Premedication Before Dental Procedures

Dental Work with Heart Problems

The American Heart Association recently revised the guidelines for prevention of Infective (Bacterial) Endocarditis (IE). Premedication with antibiotics prior to dental treatment is no longer recommended EXCEPT for patients with the highest risk of adverse outcomes resulting from IE. These patients include:

These recommendations are guidelines only. Working together, your dentist and your physicians (primary care, cardiologist, and cardiac surgeon), will determine an appropriate course of treatment for you.

For additional information on IE, click on this link:
http://www.americanheart.org/presenter.jhtml?identifier=4436.

Dental Work After Joint Replacement

Representatives from the American Dental Association and the American Academy of Orthopaedic Surgeons developed the following recommendations for people with joint replacements who are planning to have some dental work done. These recommendations are guidelines only. Your dentist and your orthopaedic surgeon, working together, will determine an appropriate course of treatment for you.

After joint replacement, when do you need preventive antibiotics before dental procedures?

You won't need to get preventive antibiotics for most dental procedures. But because you have an artificial joint, your risk of contracting a blood-borne infection is higher than normal. After joint replacement you should get preventive antibiotics before dental procedures if you are in one of the following categories:

  • You had a joint replacement less than two years ago.
  • You have an inflammatory type of arthritis such as rheumatoid arthritis or systemic lupus erythematosis.
  • Your immune system has been weakened by disease, drugs, or radiation.
  • You have insulin-dependent (Type I) diabetes.
  • You've had previous infections in your artificial joint.
  • You are undernourished or malnourished.
  • You have hemophilia

...and you are having one of the following dental procedures:

  • Dental extractions
  • Periodontal (gum disease) procedures
  • Dental implant placement and reimplantation of teeth that were knocked out
  • Endodontic (root canal) instrumentation or surgery
  • Initial placement of orthodontic bands (not brackets)
  • Injection of a local anesthetic into the gums near the jaw
  • Regular cleaning of teeth or implants where bleeding is anticipated

If you require premedication, the following preventive antibiotics are suggested:

  • If you can take oral medications and are not allergic to penicillin, 2 grams of Amoxicillin, Cephalexin, or Cephradine should be taken one hour before the procedure.
  • If you cannot take oral medications and are not allergic to penicillin, 2 grams of Ampicillin or 1 gram of Cefazolin should be administered by injection one hour before the procedure.
  • If you are allergic to penicillin, 600 milligrams of Clindamycin should be taken orally or administered by injection one hour before the procedure.

For additional information click on the following link:
http://orthoinfo.aaos.org/topic.cfm?topic=A00226.

 
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