Antibiotic Prophylaxis

Antibiotic prophylaxis is when antibiotics are given to a patient prior to certain dental procedures with the aim of preventing bacterial infections before they happen.

Because the risk of an infection to a healthy patient is very rare for most routine dental procedures, they are generally not given - antibiotics can have unpleasant side effects and there is always the concern about bacterial resistance developing.

Certain patients, however, are at higher risk. Those who have a weakened immune system, or with certain heart conditions, may require antibiotic coverage prior to some dental appointments. The dentists at our office will advise such patients in advance if antibiotics are needed, using the latest guidelines put forth by the pertinent professional associations such as the Canadian Dental Association (CDA), the American Heart Association (AHA), and the Canadian Orthopedic Association (COA), and Association of Medical Microbiology and Infectious Disease (AMMI).

Currently, the use of routine antibiotic prophylaxis is only recommended in patients at highest risk of a heart infection, termed infective endocarditis. These patients include those with:

• Prosthetic cardiac valve(s)
• Previous infective endocarditis
• Congenital heart disease (CHD) if 1 of the 3 conditions listed below:

  1. Unrepaired cyanotic CHD, including palliative shunts and conduits

  2. Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure

  3. Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)

• Cardiac transplantation recipients who develop cardiac valvulopathy

Please note that this list does not include those with joint replacements (eg. knees, hips). While older and outdated guidelines previously recommended antibiotics be given for those with joint replacements, the latest scientific literature has failed to show any benefit. Thus, it is the position of the CDA, COA and AMMI that routine antibiotic prophylaxis is not indicated for dental patients with total joint replacements, nor for patients with orthopedic pins, plates and screws.

Thus, it is our office policy that routine antibiotic prophylaxis will not be given to patients with joint replacements prior to dental appointments. Please discuss with the dentist if you have any concerns, or would like to learn more about antibiotic prophylaxis.