Why Dentists Prescribe Premedication

At times physicians and dentists recommend that a patient take antibiotics before certain dental procedures. This is called “antibiotic prophylaxis.” But why do healthcare providers suggest this extra step?

We all have bacteria in our mouths, and a number of dental treatments—and even daily routines like chewing, brushing or flossing—can allow bacteria to enter the bloodstream (bacteremia). For most of us, this isn’t a problem. A healthy immune system prevents these bacteria from causing any harm. There is concern, however, that for some people bacteremia can cause an infection elsewhere in the body.

Who is at risk? Antibiotic prophylaxis is recommended for a small number of people who have specific heart conditions. The American Heart Association has guidelines identifying people who should take antibiotics prior to dental care.

According to these guidelines, antibiotic prophylaxis should be considered for people with:

• Artificial heart valves.
• A history of an infection of the lining of the heart or heart valves known as infective endocarditis, an uncommon but life-threatening infection.
• A heart transplant in which a problem develops with one of the valves inside the heart.
• Heart conditions that are present from birth, such as:
  • Unrepaired cyanotic congenital heart disease, including people with palliative shunts and conduit.
  • Defects repaired with a prosthetic material or device—whether placed by surgery or catheter intervention—during the first six months after repair.
  • Cases in which a heart defect has been repaired, but a residual defect remains at the site or adjacent to the site of the prosthetic patch or prosthetic device used for the repair.

Talk to your dentist about these guidelines if you have any questions about antibiotic prophylaxis.

Antibiotic prophylaxis guidelines have also been revised for people with orthopedic implants such as artificial joints. Learn more about why the ADA and American Association of Orthopedic Surgeons updated the recommendations and no longer recommend antibiotics for everyone with artificial joints.

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