Dental Antibiotic Regimen Has Changed

Question: “I have always had to take antibiotics before my dental cleanings. I read online recently that a lot of people don’t need to do this anymore. Who really needs antibiotics before their dental appointments?”

Answer: First of all, I would advise you and anyone else who has questions about taking antibiotics before a dental appointment to discuss this with your physician and dentist. They know specifically what your situation is, and they will make the appropriate recommendation.

Generally, preventive antibiotics have been recommended by physicians for patients with congenital heart problems in order to avoid infective endocarditis. When the gums bleed, bacteria from the mouth enters the bloodstream and has the potential to create an infection of the heart.

That having been said, the American Heart Association periodically reviews and modifies its recommendations. After an extensive review of existing dental literature on this subject, they have determined that the risks associated with using preventive antibiotics can sometimes outweigh the benefits.

Some people experience allergic reactions to these antibiotics, and the development of drug-resistant bacteria is another potential side effect. The research has also shown that people are much more likely to be exposed to blood-borne bacteria from brushing their teeth over the period of a year than they are from a dental procedure.

This means that the new recommendations require only patients who are at the highest risk for infective endocarditis to take preventive antibiotics before dental cleanings or tooth extraction appointments. These people include those with serious congenital heart defects, artificial heart valves, or those who have had heart transplants.

Furthermore, most patients with mitral valve prolapse, minor congenital heart problems, and rheumatic heart disease will no longer have to “pre-medicate”. The risk of these patients contracting infective endocarditis is so minimal that they would be more at risk by taking antibiotics unnecessarily.

As I mentioned previously, every situation is different, and it is important that you discuss this with your family physician and dentist before your next dental appointment.