If you're like most people who have a prosthetic joint, artificial heart valve, heart murmur, cardiac stent, or any one of numerous medical conditions, you have probably been told at some point to "premedicate" with antibiotics before your dental appointments. Later, depending on the condition, your physician or dentist may have told you it was no longer necessary. Or maybe just needed for 2 years following a procedure. Maybe 1 year. Maybe for the rest of your life. How confusing!
I'd like to clarify these recommendations, or at least try to until they are changed again. Since I've been in dentistry, the premedication guidelines have changed at least 4 times. Often, the physician or dentist may not even be aware new guidelines have been issued and are still making recommendations based on old science. So here are the most recent recommendations published in The Journal of the American Dental Association (JADA) in 2015...
Let's start with prosthetic joint replacement. This one is different than previous recommendations and may be a shock to those who have been taking antibiotic prophylaxis for years. From the ADA's report, "In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection." So there it is, most people with artificial knees and hips do not need to continue taking antibiotics prior to their dental appointment. Of course, it is best to discuss this with your dentist and physician before making that decision.
You might ask, "who makes these recommendations?" The guidelines were agreed upon by a panel of experts from the American Academy of Orthopaedic Surgeons and the American Dental Association. The guidelines go on to say that there is evidence that: 1) dental procedures are not associated with joint infections, 2) taking antibiotics before dental procedures does not prevent joint infections, 3) there are potential harmful effects of taking antibiotics regularly, and 4) the benefits of antibiotic premedication does not outweigh the potential harm. Some people may still need to premedicate, however, including those with previous prosthetic joint infection, those who have a compromised immune system, or those with certain diseases such as diabetes.
How about premedication for those with heart conditions? These guidelines have been more consistent in recent years, but have been changed previously. Currently, it is recommended that those with an artificial heart valve should premedicate with antibiotics prior to certain dental procedures. You should also premedicate if you have a history of infective endocarditis or have one of a few congenital heart defects. Patients do NOT have to premedicate is they have mitral valve prolapse, a heart murmur, or a cardiac stent.
Well there is it. I hope you found this helpful and if you need any further clarification, it is best to ask your dentist at your next visit. Your dentist and physician may work together to decide if and when antibiotic premedication is appropriate prior to your dental visit.
David Scardella, DMD