In a dental practice, the clinician is often confronted with a decision to prescribe antibiotics as a preprocedural treatment in the prevention of adverse infectious sequelae in:
- The prevention of endocarditis
- Prosthetic implants.
The decision to use antibiotic prophylaxis is made by the dentist and/or physician based on the patient's medical history.
Cardiac conditions predisposing to endocarditis where prophylaxis is recommended:
High Risk Category
- Prosthetic cardiac valves
- Previous bacterial endocarditis
- Complex cyanotic congenital heart disease
- Surgically constructed systemic pulmonary shunts or conduits
Patients with potential elevated risk of joint infection:
- Inflammatory arthropathies: Rheumatoid arthritis and systemic lupus erythematosus
- Disease, drug, or radiation-induced immunosuppression
- Insulin-dependent diabetes
- First 2 years following joint replacement
- Previous prosthetic joint infections
- Patients with acute infections at a distant site
- Hemophilia
The dentist should also be aware that antibiotic coverage of the patient might be appropriate due to diseases such as human immunodeficiency virus, cavernous thrombosis, undiagnosed or uncontrolled diabetes, lupus, renal failure, and periods of neutropenia as are often associated with cancer chemotherapy. In these instances, medical consultation is almost always necessary for making antibiotic decisions in order to tailor the treatment and dosing to the individual patient�s needs.
Endocarditis or prosthesis prophylaxis recommended due to likely significant bacteremina
Dental Procedures:
- Dental extractions
- Periodontal procedures including surgery, subgingival placement of antibiotic fibers/strips, scaling and root planning, probing, and recall maintenance
- Dental implant placement and reimplantation of avulsed teeth
- Endodontic (root canal) instrumentation or surgery only beyond the apex
- Initial placement of orthodontic bands, but not brackets
- Intraligamentary local anesthetic injections
- Prophylactic cleaning of teeth or implants where bleeding is anticipated
Endocarditis prophylaxis not recommended due to usually insignificant bacteremia
Dental Procedures:
- Restorative dentistry (operative and prosthodontic)
- Local anesthetic injections (nonintraligamentary)
- Intracanal treatment
- Postoperative suture removal
- Placement of removable prosthodontic/orthodontic appliances
- Oral impressions
- Fluoride treatments
- Oral radiographs
- Shedding of primary teeth
In general, the presence of moderate to severe gingival inflammation may elevate these procedures to a higher risk of bacteremia. Clinical judgment may indicate antibiotic use in any circumstances that may create significant bleeding.
Prophylactic regimens for bacterial endocarditis for dental procedures:
Standard general prophylaxis
Amoxicillin |
Adults: 2g orally 1 hour before procedure
Children: 50 mg/kg orally 1 hour before procedure
|
Unable to take oral medications
Ampicillin |
Adults: 2g IM or IV within 30 minutes before procedure
Children: 50mg/kg IM or IV within 30 min. before procedure
|
Allergic to penicillin
Clindamycin |
Adults: 600mg orally 1 hour before procedure
Children: 20mg/kg orally 1 hour before procedure
|
| Cephalexin or Cefadroxil |
Adults: 2g orally 1 hour before procedure
Children: 50mg/kg orally 1 hour before procedure |
| Azithromycin or Clarithromycin |
Adults: 500mg orally 1 hour before procedure
Children: 15mg/kg orally 1 hour before procedure
|
Allergic to penicillin and unable to take oral medications
Clindamycin |
Adults: 600mg IV within 30 minutes before procedure
Children: 20mg/kg IV within 30 minutes before procedure
|
| Cefazolin |
Adults: 1g IM or IV within 30 minutes before procedure
Children: 25mg/kg IM or IV within 30 minutes before procedure
|
