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Should You Premedicate For A Dental Procedure?


In years past, dentists frequently prescribed antibiotics before even a basic dental cleaning.

Things are a little different, nowadays.

Why Premedicate?

The rationale for premedication was to immobilize any bacteria that entered the bloodstream from the mouth before they could cause an infection.

The mouth is full of all kinds of bacteria, some of which are harmful and occasionally involved in serious infections in other parts of the body.

If these germs entered the bloodstream, doctors feared that the bacteria could trigger inflammation in tissue or blood vessels that created a deadly blood clot.

Premedication became the gold standard for avoiding a circumstance (called a “bacteremia”) that could lead to stroke or heart attack.

Less Medication Today

There are far fewer cases of premedicating in dentistry today.

Why? There are a couple reasons:

  1. A bacteremia, the introduction of bacteria to the bloodstream, is not unique to dental treatment but is actually almost a daily occurrence.

  2. We better understand the risk of antibiotic resistance.

First consider the condition that necessitates using an antibiotic.

Bacteria in the mouth don’t just slip into the blood because of a dental cleaning. Any instance of bleeding in the mouth provides the chance for that to happen. Bleeding can occur when you floss too roughly, accidentally bite your tongue, get a canker sore, and so on. None of those situations call for you to rush to the hospital for an antibiotic!

True, dental professionals want to lower the chances that performing dental work could cause an infection. But the risks of using an antibiotic in each case can outweigh the potential benefits.

As with all antibiotic use, there’s the chance of having an adverse reaction.

Besides this, routinely taking small, frequent, unnecessary doses of antibiotics can lead to resistance. The next time you have a serious infection, the antibiotic of choice could be rendered ineffective against the bacteria.

Current Premedication Guidelines

Patients at high-risk for developing infective endocarditis can still benefit from antibiotic prophylaxis.

These high-risk individuals include:

  • prosthetic cardiac valves, including transcatheter-implanted prostheses and homografts;

  • prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords;

  • a history of infective endocarditis;

  • a cardiac transplant with valve regurgitation due to a structurally abnormal valve;

  • the following congenital (present from birth) heart disease:

  1. unrepaired cyanotic congenital heart disease, including palliative shunts and conduit

  2. any repaired congenital heart defect with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or a prosthetic device

(List taken from the American Dental Association.)

One major change here in recent years is that prophylactic antibiotics are no longer recommended for those with joint replacements and other prosthetics. If you do have a prosthetic, please check with your orthopedic surgeon to find out whether or not you should premedicate. It’s ideal if your surgeon makes the call and, if possible, writes out the prescription.

How to Premedicate

If your doctor, cardiologist, dentist, or orthopedic surgeon recommends an antibiotic, then it’s important to take it as directed. You should take it within 30 to 60 minutes before your treatment. If you miss your dose, it can be taken within two hours after the procedure.

If you are already taking an antibiotic for a separate condition, then you should be prescribed an antibiotic of a separate class.

It’s okay if you’re not entirely familiar with the latest guidelines for premedication for dental treatment. Your doctor and a Tacoma dentist will work together to help determine the safest course for you.

Call Dr. Duke Bui today to schedule a non-invasive dental checkup and find out more about antibiotic prophylaxis in dentistry.

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