Most antibiotics prescribed before invasive dental procedures to guard against distant-site infections are unnecessary, a recent study in JAMA Network Open found.
In the past, antibiotics were routinely prescribed for patients who had certain heart conditions before undergoing invasive dental procedures. This practice was intended to reduce the risk of endocarditis (a serious infection of the heart lining or valves), which could be triggered by oral bacteria that traveled through the bloodstream to the heart. Similarly, antibiotics were once prescribed to some patients who had undergone joint replacement to prevent oral bacteria from infecting prosthetic joints.
Over the past decade, researchers have questioned this practice—especially amid concerns about antibiotic resistance—and found little evidence that antibiotics are associated with preventing distant-site infections during dental procedures. But many health care practitioners still prescribe antibiotics without good cause. The JAMA Network Open study found that nearly 81 percent of antibiotics prescribed before dental procedures like tooth extractions, dental implants, abscess drainage, and root canals weren’t needed.
Prophylaxis antibiotics before some dental procedures are still recommended for people who have a history of endocarditis, certain congenital heart disease conditions, or a heart valve that’s prosthetic or contains prosthetic materials, or who are heart transplant recipients with a valve disorder. Antibiotics might also be prescribed for people with a high risk for infection, such as patients with compromised immune systems or a previously infected artificial joint.
What you should do
Be sure your dentist knows your medical history before any invasive procedure. If a health care provider prescribes a prophylactic antibiotic and you’re not in a high-risk category, ask whether it’s necessary.
This article first appeared in the November 2019 issue of UC Berkeley Health After 50.
Also see Your Dental Checkup.