antibiotics before a dental visit is not indicated. The guidelines state that prophylactic antibiotics, which were routinely administered to certain patients in the past, are no longer needed for patients with:

  • mitral valve prolapse
  • rheumatic heart disease
  • bicuspid valve disease
  • calcified aortic stenosis
  • congenital heart conditions such as ventricular septal defect, atrial septal defect and
  • hypertrophic cardiomyopathy.

Only patients at greatest risk of developing infective endocarditis, an infection of the heart’s inner lining or the heart valves should receive short term preventive antibiotics before common, routine dental procedures.

People who should take antibiotics include those with:

1.prosthetic cardiac valve or prosthetic material used for cardiac valve repair

2.a history of infective endocarditis

3.certain specific, serious congenital (present from birth) heart conditions, including:

  • unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
  • a completely repaired congenital heart defect with prosthetic material or device,
  • whether placed by surgery or by catheter intervention, during the first six months after the procedure
  • any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device

4.a cardiac transplant that develops a problem in a heart valve

Antibiotic prophylaxis is recommended for patients with the above conditions who undergo any dental procedure that involves manipulation of gingival tissues or the periapical region of a tooth and for those procedures that perforate the oral mucosa. The following procedures and events do not need prophylaxis:

  • routine anesthetic through noninfected tissue
  • dental radiographs
  • placement of removable prosthodontic or orthodontic appliances adjustment
  • of orthodontic appliances
  • placement of orthodontic brackets
  • shedding of deciduous teeth
  • bleeding from trauma to the lips or mucosa

Joint Replacement

The Canadian Orthopedic Association (COA), the Canadian Dental Association (CDA) and the Association of Medical Microbiology and Infectious Disease (AMMI) Canada provide the following guidance in regards to the management of dental patients with orthopedic devices:

  1. Patients should not be exposed to the adverse effects of antibiotics when there is no evidence that such prophylaxis is of any benefit.
  2. Routine antibiotic prophylaxis is not indicated for dental patients with total joint replacements, nor for patients with orthopedic pins, plates and screws.
  3. Patients should be in optimal oral health prior to having total joint replacement and should maintain good oral hygiene and oral health following surgery. Orofacial infections in all patients, including those with total joint prostheses, should be treated to eliminate the source of infection and prevent its spread.

From time to time we do see patients whose Orthopedic Surgeons still insist that the patients take an antibiotic prior to dental treatment in some cases for 2 years after surgery and in some cases for the rest of the patient’s life. In light of these new guidelines, it is therefore recommended that the Orthopedic Surgeon prescribe the course of antibiotics for the patient in these cases. If you have any questions regarding any of the above information, please feel free to call us!