Antibiotic Prophylaxis

What is Antibiotic Prophylaxis?

Before certain kinds of dental care, some patients that have heart problems and people with artificial joints take antibiotics. These individuals might be at risk of developing an infection in the heart or at the site of the artificial joint, respectively. Antibiotic prophylaxis may decrease the risk of an infection involving these organs.

Guidelines for People with Heart Conditions

Guidance changed - the AHA concluded that:

The potential risks of side effects to antibiotics outweigh the use of prophylaxis for many people. Side effects can vary from mild (rashes) to serious (difficulty in breathing that can lead to death).

When viewed all of the research results collectively, it was not obvious that antibiotic prophylaxis prevented infective endocarditis.

Bacteria in the oral cavity can enter the blood stream through daily activities like brushing or flossing between the tooth. As soon as bacteria enter the blood flow, it may go to one's heart. Individuals prone to an infection may be much more likely to develop infective endocarditis from routine activities than from dental care.

If physicians used antibiotics too frequently, microorganisms that cause infections may become resistance against antibiotics. For this reason, it is best to try to restrict using antibiotics.

Patient selection
The current guidelines recommend the use of preventive antibiotics before certain dental procedures for people with:

1. Artificial heart valves
2. History of infective endocarditis
3. Cardiac transplant that develops a heart valve problem
4. The following congenital (present from birth) heart conditions:

• Cyanotic congenital heart disease, including those with palliative shunts and conduit
• A completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or catheter intervention, during the first six months after the procedure.
• Any repaired congenital heart defect with residual defect at the site or adjacent to the location of a prosthetic patch or a prosthetic device.

Consult with your cardiologist if you are uncertain whether you fall under one of these groups. Individuals who required prophylactic antibiotics previously but will no longer need to have them now are individuals with:

1. Mitral valve prolapse
2. Rheumatic heart disease
3. Bicuspid valve disease
4. Calcified aortic stenosis
5. Congenital (present at birth) heart conditions such as ventricular septal defect, atrial septal defect, and hypertrophic cardiomyopathy.

Discuss with your dentist regarding how these recommendations may apply to you.

Additional resources:

American Heart Association downloadable wallet card (available in English and Spanish)

For the Dental Patient: Antibiotics and Your Heart 

Guidelines for People with Total Joint Replacements

Recommendations from the American Academy of Orthopedic Surgeons (AAOS) are intended to lower the potential risk of bacterial infections at the site of an artificial joint. They apply to those who have complete joint replacements. Patients that have pins, plates or other orthopedic hardware are not affected.  AAOS recommends that all patients who have total joint replacements should take antibiotics before certain kinds of dental care treatments.

Consult your dentist about how these recommendations may apply to you.

Regimens recommended:

Reference: JADA, vol.138, June 2007