Who Needs Premedications for Dental Treatment?

dental premedications

About 800,000 Americans have a hip or knee replacement each year, and more than half a million Americans have heart surgery each year, according to the National Institutes of Health. When you fill out your medical history form at the dentist's office, you'll notice it asks if you've had any of these procedures.

If you answer yes, you may need to take an antibiotic before certain types of dental treatment.

"Whenever a patient has an artificial heart valve or an artificial joint, there's a higher risk of infection," said Dr. Ajay Singh, a general dentist at Coast Dental Ocala South in Ocala, Florida. "When you perform a cleaning or an extraction where there may be bleeding, there's the potential for bacteria from the mouth to enter the bloodstream and travel to the valve or joint, triggering an infection. That's why we prescribe an antibiotic like amoxicillin. The patient takes one dose about a half-hour to one hour before the procedure, and that should be all he or she needs."

Either your dentist or your primary care physician will prescribe the dosage. If you forget to take it before your appointment, ask your dentist. You may be able to take it up to an hour after the procedure and have the same health benefits.

Joint Replacement Premedication Guidelines

The guidelines for when you need an antibiotic have changed in the past few years.  The recommendation used to be that patients take an antibiotic before dental cleanings, extractions or oral surgery for up to two years after a joint replacement surgery. Then the American Academy of Orthopedic Surgeons recommended all patients who have had joint replacement surgery continue to premedicate beyond two years. Now, the American Dental Association and the American Academy of Orthopedic Surgeons are studying the clinical data to come up with a joint set of recommendations.  Ask your dentist or your orthopedic surgeon for what is best for you.

Dental Premedication Guidelines for Patients with Heart Problems

In 2008, the American Heart Association updated its recommendations for dental premedications.  It now recommends premedication for patients with:

  • artificial heart valves
  • a history of infective endocarditis, which is an infection of the lining inside the heart or heart valves
  • a heart transplant that developed a heart valve problem
  • certain types of congenital heart conditions

The good news is the AMA says many patients with heart problems who used to take prophylactic antibiotics no longer need them, including patients with:

  • heart murmurs
  • rheumatic heart disease
  • bicuspid valve disease
  • calcified aortic disease
  • congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy

If you have any questions about whether you need to take an antibiotic before your dental appointment, just ask your dentist.

Ocala general dentist Ajay Singh, DDS, provides general, restorative and cosmetic dentistry services to patients age 16 and older.  He earned his dental degree at New York University College of Dentistry and his undergraduate degree at the University of Miami in Coral Gables, Florida.  Dr. Singh is a member of the Academy of General Dentistry, Florida Dental Association and the American Dental Association.  He practices at Coast Dental Ocala South, 1110 Southeast 18th Place, Building 200, Ocala, FL 34471.  The phone number is (352) 351-3891.

Written by: Beth Gaddis
Reviewed by: Ajay Singh, DDS
Reviewed by: Cindy Roark, DMD

 

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