Antibiotic prophylaxis guidelines, taking an antibiotic before dental treatment, exist for two groups of dental patients: those with Heart Conditions that may predispose them to infective endocarditis (IE), and patients who have Total Joint Replacements, who may be at risk for developing infections at the site of their prosthesis.Guidelines for patients who have Total Joint Replacements have not been changed.For the first two years after a joint replacement, all patients may need antibiotics for all high-risk dental procedures (those which may involve bleeding). After two years, only 'high-risk' patients may need to receive antibiotics for high-risk procedures. The bacteria commonly found in the mouth may travel through the bloodstream and settle in your artificial joint. This increases your risk of contracting an infection. Ask your dentist about preventive antibiotics for all dental procedures with a high risk of bleeding or producing high levels of bacteria in your blood. Your dentist and your orthopaedic surgeon, working together, will develop an appropriate course of treatment for you.Antibiotic prophylaxis is not indicated for dental patients with pins, plates or screws, nor is it routinely indicated for most dental patients with total joint replacements. However, it is advisable to consider premedication in a small number of patients who may be at potential increased risk of experiencing hematogenous total joint infection. The ADA full report and recommendations can be downloaded below. Guidelines for patients who have Heart Conditions have been changed.For decades, the American Heart Association recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. This was done with the belief that antibiotics would prevent infective endocarditis (IE), previously referred to as bacterial endocarditis. The AHA’s latest guidelines were published in its scientific journal, Circulation, in October 2007 and there is good news: the AHA recommends that most of these patients no longer need short-term antibiotics as a preventive measure before their dental treatment. The American Dental Association participated in the development of the new guidelines and has approved those portions relevant to dentistry. The guidelines are based on a growing body of scientific evidence that shows the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks include adverse reactions to antibiotics that range from mild to potentially severe and, in very rare cases, death. Inappropriate use of antibiotics can also lead to the development of drug-resistant bacteria. Scientists also found no compelling evidence that taking antibiotics prior to a dental procedure prevents IE in patients who are at risk of developing a heart infection. Their hearts are already often exposed to bacteria from the mouth, which can enter their bloodstream during basic daily activities such as brushing or flossing. The new guidelines are based on a comprehensive review of published studies that suggests IE is more likely to occur as a result of these everyday activities than from a dental procedure.The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with:Mitral valve prolapse Rheumatic heart disease Bicuspid valve disease Calcified aortic stenosis Congenital heart conditions
The new guidelines are aimed at patients who would have the greatest danger of a bad outcome if they developed a heart infection. Preventive antibiotics prior to a dental procedure are still advised for patients with:Artificial heart valves A history of infective endocarditis Certain specific, serious congenital (present from birth) heart conditionsA completely repaired congenital heart defect with prosthetic material or deviceCardiac transplants that develops a problem in a heart valve
The new recommendations apply to many dental procedures, including teeth cleaning and extractions. Patients with congenital heart disease can have complicated circumstances. They should check with their cardiologist if there is any question at all as to the category that best fits their needs. A summary of AHA recommendations to prevent Infective Endocarditis during dental care can be found below.
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