Antibiotic Prophylaxis Prior to Dentistry

Jamie J. Alexander on February 22, 2019

The preventive measure of taking an antibiotic prior to dental procedures is referred to as “antibiotic prophylaxis.” When it is medically indicated, Jamie J. Alexander, D.D.S., in Boynton Beach, FL, prescribes an antibiotic, for patients, to be taken one hour prior to dental procedures. Keeping your medical history up to date is important, and it is carefully reviewed in conjunction with all dental services in our office.

Do You Need Antibiotic Prophylaxis Prior to Dental Work?

There are two groups of patients for which antibiotic prophylaxis is always a consideration – heart patients and patients who have undergone joint replacement. More specifically, patients who are at high risk of developing an infection of the heart’s inner lining or heart valves (called infective endocarditis) and those who are at high risk of bone infection after joint replacement.

The antibiotic that is usually prescribed is oral amoxicillin. For patients who are allergic to amoxicillin, there are alternative antibiotics. The antibiotic will immediately combat bacteria that may enter the bloodstream during your dental service.

The guidelines for taking antibiotics prior to dental procedures have been changing. Although some patients who took antibiotics in the past may no longer need to, each patient should comply with the recommendation of their physician. Keep in mind that, with your signed permission, Dr. Alexander can communicate with and coordinate your oral health care in consultation with your physician.  

Current Guidelines for Heart Patients:

The American Heart Association (AHA) now says that many patients who have taken preventive antibiotics regularly in the past no longer need them, including people with the following conditions:

  • Mitral valve prolapse
  • Rheumatic heart disease
  • Bicuspid valve disease
  • Calcified aortic stenosis
  • Congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

Your doctor may still recommend antibiotics if you have:

  • 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.
  • Some heart conditions that are present from birth:
    • Cyanotic congenital heart disease (birth defects with oxygen levels lower than normal), that has not been fully repaired, including children who have had a surgical shunts and conduits.
    • A congenital heart defect that’s been completely repaired with prosthetic material or a device for the first six months after the repair procedure. †
    • Repaired congenital heart disease with residual defects, such as persisting leaks or abnormal flow at or adjacent to a prosthetic patch or prosthetic device.

Preventive antibiotics are no longer recommended by The American Heart Association for any other congenital heart disease. These guidelines are based on a growing body of scientific evidence that shows that the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks include adverse reactions to antibiotics and, more significantly, the development of drug-resistant bacteria.

If you are a heart patient, Dr. Jamie Alexander wants to know and adhere to the recommendation of your heart physician.

Current Guidelines for Joint Replacement Patients:

In 2012 the American Dental Association (ADA) and the American Academy of Orthopedic Surgeons (AAOS) jointly stated that antibiotics were not mandatory for joint implant patients undergoing routine dentistry. This statement was issued again in 2015 by the ADA, after an updated review of the scientific literature in 2014.

Many orthopedists still recommend antibiotic prophylaxis for two or more years after joint replacement, citing that individuals with joint replacement are less able to fight the onset of bone infection and less able to combat it, if it occurs. At greatest risk are individuals with rheumatoid arthritis, lupus and other autoimmune disorders, insulin-dependent diabetics, and hemophiliacs, organ transplant recipients, those undergoing cancer therapy, those with advanced HIV infection, and those who have had previously had an infection of a joint implant.

If you have had a joint replacement, Dr. Jamie Alexander wants to know and adhere to the recommendation of your orthopedic surgeon.


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