To Pre-medicate Or Not To Pre-medicate? That Is The Question
Author: Dr. Alison V. Berger, DMD, FAGD
For several years now, multiple medical associations have recommended to pre-medicate our patients before dental procedures. But what is pre-medication? Why do we need to be pre-medicated? Who needs to be do this and for what procedures? These are all very important questions but unfortunately, there not always clear answers.
What is pre-medication? Pre-medication consists of administering a high dose of antibiotic before certain procedures that can stir up bacteria flow in the bloodstream, increasing the risk of a compromised patient of developing an infection of the heart or joint.
Why do we have a patient use a pre-medication? Some dental procedures can be relatively invasive and these can create a communication of bacteria present in the oral cavity with the circulatory system. When bacteria get in the bloodstream, it can get lodged in other organs, specially the heart, or joints.
Who needs to be pre-medicated and for what procedures? Patients who have had heart transplants, heart defects, artificial joints, among some other specific cases. Also, those patients who suffer from some other systemic diseases, put them at a higher risk of developing an infection of the heart or the new joint. For patients who have had recent joint replacement, we do recommend to protect with antibiotics only for the first 6 months after the surgery. For the most part, after this period, the risk for developing an infection in the artificial joint decreases significantly unless there has been previous detrimental history to the joint and the orthopedic surgeon is already suggesting the premedication. Dental cleanings, dental surgeries, such as extractions and gum surgeries, and other procedures that require administration of local anesthetic are some of the procedures that call for the antibiotic administration.
You are probably familiar with the controversy of bacteria resistance to antibiotics, which brings up the constant updates to the pre-medication guidelines. These updates happen between the American Heart Association (AHA), the American Academy of Orthopedic Surgeon (AAOS), and the American Dental Association (ADA). The most recent studies and updates keep suggesting that the need for antibiotic prophylactic premedication is based on a case by case evaluation. The rise in bacteria resistance to some antibiotics has caused a significant decrease in the recommendations of pre-medication, as well as for antibiotic use.
If you are a patient who is recommended to use an antibiotic pre-medication, let us have a good talk with you about the need for it for your future visits.
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