Do You Need Antibiotics Before Dental Treatment?

Antibiotics can save lives. But if they’re prescribed when not medically necessary, they can do more harm than good. For example, antibiotics can cause dangerous adverse allergic reactions in some people. In addition, the more antibiotics are prescribed in the general population, the greater the chance that drug-resistant bacteria will develop.

While no one argues that antibiotics should be used to treat active infections, there have been differing opinions on whether antibiotics should be given to certain patients before specific dental treatments. This use is called primary prophylaxis, and the goal is to prevent an infection from occurring in the first place.

During oral surgery and some dental treatments, there’s a risk that bacteria from the mouth will be introduced into the bloodstream. This can lead to infective endocarditis (IE), a dangerous infection of the heart’s inner lining or valves.

Who might need preventive antibiotics

Preventive use of antibiotics was more prevalent in the past, but research has shown that for most people, pre-treatment with antibiotics is unnecessary. However, it’s still recommended for select patients, including those who have a history of IE, heart-valve disease or certain congenital heart conditions that affect the valves. The types of treatment that would justify pretreatment with antibiotics for this group include those that involve making incisions, manipulating gum tissue or working around the roots of teeth.

Another group that commonly used to be treated with antibiotics prior to dental procedures that might introduce bacteria into the bloodstream is people who have had one or more joints replaced. Why? Because it’s possible, under certain conditions, for bacteria from the mouth, teeth or gums to travel through the bloodstream and settle in an artificial joint. But researchers have now found that there’s no evidence of a direct link between dental procedures and infection of prosthetic joints, and that giving patients preventive antibiotics doesn’t reduce the risk of implant infection.

Today, only patients who have experienced complications with their joint replacements, such as prior infection, are likely to receive antibiotics before dental treatment. When there’s a question, your oral surgeon or dentist can discuss with your orthopedic surgeon whether you should be prescribed preventive antibiotics.

Everyone can reduce their risk of IE by keeping up with regular dental cleanings and exams and maintaining good oral health—consistent, thorough and careful toothbrushing and use of floss and other plaque-removal devices.

As in all other aspects of your oral healthcare, it’s best to consult with your oral surgeon or dentist if you’re concerned that you should perhaps have antibiotics prior to treatment. He or she can help you understand what the best course of action is in your case.