Dental Treatments which require Antibiotic Prophylaxis

Dental Treatments are usually divided into two types, one which are done to cure or prevent any infection such as periapical infection and the other type being cosmetic which are done to enhance the appearance of the teeth like Bleaching, Composite restorations, dental crowns etc. So the first kind of treatments usually require the use of Antibiotics to control the infection before going ahead with the treatment plan as this will prevent any post surgical infection. For example some cases of Infective Endocarditis which is the inflammation of the inner tissues of the heart is caused by Bacteria entering the blood stream through the surgical site of a dental treatment and reaching the Heart which leads to IE.

It is important to know proper Medical History of patients and to get all the pre diagnostic tests done to rule out any doubts which you might have, as recently we have seen  – Teenage Girl Dies of Cardiac Arrest after Wisdom Tooth Removal (It was unfortunate as there was no history about any heart disease in this patient) incidences like these which can be prevented by proper diagnosis and following Treatment protocol.

To prevent such occurrences it is important to give Antibiotic Prophylaxis which controls the spread of Bacteria from the infection / Surgical site into the Blood stream. So let us look at the list of Dental Treatment procedures which require Antibiotic Prophylaxis and also the ones which do not require Antibiotic Prophylaxis. The most commonly used Antibiotic is Amoxicillin and it depends on the patients competence with the antibiotic which has to be considered. In cases of Amoxicillin Allergy Cephalexin, Clindamycin or Azithromycin can be prescribed.

Which patients require Antibiotic Prophylaxis before Dental Surgery:

• Patients with prosthetic cardiac valve or prosthetic material used for cardiac valve repair
• Untreated Congenital Heart Disease patients such as cyanotic congenital heart disease, 0-6 months of completely repaired congenital heart defect with prosthetic material or device, any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device (that inhibit endothelialisation).
• Between 0-6 months after any Heart Surgery of any age group
• Previous History of Infective Endocarditis
• Cardiac Transplantation

Note: According to ADA any other patients other than the ones listed above do not require Antibiotic Prophylaxis – Antibiotic Prophylaxis by ADA

When should Antibiotic Prophylaxis be given before Surgery:

Antibiotics prophylaxis should be give 60 mins prior to start of the procedure and it should be given orally, in case the 60 mins prior to start of procedure is missed the Antibiotics should be given by IM or IV routes either Ampicillin or Cephazolin which should be given 30 minutes prior to the start of any procedure.

List of Dental Treatments which require Antibiotic Prophylaxis:

• Dental extraction of any tooth which is not grade 2 or grade 3 mobile
• Dental Impaction Surgery
• Alveoloplasty
• Dental Implant placement surgeries.
• Root canal treatment in teeth having infection beyond the apex (Periapical cyst, granuloma, periodontitis)
• Endodontic surgeries like Apicoectomy
• Any Periodontal procedures such as scaling, root planning, surgeries, probing (Note: In patients with Pacemaker
• Ultrasonic Scaling is contraindicated with Gingivitis
• Gingivoplasty
• Generalized Crown lengthening procedure
• Subgingival placement of fibres, strips, and regeneration Devices.
• Local anaesthesia (intra ligamental)
• Oral Prophylaxis cleaning involving bleeding
• Initial placement of orthodontic bands (molar bands)

List of Dental Treatments which do not require Antibiotic Prophylaxis:

• Restorative procedures such as Composite Restorations, crowns, GIC fillings etc with or without gingival retraction cords.
• Removable partial Denture procedure
• Fixed Crowns procedure without RCT or any surgical procedure like Crown lengthening
• Non intra ligamental local anaesthesia.
• Post and core placement procedure in Root canal treatment.
• Post surgical suture removal.
• Dental impression
• Bleaching
• Placement of orthodontic appliance.
• Tropical fluoride application.
• Placing dental jewellery on tooth

It is always important to know the past Medical History of patients and it the duty of the Dentist and Dental Assistant to take proper history of patients as some patients tend to hide past medical history thinking it does not affect or matter in dental treatments.