Updated Antibiotic Prophylaxis Guidelines Prior to Dental Treatment
The Canadian Dental Association supports the American Heart Association’s (AHA) 2007 guidelines for antibiotic prophylaxis prior to dental procedures to prevent infective endocarditis. The guidelines are based on a growing body of scientific evidence that shows the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks include adverse reactions to antibiotics that range from mild to potentially severe and the development of drug-resistant bacteria.
The AHA guidelines emphasize the importance of achieving and maintaining excellent oral health and practising daily oral hygiene. For most patients, taking preventive antibiotics before a dental visit is not indicated. The guidelines state that prophylactic antibiotics, which were routinely administered to certain patients in the past, are no longer needed for patients with:
mitral valve prolapse
rheumatic heart disease
bicuspid valve disease
calcified aortic stenosis
congenital heart conditions such as ventricular septal defect, atrial septal defect and
Only those at greatest risk of developing infective endocarditis, an infection of the heart’s inner lining or the heart valves should receive short term preventive antibiotics before common, routine dental and medical procedures.
People who should take antibiotics include those with:
1.prosthetic cardiac valve or prosthetic material used for cardiac valve repair
2.a history of infective endocarditis
3.certain specific, serious congenital (present from birth) heart conditions, including:
unrepaired or incompletely repaired cyanotic congenital heart disease, including
those with palliative shunts and conduits
a completely repaired congenital heart defect with prosthetic material or device,
whether placed by surgery or by 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 site of a prosthetic patch or a prosthetic device
4.a cardiac transplant that develops a problem in a heart valve
Antibiotic prophylaxis is recommended for patients with the above conditions who undergo any dental procedure that involves manipulation of gingival tissues or the periapical region of a tooth and for those procedures that perforate the oral mucosa. The following procedures and events do not need prophylaxis:
routine anesthetic through noninfected tissue
placement of removable prosthodontic or orthodontic appliances adjustment
of orthodontic appliances
placement of orthodontic brackets
shedding of deciduous teeth
bleeding from trauma to the lips or mucosa
The Canadian Orthopedic Association (COA), the Canadian Dental Association (CDA) and the Association of Medical Microbiology and Infectious Disease (AMMI) Canada provide the following guidance concerning the management of dental patients with orthopedic devices:
Patients should not be exposed to the adverse effects of antibiotics when there is no evidence that such prophylaxis is of any benefit.
Routine antibiotic prophylaxis is not indicated for dental patients with total joint replacements, nor for patients with orthopedic pins, plates and screws.
Patients should be in optimal oral health prior to having total joint replacement and should maintain good oral hygiene and oral health following surgery. Orofacial infections in all patients, including those with total joint prostheses, should be treated to eliminate the source of infection and prevent its spread.
From time to time we do see patients whose Orthopedic Surgeons still insist that the patients take an antibiotic prior to dental treatment in some cases for 2 years after surgery and in some cases for the rest of the patient’s life. In light of these new guidelines, it is therefore recommended that the Orthopedic Surgeon prescribe the course of antibiotics for the patient in these cases.
CDA Position on
Antibiotic Prophylaxis for Dental Patients at Risk
This information was created by the Canadian Dental Association for use by CDA member dentists. It should not be used as a replacement for professional dental or medical advice. If you have questions about this position statement, please consult your dentist or contact the Canadian Dental Association.