Today’s Question: My orthopedic surgeon has recommended after my knee replacement surgery that I take an antibiotic before my dental work. Would other people in my age group benefit from the same medicine? Paul, Warsaw.
Paul, your doctor is absolutely correct—you should take an antibiotic before you visit the dentist after your knee replacement surgery.
Other people who would benefit from that therapy include people who have some heart conditions, or other joint replacements or implanted devices. Antibiotic premedication recommendations are not based on age.
It is very important to advise your dentist of your health history on the medical history form you were requested to fill out on your first visit to the office.
You should continue to update the dentist on subsequent visits if there are any changes, regardless how insignificant.
By using antibiotics the dentist is attempting to prevent an infection known as subacute bacterial endocarditis, the collection and colonization of bacteria in the heart muscle, not to subsidize the drug industry. SBE can lead to inflammation and deformation of the heart and is a life-threatening condition. The bacteria from the mouth can also migrate into the area around an artificial joint and cause other complications such as failure or rejection of the joint or possibly amputation of the limb.
During many dental procedures, some bleeding is expected and does occur.
If bleeding does occur, it is possible for the bacteria in your mouth to enter the bloodstream and work their way to an artificial joint or the heart—a sometime deadly situation for a person with cardiac abnormalities.
Bacteria are normally present in our mouth and can get into our bloodstream during the routine of tooth brushing and chewing.
With good dental hygiene and regular dental check-ups to prevent gum infections and catching decay before in enters the nerve in the tooth, it is possible to prevent the “bad” bacteria from growing and getting into the blood stream.
Good dental hygiene is very important for people who have heart conditions or joint replacements even if they are not going to visit their dentists that day, as a bacterial infection (bacteremia) can occur without any oral bleeding.
Their physician has probably explained this phenomenon and may have even prescribed an antibiotic for their protection from the possibility of an infection.
However, we must be aware that the promiscuous use of antibiotics may result in bacteria becoming resistant to the therapy.
The presence of “Super Bugs” has been documented and they are resistant to the usually prescribed antibiotics such as penicillin and amoxicillin.
These bugs require the use of “Super” oral antibiotics in the Fluoroquinolone class, such as Cipro or Levaquin.
People who have been advised to take any antibiotic before visiting the dentist, can include people with risk factors such as: recent heart surgery, stent placement, artery replacement, or pulmonary shunt, any congenital heart defect, a history of rheumatic fever or a heart murmur, an artificial heart valve, or any previous bout with SBE.
These conditions along with some others that your physician might list would make it necessary to use an antibiotic before any dental procedure where bleeding may result.
These dental procedures include any extractions, dental implants, root canals, periodontal procedures (gum probing or surgery), placement of orthodontic bands, but not the brackets, some local anesthetic injection procedures not much in use these days, or cleaning of teeth where bleeding is anticipated. Some crowns and some fillings between the teeth at or below the gum line may also require antibiotic therapy.
The concern is with any procedure that may result in oral bleeding where bacteria may get into the bloodstream.
Paul, you should take the antibiotic that your physician has recommended before your dental treatment. Other people you have heard about that may benefit from antibiotics likely have a condition or are expecting to experience a dental procedure that makes antibiotics necessary, but you should never self-prescribe or recommend to your friends of any age any medication just because you are using it. That leftover antibiotic in your medicine cabinet, if it’s not out of date, may have been just the thing for your infected toe but may not be effective in preventing bacterial endocarditis. Also don’t take any antibiotic for any reason if it is not prescribed or necessary. Those “Super bugs” don’t need any more encouragement.
Dr. Bill Stofer is a practicing dentist in Warsaw, Indiana, and is a member of the Academy of General Dentistry, American Dental Association, Indiana Dental Association, and the North Central Dental Society. He is a lifelong resident of the Warsaw area, a graduate of Warsaw Community High School, Hillsdale College, and the Indiana University School of Dentistry.
Do you have a question about this article or about any of your dental concerns for Dr. Bill? He can be reached at 574-269-1199. All questions will be answered and considered for future columns. Visit us online at www.dentalsolutions.net
