Do I need antibiotics before my dental appointment?
Taking steps to prepare for your dental appointment is a responsible approach to your dental health. For basic dental treatments, this includes simple things like regular brushing and flossing. For other treatments, and for patients with certain conditions, this could include taking antibiotics.
There’s been a lot of debate in the dental and healthcare community about when it is appropriate to use antibiotics before dental treatment. Overall, the group of patients who meet the guidelines for antibiotic prophylaxis is very small. However, it’s still important to examine how antibiotics are used in dentistry today.
What Are Antibiotics?
You’ve probably been prescribed antibiotics by a doctor many times before, but do you actually know what they are?
To be clear, Antibiotics are medicines used to treat infections or diseases caused by bacteria. Antibiotics are used to treat infections such as respiratory tract infections, urinary tract infections, skin infections, and infected wounds.
Antibiotics work by killing the bacteria or stopping them from multiplying. With the help of antibiotics, your body’s natural immune system can better fight against bacterial infection. Some antibiotics work to kill a wide range of bacteria (broad-spectrum antibiotics) while others affect only a few types of bacteria (narrow spectrum antibiotics).
While the way in which antibiotics kill bacteria can differ, the bottom line is they fight all different types of bacterial infections.
How Are Antibiotics Used In Dentistry?
There are two ways in which antibiotics are used in dentistry.
First, antibiotics are used to treat dental infections - think dental abscesses or swelling related to a gum infection. However, antibiotics are not often curative in dentistry but instead are used as a temporary measure until treatment can be performed. In most cases, the infected tooth, gum, or tissue needs to be dealt with in another way, such as with dental extraction, root canal therapy, or deep cleaning of the gums.
The second way antibiotics are used in dentistry are as premedication prior to dental treatment. Antibiotics can be used in this way to help prevent certain rare infections in a small group of patients.
Overall, antibiotics have a very limited use in dentistry, but in my opinion (and in the opinion of many other dentists) tend to be over-used.
When Is The Use of Antibiotics In Dentistry Appropriate?
There is a select group of patients who may benefit from antibiotic prophylaxis (or premedication) prior to a dental appointment. What patients and conditions are included in this group has been debated for years within the American Dental Association, the Association of Orthopedic Surgeons, and the American Heart Association.
According to the most recent guidelines by the ADA, antibiotic prophylaxis is only recommended for patients with certain heart conditions, to prevent a serious heart condition, infective endocarditis. The guidelines state that the use of preventative antibiotics before certain dental procedures is appropriate for patients with:
- Artificial heart valves
- History of infective endocarditis
- Cardiac transplant with valve regurgitation
- Certain specific, serious congenital heart conditions
There are a number of heart conditions that used to be on “the list” of pre-medicated heart conditions but are not any longer, like mitral valve prolapse. The ADA takes a careful look at scientific literature every few years to determine if evidence suggests certain conditions continue to require premedication, and the good news is, fewer and fewer people need to be worried about the risk of infection related to dental treatment.
It is still the subject of debate whether or not patients who have undergone joint replacement surgery would benefit from antibiotic prophylaxis, to help prevent infection in the replaced joint and surrounding supporting structures.
Though for years the ADA recommended premedication after joint replacement, the current ADA guidelines no longer recommend prophylactic antibiotics prior to dental procedures for patients with prosthetic joint implants, as no association has been found between dental procedures and prosthetic joint infections in the scientific literature.
However, prophylactic antibiotics for joint replacement recipients may be appropriate for certain invasive dental procedures, especially for patients who are medically compromised, such as those with immunocompromising diseases or multiple, poorly controlled chronic diseases.
In these cases, a consultation between the patient, dentist, and orthopedic surgeon is necessary to determine the best course of action.
What Are The Risks Of Antibiotics In Dentistry?
The biggest risks of using antibiotics are developing an allergy to the medication and promoting antibiotic-resistant bacteria.
It is possible to develop an allergy to antibiotics, even if you’ve never experienced a reaction before. Allergic reactions to antibiotics can include rashes, hives, and itching. A more serious allergic reaction can lead to symptoms of anaphylaxis, which is life-threatening and requires immediate treatment. Frequent use of antibiotics can increase your risk of developing an allergy. So why risk it if taking the antibiotic is not medically necessary?
Antibiotic resistance happens when bacteria in your body change so that antibiotics can no longer fight them, leaving you (and the entire human race) more vulnerable to dangerous infections. Infections caused by antibiotic-resistant bacteria are much more difficult to treat than regular infections.
Generally, it’s important to avoid unnecessary use of antibiotics. Not only can overuse cause antibiotic resistance, it can also throw off your body’s chemistry by killing good bacteria as well as bad ones.
Is Antibiotic Premedication Right For Me?
Taking antibiotics before dental treatment is really only necessary for a select group of people. Talk to your dentist and healthcare providers about antibiotics and your dental treatment to see if premedication is right for you.
At Dr. Batchelor’s office, we’re here to answer all of our patients' questions before, during, and after treatment. If you’re in the Harrisonburg area, Dr. Batchelor and her team can work with you to help you prepare for your next appointment.