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Dentistry Ohio

'Living' Article February 2013- Antibiotic Pre-medication Update

‘Bacteremia’ is the word used to describe any situation in which bacteria get into the blood stream.  Across the years of my dental career there have been two groups of patients who have been told that they need to fear bacteremia as a condition that could cause significant disease or even death.  One of these groups had cardiac defects that made their hearts more susceptible to bacterial infections (bacterial endocardititis).  The other group had artificial/prosthetic joint replacements.  With these folks the fear was that bacteria within the blood stream could lead to infection around the artificial knee or hip. 

Since it was widely known that pretty much any dental procedure has the potential to introduce bacteria into the blood stream a well-meaning practice was developed calling for these ‘at-risk’ patients to take a dose of antibiotics prior to their dental procedure to kill bacteria that invariably would enter their blood stream. 

In time curious researchers began to look for evidence that dental work was indeed a threat to patients within these two at risk groups.  In short they discovered two things.  First, there is no actual scientific evidence to suggest that patients with heart defects or artificial joints actually are at risk as a consequence of dental induced bacteremia.  Second, we learned that people self induce bacteremias almost every day through their home dental hygiene procedures or even things as innocent as eating certain coarse foods. 

Ultimately the American Heart Association determined that the practice of premedicating cardiac patients for dental work was counter-productive for all but a very small group of people who actually have an artificial heart valve or previous history of bacterial endocarditis. 

The genuine news this month is that finally guidelines have come forth from analysis completed jointly by the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA) with regard to the use of pre-dental prophylactic antibiotics for patients with prosthetic joints.  Like the American Heart Association, this group has found absolutely no evidence to date suggesting that dental procedures contribute to prosthetic joint infections.  They are suggesting that “practitioners consider changing their longstanding practice of prescribing prophylactic antibiotics for patients who undergo dental procedures.” 

The one remaining problem is that they are describing their analysis as ‘limited’.  They are only suggesting that orthopaedic surgeons consider changing their existing prophylactic antibiotic guidelines.  One poling of orthopaedic surgeons seems to suggest that many will continue on as they have in the past with their current antibiotic protocol until these ‘limited’ studies are supported by additional research. 

If you or someone you love has an artificial knee or hip I would strongly suggest you raise this issue with the surgeon responsible for the joint(s).  If he or she insists on antibiotic coverage in advance of dental procedures I would suggest you be so bold as to ask why.  Are they simply clinging to a well-intended but dated notion or are they genuinely convinced from experience that dentistry poses a unique risk?  

Tagged In: Matchbox Toys, Amalgam, Anthropology, Antibiotic Premedication, Artificial Joints Dental Care

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