Antibiotics and Dental Treatment

Your mouth has bacteria that can get into your bloodstream. For most people, these bacteria don’t cause a problem. But there is concern that for some people, bacteria in the bloodstream can cause an infection elsewhere in the body. That’s why your physician or dentist may advise you to take an antibiotic before some dental procedures. The antibiotic can kill infection-causing bacteria.

Not everyone should take antibiotics before dental treatment. This brochure will explain who should take antibiotics in this case and who should not.

What is the dental connection?

Bacteria normally are found on and in some parts of the body, including the skin and mouth. The bacteria in the mouth can enter the bloodstream. This can happen during some dental treatments, like teeth cleanings, or even from daily activities like chewing, toothbrushing, and flossing. For most people, the body’s immune system fights any bacteria, so the risk of infection stays low.

There’s concern that for some people, bacteria in the bloodstream can cause an infection of the heart lining or valves (infective endocarditis) or an infection of an orthopedic implant (such as artificial joints or metal plates or rods).

Because of this concern, some people with certain heart conditions and orthopedic implants are told to take antibiotics before having certain dental treatments. This is done with the belief that antibiotics might help prevent infective endocarditis or an implant infection. Taking antibiotics before dental treatment is called antibiotic prophylaxis (or preventive medicine).

However, there is no scientific evidence to show that bacteria in the bloodstream cause orthopedic implant infections. There is also no scientific evidence that antibiotic prophylaxis defends against infective endocarditis or an implant infection.

Who should take preventive antibiotics?

The American Heart Association recommends antibiotics for patients who would be in the most danger if they developed a heart infection.

If you have one of these heart conditions, your dentist or physician may recommend that you take an antibiotic before dental treatment:

• artificial heart valves
• a history of infective endocarditis
• 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 American Dental Association and American Academy of Orthopedic Surgeons also do not recommend antibiotics for all dental patients who have had orthopedic implants. However, some people with orthopedic implants may decide to take antibiotics. For example, people who have weak immune systems are at greater risk for artificial joint infection. Diabetes, rheumatioid arthritis, cancer, chemotherapy, and chronic steroid use can weaken the immune system. All patients should talk to their dentists and/or physicians before deciding whether or not to take antibiotics.

Why shouldn’t everyone with a heart condition or orthopedic implant take preventive antibiotics?

In most cases, taking antibiotics is more likely to cause a problem than defend against one. Antibiotics can cause side effects from mild stomach problems to severe allergic reactions. Taking antibiotics can destroy good germs that protect against infection. Also, improper use of antibiotics can lead to the development of drug-resistant bacteria.

Talk to your dentist or physician

Talk to your dentist or physician if you have any questions about antibiotics. If there are any changes in your health history or the medicines you take, let your dental office know so they can update your records.

You can maintain a healthy mouth by brushing twice a day, cleaning between your teeth daily, and visiting the dentist regularly.