What is Antibiotic Prophylaxis and When Would You Need It?

By Dr. Michael Handler

If your dentist recommends any sort of oral surgery, you might hear the term “antibiotic prophylaxis” being used. This refers to the administration of antibiotics before the procedure, and it’s aimed at preventing infection developing from the contamination caused by the surgery.

Antibiotic prophylaxis isn’t necessary for everyone, or for every type of procedure, but you are most likely to need it if the following scenarios apply.

1. You have had joint replacement surgery in the past and experienced complications as a result, and are scheduled to undergo a dental procedure that requires a gum tissue incision. These include Class II operations such as orthognathic surgery, implant placement, bone grafting or even a tooth extraction.
2. In this instance, your dentist might request information from the orthopedic surgeon who performed your joint replacement, or refer you back to him or her for an antibiotic prescription.
3. In patients with underlying conditions such as obesity, diabetes, have endocarditis or other congenital heart problems, you should have antibiotic prophylaxis for all dental procedures that could expose your gum tissue to bacteria. This includes scaling and planing during a cleaning procedure.
4. The patient is either very young or a very old senior, is a smoker, has recently had surgery or an infection, or has been in hospital for longer than 48 hours in the year prior to the dental procedure.

The reason behind taking these precautions is that patients in either of these situations may have a higher risk of developing a bacterial infection, but this depends entirely on your individual circumstances.

How Antibiotic Prophylaxis Works

In the event that your particular situation calls for antibiotic prophylaxis, here’s what you can expect. Your oral surgeon will require a complete medical history, including details of former surgeries and any complications you’ve experienced as a result. He or she may consult with the surgeon who performed your previous procedures, and depending on the outcome of their findings you will most likely be prescribed a dosage of ampicillin or amoxicillin, which are commonly used for dental prophylaxis.

The antibiotics usually come in the form of tablets that you take about 30 minutes before the procedure. Alternatively, if your proposed dental procedure is fairly major, the surgeon might choose to give them intravenously before or during the procedure.

What Scientific Evidence Says

In recent years, evidence has shown that dental procedures don’t have the previously-believed connection with joint implant infections, and that antibiotic prophylaxis doesn’t always prevent infection. In addition, risks such as the potential for antibiotic resistance and opportunistic infections like C-difficile often outweigh the benefits, so this measure is being used less now than in the past. Rest assured that if your dentist prescribes antibiotic prophylaxis for you, it’s because they believe you really need it and will benefit from having it. Be sure to tell the dental surgeon about all medications, vitamins and supplements you take and whether you have any allergies to antibiotics, to avoid being prescribed something that won’t agree with you.

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