Antibiotic Prophylaxis – implies taking antibiotics prior to routine dental care to prevent possible infection in those at risk. There are many medical conditions (see below) that place you at some risk when visiting the dental office for cleanings, fillings and minor oral surgical procedures. Certain categories of invasive dental treatment are known to produce significant bacteremia (infections). Such bacteremia, although transient, may be detrimental to the health of patients with a variety of medically compromising conditions and pre-treatment with antibiotic prophylaxis may be indicated.
If your medical team suggests that you are at risk then you should have a prescription for an antibiotic prior to having all you future dental appointments. Typically you would have a 2 gram dose of amoxicillin (pending no allergy) 1 hour prior to the dental appointment each time you visit the dental office. It is important to keep your dental office updated with your medical health changes. Please print this form and show it to your medical doctor if you have any of the following conditions prior to your next dental appointment. Either your dentist or your MD can call a prescription into the pharmacy for you to take prior to your dental appointment if you are at risk.
ANTIBIOTIC PROPHYLAXIS FOR DENTAL PATIENTS AT RISK
CONDITIONS FOR WHICH
ANTIBIOTIC PROPHYLAXIS IS RECOMMENDED:
Previous episode of infective bacterial endocarditis
Heart valve replacement, including bioprosthetic and homograft valves
Recent surgical repair of cardiovascular defects within the past six months
Surgical systemic to pulmonary artery shunts or conduits
In the absence of associated heart disease:
Sickle cell anemia
Simple orthopedic metallic devices, including pins and plates
ANTIBIOTIC PROPHYLAXIS FOR DENTAL PATIENTS AT RISK
These recommendations are based upon a variety of in vitro studies, clinical experience, animal model data and an assessment of the common oral flora most likely to cause potential bacteremia. Definitive patient risk/benefit ratios for these prophylactic procedures have not been definitively determined nor have they been medically or scientifically proven to be effective by well designed controlled human trials (with or without randomization).
Dental procedures which may produce significant bacteremia include all procedures where significant oral bleeding and/or exposure to potentially contaminated tissue is anticipated. These procedures may include, but are not limited to, dental extractions and other oral surgery, sub-gingival scaling and the sub-gingival placement of dental dam clamps or orthodontic bands. Such procedures would typically require antibiotic prophylaxis in patients at risk. Simple adjustment of orthodontic appliances, tooth brushing or spontaneous loss of primary teeth do not require antibiotic prophylaxis.
Patients at risk would include those with cardiac deformities, those with artificial devices in the circulatory system, and those with immunocompromising conditions.
Patients with cardiac deformities should receive antibiotic prophylaxis according to the current guidelines of the American Heart Association. Consultation with the patient's physician may be required.
Patients with artificial devices in the circulatory system should receive antibiotic prophylaxis using the current protocols of the American Heart Association. Such patients would include, but not be limited to, those with heart valve replacement including bioprosthetic and homograft valves, recent surgical repairs of cardiovascular defects within the past six months, and indwelling shunts or conduits (such as patients with indwelling central lines or vascular access catheters, such as Portacaths, for cancer chemotherapy, ventriculoarterial or ventriculovenus shunts for hydrocephalus and arteriovenus shunts for hemodialysis). Consultation with the patient's physician may be required.
Patients with a variety of immunocompromising conditions should receive antibiotic prophylaxis using the current protocols of the American Heart Association. Such patients would include, but not be limited to, those with a suppressed leukocyte count (such as cancer chemotherapy, AIDS, blood dyscrasias, transplant recipients) where the white blood cell count (WBC) is less than 3500 cells /mm3 (3.5 K/mm3) or the absolute neutrophil count (ANC) is less than 500 cells /mm3 (0.5 K/mm3). Consideration for antibiotic prophylaxis should be given for other patients with an impaired immune system or those with delayed healing, such as those with, but not limited to, patients with previous radiation therapy where planned extractions or other bony surgery is in the radiation field, patients with an ANC less than 1000 cells /mm3 (1.0 K/mm3), uncontrolled diabetes, systemic lupus erythematosus and injection drug users. Consideration should be given for longer antibiotic prophylaxis schedules (seven to ten days or longer) for those patients where delayed healing following invasive procedures would further expose those patients at risk to ongoing bacteremia. Consultation with the patient's physician may be required.
The CDA adopts the position of the American Dental Association regarding antibiotic prophylaxis for dental patients with total joint replacement and thus, patients with total joint replacement should typically not receive antibiotic prophylaxis. Chemoprophylaxis, however, should be considered for patients with immunocompromising conditions, particularly patients during the first two years following joint replacement. Consultation with the patient's orthopedic surgeon may be required.
Conditions which generally do not require antibiotic prophylaxis would include, but not be limited to, physiologic, functional or innocent murmurs, a history of rheumatic fever without residual clinical heart disease, uncomplicated secundum atrial septal defect, mitral valve prolapse without mitral insufficiency, regurgitation or a murmur, coronary artery stenosis, cardiac pacemakers, atherosclerotic heart disease, well-controlled diabetes, immunocompromising conditions without decreased WBC or ANC, sickle cell anemia, cystic fibrosis or other simple orthopedic metallic devices. Consultation with the patient's physician may be required.
Patients at risk requiring antibiotic prophylaxis who are already receiving an antibiotic for a preexisting condition should receive an antibiotic for prophylaxis from a different classification. For example, a patient at risk already receiving a penicillin for some other condition should receive another antibiotic for prophylaxis, such as clindamycin.
Patients at risk should establish and maintain the best possible oral health to reduce potential sources of bacterial infection. Every attempt should be made to reduce gingival inflammation in patients at risk by means of brushing, flossing, topical fluoride therapy, antimicrobial rinses and professional cleaning before proceeding with routine dental treatment.
In order to help prevent the development of resistant strains, antibiotics should not be used indiscriminately. Complications associated with the use of antibiotics include toxic and allergic reactions, superinfections and the development of resistant organisms. It is essential that practitioners be well informed about the actions and reactions of any drugs they prescribe or administer and must be prepared to handle any reasonably foreseeable complication, including anaphylaxis. Each health care professional is ultimately responsible for his or her own treatment decisions.
These guidelines have been adapted with permission from the American Academy of Pediatric Dentistry Reference Manual 1996 - 1997, Antibiotic Chemoprophylaxis for Pediatric Dental Patients at Risk.
Reprinted from Canadian Dental Association
Approved by Resolution 99.17
Canadian Dental Association Board of Governors