Do You Still Need It?
By the Dental Team at Dr. Harvey Levy & Associates
Edited. Original published in our July 27, 2023 e-Newsletter
If you’ve been prescribed antibiotics prior to going to the dentist (“antibiotic prophylaxis”), it’s likely that you no longer need to take them. Taking unnecessary antibiotics can actually be harmful, per studies summarized in this 2023 paper published by the NIH, Antibiotic Prophylaxis in Dental and Oral Surgery Practice – StatPearls – NCBI Bookshelf, and this 2022 ADA article Antibiotic Prophylaxis Prior to Dental Procedures.
Here are the highlights:
Joint replacement (prosthetic surgery):
- If you have any kind of joint replacement (prosthetic) surgery, please wait 6 months before coming into the office for elective treatment. We will not be able to perform any procedure that may cause bleeding, including a dental cleaning. Please call us if you’ve had joint replacement surgery within 6 months so we can reschedule your appointment.
- If you have a dental emergency before the 6 months are over, please schedule an appointment for a limited exam. Your dentist may need to contact your surgeon for clearance if additional treatment is needed.
- If you have not had a dental check up within 6 months prior to your upcoming surgery, it is strongly encouraged that you schedule an appointment for an exam and possible x-rays to rule out any infections or deep cavities that may result in treatment during your 6 month recovery period.
- If it’s been six months after you’ve had prosthetic replacement surgery and you are healthy, you do NOT need antibiotics. If you would feel more comfortable, or your surgeon believes that a pre-med is recommended, you will need to have a discussion with them to get a prescription because we will not prescribe it.
- If you have a history of failed joint replacement or infection at the site, please contact your surgeon for a prescription.
- There are underlying conditions that require antibiotics prior to your dental visit. These include, but are not limited to: prosthetic cardiac valve or material, history of infective endocarditis (IE), patients with certain conditions of congenital heart disease (CHD) and cardiac transplant recipients who develop cardiac valvulopathy.
- Other heart conditions may lead your physician to prescribe antibiotics before you visit the dentist. Make sure to ask your physician for a prescription prior to your appointment.
Downsides of pre-medicating with antibiotics prior to dental procedures:
- Antibiotics have been found to be mostly ineffective in reducing the risk of bacteremia (bacteria in the bloodstream) and the risk of infective endocarditis in patients who do not meet the above criteria.
- Antibiotics may cause adverse effects that can result in emergency room visits, such as anaphylaxis (life threatening allergic reaction) and C. Diff infection (which can cause severe damage to the colon).
- Unnecessary antibiotics contribute to the growing problem of antibiotic resistance.
In summary, recommendations regarding antibiotic prescriptions prior to dental visits are now limited to specific criteria in patients with cardiac risks, and most likely not needed for patients with prosthetic joints more than 6 months after surgery.
Antibiotic Pre-Med: Protocol and Policy Change Effective September 1, 2023
Due to the updated antibiotic research and protocol recommending that antibiotic prophylaxis (pre-med) is often unnecessary, effective September 1, 2023, we will no longer be prescribing antibiotics for our patients.
If your cardiologist or surgeon still recommends that you take them, you will need to get a prescription from them. If you are unable to get a prescription in time for your appointment, please contact our office.
If you are enrolled in electronic patient communications, you will soon receive an additional confirmation text message prior to your dental appointment. This text message will remind you to speak to your physician regarding the need to premedicate with antibiotics prior to dental appointments, and to obtain the prescription from that physician if necessary. (Not enrolled in text messages? Click HERE now (it’s easy!) to ensure that you receive the confirmation message for all future appointments).