Receiving Antibiotics Before Dental Treatment

If you are a patient with certain kinds of heart disease or a special heart condition, or you've had a joint replaced, taking good care of your teeth and gums is a must--not just for a healthy smile, but also for your overall health.

BACTERIAL ENDOCARDITIS
Your dentist or physician may recommend that you take antibiotics before your dental appointment, because bleeding sometimes occurs during dental treatment, and bacteria from the mouth possibly can enter the bloodstream. It is possible that these bacteria could work their way to the heart. This presents a risk for some people with cardiac abnormalities because the bacteria may cause bacterial endocarditis, a serious inflammation of the heart valves or tissues.

Certain heart conditions are associated more often with endocarditis than are others. To determine if an existing heart condition poses a risk, your dentist needs complete health information on your medical history form. The form also should include the name and address of your family physician or cardiologist as well as the names and dosages of all medications that you take. Do any of these apply to you?
- heart surgery within the past six months
- pacemaker
- vascular surgery (replaced artery) within the past six months
- artificial heart valve
- history of rheumatic fever
- history of heart murmur (mitral valve prolapse)
- previous bacterial endocarditis
- systemic pulmonary shunt
- congenital heart defect
- acquired valvular dysfunction

If you have any of these conditions, if you have been diagnosed with other heart ailments or if your health status has changed since your last dental visit, tell your dentist.

JOINT REPLACEMENT INFECTIONS
It also is possible that the bacteria commonly found in the mouth may travel through the bloodstream and settle in your artificial joint. This increases your risk of contracting an infection. Your dentist and your orthopedic surgeon, working together, will develop an appropriate course of treatment for you.

For everyone who has received a total joint replacement, antibiotic prophylaxis is recommended for the first two years after the replacement. After two years, only high-risk patients may need to receive antibiotics for high-risk procedures. Do any of these high-risk situations apply to you?
- rheumatoid arthritis, systemic lupus or other medical conditions that cause you to be immunocompromised or immunosuppressed
- immunosuppression caused by drug or radiation treatment
- malnourishment
- hemophilia
- HIV infections
- insulin-dependent (type 1) diabetes
- cancer

All patients in these high-risk categories may need antibiotics for all high-risk dental procedures.

ANTIBIOTICS TO HELP PREVENT INFECTION
Your dentist or physician may prescribe antibiotics for dental procedures that would result in bleeding from the gums or mucous membranes in the mouth. For patients with heart conditions, prescribing recommendations are contained in a report by the American Heart Association and the American Dental Association. For patients with total joint replacements, prescribing recommendations are contained in a report by the American Dental Association and the American Academy of Orthopedic Surgeons.

If you are taking new or different medicine (prescription or over-the-counter drugs) since your last dental appointment, advise your dentist so that your medical records can be updated. If you have developed allergies to any medicine since your last visit, advise your dentist.

Your dentist may consult with your physician, cardiologist or orthopedic surgeon to determine which antibiotics you should take before your dental visit. If you are taking antibiotic pills orally, be sure to fill your prescription before your next visit. Carefully follow instructions for the dosage and frequency.