By Keith Roach, M.D.
Signal Contributing Writer
Taking antibiotics before dental work
I have a stent, but also a knee replacement, for which I take four 500-mg capsules of amoxicillin each time I go to the dentist, including just for cleaning. This is per my surgeon’s orders. Do you have any information that would question the necessity of this? — M.W.
ANSWER: Bacteria can get into the bloodstream occasionally in healthy people. They often enter through the mouth, especially in people with poor oral hygiene or with inflammatory oral conditions, such as gingivitis (gums) or periodontitis (tooth lining). The reason to take antibiotics is to prevent the bacteria in the blood from getting into someplace they are likely to cause harm, such as prosthetic heart valves, joints or stents. For years, expert groups recommended taking antibiotics around the time of dental procedures.
The problem is that it’s not clear whether antibiotics help prevent infection, however, it is clear that antibiotics have the potential to cause harm, although the risk of serious problems with a single dose of amoxicillin is pretty small. No study has ever shown a reduction in the rate of serious infections from using antibiotics before a dental procedure.
Further, bacteria are just about as likely to get into the bloodstream after brushing (or even after a bowel movement). For this reason, antibiotics to be taken before dental procedures are reserved for people at the highest risk, those in whom an infection would be extremely dangerous.
This includes people with artificial materials in the bloodstream, such as prosthetic heart valves, or with repaired congenital heart disease. People with any history of infection of the heart valves are at high risk and should receive antibiotics.
For people like you, with orthopedic hardware, infection after a dental procedure is rare. A joint statement by the American Dental Association and the American Academy of Orthopedic Surgeons instructed: “In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection.” However, any given person may have underlying surgical or medical issues that may supersede these general recommendations.
What remains important is maintaining good oral hygiene and promptly treating any dental infections.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
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