DO YOU PRE-MED?

For decades, the American Heart Association (AHA) recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. For those with these certain heart conditions, this was done with the belief that antibiotics would prevent infective endocarditis (IE), previously referred to as bacterial endocarditis. IE is an infection of the heart’s inner lining or valves, which results when bacteria enter the bloodstream and travel to the heart. Bacteria are normally found in various sites of the body including on the skin and in the mouth.

In 2007, the AHA’s revised guidelines were published in its scientific journal, Circulation, and there was good news: the AHA recommended that most of these patients no longer needed short-term antibiotics as a preventive measure before their dental treatment. This saved a lot of patients from taking antibiotics prior to dental appointments. However, those with replacement joints were still required to take the medication prior to dental visits.
These revised guidelines back in 2007 were based on a growing body of scientific evidence that showed the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks included 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.

More recently The American Dental Association (ADA) finally weighed in on the controversy about prophylactic antibiotics prior to dental visits for those who have had artificial joint replacement:

“In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection. The practitioner and patient should consider possible clinical circumstances that may suggest the presence of a significant medical risk in providing dental care without antibiotic prophylaxis, as well as the known risks of frequent or widespread antibiotic use. As part of the evidence-based approach to care, the clinical recommendation should be integrated with the practitioner’s professional judgment and the patient’s needs and preferences.”

While the ADA’s statement is not an outright cancellation of all prophylactic antibiotics, it is reassuring to know that we (dentists and patients) have more flexibility, and are able to make these decisions without having to always hunt down the orthopedic surgeon. People who have had previous complications with infected joints or have compromised immune systems may still be required to pre-medicate.

For those patients who have been swallowing all those pills prior to your dental appointments, I would suggest having a discussion about this with your dentist. Patients with artificial joints have become accustomed to pre-medicating and I can understand if there is hesitation about stopping this routine. Have the conversation with your dentist and decide what makes sense for your specific situation.