Antibiotic prophylaxis dentistry

Antibiotic prophylaxis for dentistry was once very common but experts no longer recommend them nearly as often. In a previous post I list a lot of the studies that show why I feel the majority of the pre-medicating done is simply done as a legality issue to cover the unknown liability that the dentist may incur.

Antibiotic prophylaxis for heart conditions

This post will deal only with infective endocarditis and when the current recommendation says to take an antibiotic prior to a dental visit. The current recommendations can be found in JADA Jan 2008 Supplement 1 Wilson.

TAble of Antibiotic prophylaxis in dentistry

Antibiotic regimen dental procedures for heart conditions. — This is from 2021 recommendations.

When is antibiotic prophylaxis NOT a recommendation?

Antibiotic prophylaxis is not required for the following devices: pacemakers and implantable cardioverter-defibrillators, prosthetic vascular grafts, hemodialysis prosthetic vascular grafts, intra-aortic balloon counterpulsation catheters, coronary angiography and percutaneous coronary artery intervention, coronary artery stents, vascular closure devices, Dacron carotid patches, vena cava filters, peripheral vascular stents, devices for patent ductus arteriosus, atrial septal defect, and ventricular septal defect occlusion, ventriculoatrial shunt infections, and cardiac suture line pledget infections.7 Lit Review

Which dental procedures require ENDOCARDITIS PROPHYLAXIS?

All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. The following procedures and events do not need prophylaxis: routine anesthetic injections through non-infected tissue, taking dental radiographs, placement of removable prosthodontic or orthodontic appliances, adjustment of orthodontic appliances, placement of orthodontic brackets, shedding of deciduous teeth, and bleeding from trauma to the lips or oral mucosa. Seems to be me that only leaves routine occlusal and incisal fillings.

Additional considerations about antibiotic prophylaxis.

Sometimes patients forget to premedicate prior to their appointments. We recommend that patients take the antibiotic before the procedure. This is important because it allows the antibiotic to reach adequate blood levels. However, the recommendations to prevent infective endocarditis state:

“If the dosage of antibiotic is inadvertently not administered before the procedure, the dosage may be administered up to two hours after the procedure.”

Another concern that dentists have expressed involves patients who require prophylaxis but are already taking antibiotics for another condition. In these cases, the recommendations for infective endocarditis is that the dentist select an antibiotic from a different class than the one the patient is already taking. For example, if the patient is taking amoxicillin, the dentist should select clindamycin, azithromycin or clarithromycin for prophylaxis. Source 2013

Partial list of dental procedures that require antibiotic prophylaxis

If you identify with a condition in the high or moderate risk groups, then we recommend antibiotic prophylaxis for the following dental procedures:

- Dental extractions
- Periodontal procedures including surgery, scaling and root planing, probing, and recall maintenance
- Dental implant placement and reimplantation of avulsed teeth
- Endodontic (root canal) instrumentation or surgery only beyond the apex
- Subgingival placement of antibiotic fibers or strips
- Initial placement of orthodontic bands but not brackets
- Intraligamentary local anesthetic injections
- Prophylactic cleaning of teeth or implants if there will be bleeding

We do not recommend antibiotic prophylaxis for the following dental procedures:

- Restorative dentistry (operative and prosthodontic) with or without retraction cord
- Local anesthetic injections (nonintraligamentary)
- Intracanal endodontic treatment; post placement and buildup
- Placement of rubber dams, postoperative suture removal, taking of oral impressions, and fluoride treatments
- Placement of removable prosthodontic or orthodontic appliances and orthodontic appliance adjustment
- Taking of oral radiographs
- Shedding of primary teeth

Source AHA Source Endo

Source