Premedication

Author : Dr. Alison Vitelli-Rodriguez, DMD

Today’s medical field has developed so quickly that it still amazes me how impressive a lot of the surgeries our patients go through to allow them to live a wonderful life.  As a Dentist, I need to take care of not only the oral health of my patients but also treat them systemically.  As years go by and science grows, it has been shown the need to cover our patients who have been through heart surgeries and joint replacements with antibiotics before invasive dental procedures (extractions, root canals, crown impressions) and cleanings.  The guidelines of who needs to be premedicated have gone through several updates. The American Dental Association (ADA) has met with the American Heart Association (AHA) and the American Academy of Orthopaedic Surgeons (AAOS) to come up with the most recent guidelines for prophylactic antibiotic usage.   All of these recommendations are supported by evidence-based studies and clinical trials that determine the real benefit of premedicating one hour before the dental procedure.

For our cardiac surgery patients, the ADA and AHA follow the 2014 guidelines which recommends premedicating for patients that have had: 1) previous history of infective endocarditis (infection on the lining covering the heart), 2) prosthetic valve replacement or repair, 3) congenital heart defects, 4) heart transplants.

The most recent guidelines for joint replacement suggests that there is no scientific evidence supporting the benefit of premedicating for the majority of the patients with prosthetic joints.  The 2015 guideline was reviewed in 2017 and agreed that premedication will be considered for patients with past history of joint infection, uncontrolled diabetics or patients who have a compromised immune system.  It is also stated that the final decision will be more effective as a comprehensive team effort between the patient, dentist and orthopedic surgeon.

Remember to always ask us for the best recommendation for you.  We strive to provide you with the best dental care and give you the tools needed to better treat you and your loved ones.

 

Additional sources:  http://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis