At Canyon Gate Dental we’re very interested in keeping you and your family safe. This is why we ask so many questions about your general health status, the medications you take, potential allergies, and your health history. It’s the reason we sometimes ask permission to call your doctor. It’s the reason we take your blood pressure before any dental procedures. It’s the reason we seem a little bit hyper in making sure you’re feeling well after dental visits. In this context of safety, I’d like to address one of the more confusing medical things we have to explain to patients: antibiotics before dental visits.

Recommendations to take antibiotics before dental visits have existed for three categories of patients: those with certain heart conditions, those with total knee and hip replacements, and those whose medical doctors and surgeons recommend such protocols. The whole idea of the concept is to identify people who have an elevated risk for infection (such as someone with a prosthetic heart valve, for instance) and do everything possible to prevent such infection from happening. Theoretically, the source of the infection would be mouth bacteria that enter the bloodstream during dental procedures, such as cleanings. This is controversial for a couple reasons though. First, it is not very clear that mouth bacteria are even connected with these kinds of infections. Second, bacteria enter the bloodstream every single time we brush or floss; what is the difference between this daily “bacteremia” and what happens during dental procedures? The answer is nothing; there is no difference. So be aware that this is an area of medicine where nobody knows the answer yet. Our knowledge of these things is still evolving. By admission, medical organizations like the American Heart Association simply try to hedge their bet by erring on the safe side of things, until clearer research is available.

And that’s precisely what makes this topic so confusing to people. Recommendations are always changing; as the latest research yields new information every couple years, recommendations are updated, usually toward the conservative side, with fewer people needing antibiotics. It is not uncommon for patients who have been taking antibiotics before dental appointments for years to suddenly find themselves in the category of those who don’t need them—and this gets confusing as old habits die hard. In addition to updated research there are some other factors at play that make us want to limit antibiotic use as much as possible. Antibiotics have a lot of potentially nasty side effects, from allergy issues to intense “C diff.” stomach problems. They also can lose their effectiveness if overused; bacteria mutate and adapt to them quite easily. This is why you hear about all these antibiotic resistant bugs in the news that give hospitals fits. It’s becoming a major problem.

These are the current guidelines we follow pertaining to prophylactic antibiotic use in our Orem, Utah dental office:

Heart Patients

Guidelines for heart patients come from the American Heart Association (AHA). Their most recent version of recommendations were released in 2007. Antibiotics are recommended for the following patients before dental appointments:

• Those who have artificial heart valves (not stents—actual “replacement parts”)
• Those who have had infective endocarditis previously
• Those who have had a heart transplant that has developed problems
• Those who have extremely rare congenital heart conditions (there is a list of conditions that I won’t mention here; those who have them likely know of their situation)

Total Joint Replacement Patients

The American Academy of Orthopaedic Surgeons (AOS) is the governing body who makes recommendations to dentists for total joint replacement patients.   Their latest guidelines came out in 2015, about a month ago. In the past they recommended that all total knee and total hip replacement patients take antibiotics before dental procedures. In 2012 they got a little softer and suggested some patients might need antibiotics only during the first two years after joint replacement. The 2015 guidelines eliminate the need for antibiotics altogether for total joint replacement patients. The AOS went this direction because research demonstrated no link between prosthetic joint infection and oral bacteria. Additionally, they recognize all the bad things that can happen with antibiotic overuse and determined that risks of prophylactic antibiotic use outweigh any potential benefits of such.

Your Doctor’s Advice

For our office, the most important guideline to follow is to heed the advice of your medical doctor or surgeon. If a doctor recommends taking antibiotics after a heart surgery or joint replacement (or for any other reason, really), we do it. This is their area of expertise, and no guideline or written rule can supersede the knowledge and clinical experience of someone who knows your particular situation well. If you trust your doctor enough to be examined by them and have them perform a procedure, also trust their judgment in keeping you safe with antibiotic use.

If you have any questions regarding your situation or want more information on this or other topics related to oral health, please feel free to give our office a call.

-Nicolas K. Young, DMD