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Who should take antibiotics before going to the dentist?

Dr. Todd A. Welch, DMD
Periodontist

You only need to take an antibiotic premedication if the dentist will be doing a procedure that involves "manipulation of the gingival tissue or the periapical region of teeth or perforation of the oral mucosa." (AHA guidelines)  The American Academy of Orthopaedic Surgeons came out with a more specific list in their guidelines from 2003, but did not include it in their most recent update.

Here's the list from the American Academy of Orthopaedic Surgeons of dental procedures where antibiotic premedication is required:

  • Dental extractions (removing a tooth or teeth)
  • Periodontal procedures including:
    • Periodontal surgery (gum surgery)
    • Subgingival (below the gumline) placement of antibiotic fibers/strips
    • Scaling and root planing (a deep cleaning of the root surface of the teeth)
    • Periodontal probing (measuring the pocket between your tooth and gums)
    • Periodontal recall maintenance (a thorough examination of the gums with the possibility of additional cleaning needed)
  • Placement of dental implants
  • Endodontic instrumentation (root canal) or surgery that goes beyond the apex (end of the tooth root)
  • Initial placement of orthodontic bands (but not brackets - see below on list of procedures not requiring antibiotic premedication)
  • Intraligamentary (in the ligament) and intraosseous (in the bone) local anesthetic injections (but not routine anesthetic injections - see below)
  • Dental cleaning of teeth or implants where bleeding is anticipated.

Here's a list from the Amerian Heart Association of dental procedures that do NOT require antibiotic premedication:

  • Routine anesthetic injections through non-infected tissue (routine "numbing" done before a procedure)
  • Taking dental X-Rays
  • Placement of removable prosthodontic appliances (dentures, removable partial dentures, etc.)
  • Placement of removable orthodontic appliances (retainers, etc.)
  • Adjustment of orthodontic appliances (tightening braces, adjusting palatal expanders, etc.)
  • Placement of orthodontic brackets (for braces)
  • Loss of a baby tooth
  • Bleeding from trauma to the lips or oral mucosa (mucosa is the lining of the mouth, such as the inside of the lips, cheeks, etc.)

The American Heart Association (AHA) guidelines recommend antibiotics before going to the dentist for patients who would be in the most danger if they developed a heart infection.

Taking antibiotics before dental treatment is advised for patients with:

  • artificial heart valves
  • a history of infective endocarditis (IE)—a rare but serious infection of the heart's inner lining or valves
  • certain specific, serious congenital heart conditions, including:
    • unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
    • a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
    • any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device
  • a cardiac transplant that develops a problem in a heart valve

The recommendations apply to such common dental procedures as teeth cleaning and extractions.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.