Premedication with antibiotics prior to dental visits can be an important part of your healthcare process, but the ever-changing, and sometimes confusing, guidelines often lead to a lot of questions and concerns in our office. Sometimes it's a touchy subject...

"Why wouldn't I just take the antibiotics if they might keep me safe?"

Unfortunately, the biggest question is the safety, and it may be a double-edged sword. The benefits are obvious: kill bad bacteria that may interfere with a heart condition or artificial joint. But what are the risks? Here is a list: 

  1. The destruction of good bacteria they may actually aid in keeping the bad bacteria at bay. You rely on these bacteria to keep the "bad guys" from attacking your heart or joint that you are trying to protect.
  2. More importantly, these good bacteria do a lot to protect you in other ways. Killing them on your skin can result in over population of bad or antibiotic resistant bacteria, causing a greater risk of bacterial or fungal infection from the smallest break in skin. 
  3. Not only is your your skin at risk, but your gut is often greatly affected by antibiotic use. Have you ever had a stomach ache when taking antibiotics? The population of beneficial bacteria in your intestines is immense. It helps to break down food and keep bad bacteria from getting out of control. Without these "good guys", opportunistic bacteria like c. difficile can lead to illness that requires even more potent antibiotics or even surgery. This infection can be deadly. 
  4. In many minds, the greatest concern is the overall effect on society. In our little world, dealing with one knee replacement or heart valve becomes the most important piece of the puzzle. When prescribing these medications, the likelihood of the creation of more "super bugs" has to considered. According to the Centers for Disease Control, over 2 million illnesses and 23,000 deaths are caused by these super bugs each year and this is directly related to over prescription of antibiotics. For more information, please click HERE.

These are not easy decisions to make. After all, we try to focus on one patient at a time at CrossKeys Dental, so how can we look at this from a global perspective? Our job is to take this on a case-by-case basis and we rely on patient input after we have provided the above key facts. Here are some reasons that I will recommend prophylactic antibiotic treatment. If you have:

  1. A history of infective endocarditis
  2. An unrepaired congenital heart defect
  3. An artificial heart valve or other prosthetic heart device
  4. Had an artificial joint placed inside of the last 2 years. At this time the ADA guidelines states that artificial joints generally do not require antibiotic pre-treatment. This is an ever-changing recommendation. Many orthopedic doctors will recommend treatment for life. I will often ask the patient to discuss this with their surgeon and have any antibiotic prescriptions written by this surgeon.  
  5. Had trouble with a joint replacement in the past or have had a joint replaced and have an immune disorder

A few more thoughts: Dentists generally no longer prescribe antibiotics for a heart murmer. Studies show this to be of very little benefit and the recommendation was removed many years ago. 

Also, the reason for these antibiotics is to keep bacteria from entering your bloodstream due to bleeding during the procedure. If you are bleeding when brushing and flossing at home you should talk to your dentist about ways to improve your home care. Healthy gums should not bleed and this bleeding is often related to an overabundance of oral bacteria. Gingivitis and periodontal disease will lead to the introduction of bacteria into your bloodstream, which may put you at far greater risk for infection when compared to a single dental procedure. 

CrossKeys Dental is located at 110 CrossKeys Office Park in Fairport. Dr. DuPre` and Dr. Badali provide comprehensive family dentistry and are always welcoming new patients. Visit us for more information. Written by Vincent Badali, DDS