Your physician or dentist may recommend that you follow special steps at home before your dental visit to safeguard your health. These steps may include taking antibiotics before your appointment. Administration of an antibiotic prophylaxis before dental procedures is commonly called premedication. The most common reasons a dentist will prescribe premedication is for patients with heart problems or if they have had a joint replaced.
For years, conscientious dentists have been following the American Heart Association's guidelines by requiring certain dental patients to take antibiotics, or pre-medicate, prior to some types of dental procedures. The main categories of patients are those who have a heart murmur, or have had scarlet fever which often leads to a heart murmur.
There are others who are asked to pre-medicate; a major group being those who have had artificial joint replacement. The reasoning is that certain dental procedures, such as dental cleanings, can temporarily elevate the bacteria level in the bloodstream.
This bacteria could attach to a slightly imperfect heart valve, which is what causes the murmur, and form a colony there that is extremely hard to fight and can therefore be very dangerous. An elevated bacteria level in the bloodstream could also compromise the health of bone where artificial joints are anchored.
For some patients with heart conditions, pre-medication is necessary to prevent infection. For decades, the American Heart Association has recommended a round of antibiotics for people with the following heart conditions:
- Artificial heart valves
- Mitral Valve Prolapse (MVP)
- heart transplant recipients
- certain congenital heart conditions
The pre-medication is given to these patients in an effort to prevent bacterial endocarditis,
an inflammation of the heart. It can cause damage to the heart muscle or the lining of the heart. This can damage or even destroy your heart valves.
Not all dental procedures require pre-medication. If significant bleeding is not going to occur, it is not necessary to take antibiotics prophylactically before your dental appointment. The most common procedures in which pre-medication is necessary are:
- Extractions
- Periodontal Surgery
- Endodontic Surgery
- Root Canal Therapy
- Periodontal Cleanings
A number of months ago, the Heart Association overturned its long standing guidelines for patients needing premedication. The research is showing that most patients with heart murmurs are not benefited by the antibiotics, and therefore should not be required to take them.
I think that part of the reasoning is that people who have this bacteria laden tartar near the gum line on their teeth are continually putting bacteria into their bloodstream every time they eat! You might look at it as the body 'gets used to' the constant infection, and is always trying to fight it. The important thing is that the bacteria buildup be removed from teeth before it builds up in strength!
While the American Heart Association may not require pre-medication for patients with minor heart conditions, many dentists still feel it is necessary to prescribe a round of antibiotics before any dental work so they are free from any liability should something happen. It is very important for you to speak with your provider and to disclose all of your medical history to him or her so that if pre-medication is necessary you will be provided with it.
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