Systemic health
Premedication (antibiotic prophylaxis)
Our office follows the current guidelines from the American Dental Association, American Heart Association, and the American Academy of Orthopaedic Surgeons in determining safety following significant surgeries, including total joint replacement and cardiac events.
What is antibiotic prophylaxis (for the patient) - Journal of the American Dental Association - 2016
Total joint replacement
- Premedication may be indicated for individuals with weight bearing joint replacement (knee, hip) and the following comorbidities:
- History of infectious complications of the joint.
- Weakened immune system, determined on an individual basis (possibly due to diabetes, cancer, rheumatoid arthritis, long term steroid use).
- Premedication is not indicated for other clinical presentations.
Antibiotic coverage outside of current guidelines
While our office will not prescribe antibiotics when not indicated, we will counsel patients to take premedication as prescribed by their surgeon or PCP, even if outside of current guidelines.
Recent surgical contraindication
Our office considers non-emergent dental treatment to be contraindicated for 3 months following any joint replacement.
Literature
- AAOS: Appropriate use criteria for patiens with implants undergoing dental procedures - The Journal of bone & joint surgery - 2017
- ADA: The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints - Journal of the American Dental Association - 2015
Cardiac
- Pre-medication is indicated for the following conditions with an increased risk of subacute bacterial endocarditis (SBE):
- Artificial heart valve.
- History of infective endocarditis.
- Congenital heart disease:
- Unrepaired cyanotic CHD, including palliative shunts and conduits.
- Completely repaired congenital heart defect for 6 months following the procedure.
- Repaired CHD with residual defects.
- Cardiac transplant patients who develop cardiac valvulopathy.
Antibiotic coverage outside of current guidelines
While our office will not prescribe antibiotics when not indicated, we will counsel patients to take premedication as prescribed by their surgeon or PCP, even if outside of current guidelines.
Recent surgical/event contraindication
Our office considers non-emergent dental treatment to be contraindicated for 3 months following any cardiac or cerebrovascular event that requires hospital admission.