Premedicating with Antibiotics

Your health is very important to us and we want to make sure you are protected after having any joint-replacement surgery or if you have a certain type of heart condition.

Our office follows the ADA guidelines for premedication. However, we do require patients who have artificial joints to provide us with clearance from their orthopedic surgeon prior to receiving dental treatment in our office. 

If you have a heart condition that requires premedication, we will need to know your specific regimen prescribed by your cardiologist.

Providing us with a note from your orthopedist or cardiologist is the simplest way to do this!

Because so many orthopedists require their patients to premed for life, we also require clearance from your surgeon if you wish to stop using premedication before dental treatment.

If you are planning to have joint replacement, please discuss with your surgeon how long you must wait before resuming dental treatment after surgery, what your recommended premed regimen will be, and how long you will be expected to continue with the regimen. 

Once we know the type and dosage of antibiotics required by your physician, we will send in all future premed prescriptions for you.

 ADA KEY POINTS FOR Antibiotic Prophylaxis Prior to Dental Procedures

• Compared with previous recommendations, there are currently relatively few patient subpopulations for whom antibiotic prophylaxis may be indicated prior to certain dental procedures.

• In patients with prosthetic joint implants, a January 2015 ADA clinical practice guideline, based on a 2014 systematic review states, “In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection.

• According to the ADA Chairside Guide, for patients with a history of complications associated with their joint replacement surgery who are undergoing dental procedures that include gingival manipulation or mucosal incision, prophylactic antibiotics should only be considered after consultation with the patient and orthopedic surgeon; in cases where antibiotics are deemed necessary, it is most appropriate that the orthopedic surgeon recommend the appropriate antibiotic regimen and, when reasonable, write the prescription.

• For infective endocarditis prophylaxis, current guidelines support premedication for a relatively small subset of patients. This is based on a review of scientific evidence, which showed that the risk of adverse reactions to antibiotics generally outweigh the benefits of prophylaxis for many patients who would have been considered eligible for prophylaxis in previous versions of the guidelines. Concern about the development of drug-resistant bacteria also was a factor.

• Infective endocarditis prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. For patients with these underlying cardiac conditions, prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa.