Sometimes a dentist will recommend taking antibiotics before a dental procedure.
Is this necessary? When and why would you need to do this?
There are two reasons that your dentist will recommend antibiotics before treatment.
The first is to treat an existing infection and the second reason is to decrease the chance of infection.
When you have a tooth infection, a pocket of pus will form near the infected tooth and is sometimes called an abscessed tooth. An abscessed tooth is usually caused by tooth decay, injuries or prior dental work, and can cause throbbing pain, sensitivity to temperature or pressure, and swelling. If you have any of these symptoms, it is important to get treatment quickly, because the infection can spread to nearby areas, including your brain.
Sometimes, a dentist can treat the infection by draining the abscess, but it may require a root canal or extraction of the infected tooth. If the infection is caused by tooth decay, the decay will also need to be treated. Antibiotics are usually prescribed by your dentist when the infection has spread or is severe, or if you have a weakened immune system. When antibiotics are prescribed for an existing infection, you will usually need to take an oral antibiotic for about a week. Just as when your doctor prescribes an antibiotic, it is important to finish the entire course, even after you feel better. If you stop taking antibiotics before you are supposed to, some bacteria can survive, and the infection will be more difficult to treat afterward.
So, why would you need to take antibiotics before a procedure when you don’t already have an infection? Everyone has bacteria in their mouth. There are over 700 different species of bacteria that can form a colony in your mouth, and some are beneficial, while others are harmful. During some dental procedures, the bacteria can enter the bloodstream and travel throughout the body. In most people, their immune system kills harmful bacteria quickly. However, some patients are more at risk for infection, and their dentist will recommend antibiotic prophylaxis, which is a dose of antibiotics to guard against the possibility of the bacteria causing infection somewhere else in the body. This is usually given as a single oral dose of amoxicillin, one hour before the procedure.
Who is at risk and would benefit from antibiotic prophylaxis? Fewer people than you would think. The American Dental Association (ADA) updated their guidelines in 2015, and the new guidelines recommend that three groups of people should be considered for antibiotic prophylaxis. The first group contains people with certain heart conditions, as they are more likely to develop infective endocarditis, which is fatal if not treated. The second group of people is those who have had joint replacement surgery and also have a weakened immune system, because they are at greater risk of developing an infection at the site of the prosthetic. The final group is made up of people who have compromised immune systems since it is more difficult for their body to fight off infection and have a healthy recovery. This group of people contains those with medical conditions such as rheumatoid arthritis, diabetes, cancer, lupus, and HIV. It also includes those who take medications that inhibit the body’s immune system. Some of these medications include those used in chemotherapy, for heartburn or indigestion or to regulate cholesterol, anti-depressants, and steroids, including the type used with inhalers for asthma.
Let’s go back to the 700 species of bacteria that can colonize in your mouth. What can you do to protect the healthy strains that work to protect your mouth and can even work to limit tooth decay? How can you fight the harmful bacteria that cause cavities and disease? The various strains live together in a balance. A healthy diet and good dental hygiene swing the balance toward greater numbers of healthy bacteria, while a poor diet and lack of good oral hygiene allow the harmful bacteria to take over.
Eventually, if you do not actively take steps to correct the imbalance, it will lead to bad breath, cavities, gum disease, and will make you more susceptible to infection from these harmful types of bacteria. Not only will you be more vulnerable to infection when you need a dental procedure, but even something as simple as making your gums bleed while brushing, flossing or chewing could allow the bacteria to enter your bloodstream, travel to another location in your body, and cause an infection. Interestingly, if a pregnant mother has gum disease, their baby will be born with more of the harmful bacteria in their mouth, predisposing them to cavities and gum disease.
The most important things you can do to support healthy bacteria and limit harmful bacteria are to develop and maintain great oral hygiene habits and to eat healthy foods. Dairy, lean proteins, nuts, plenty of fruit and veggies, and water should make up the majority of your diet to support healthy bacteria and strong teeth.
Great oral hygiene habits include brushing your teeth twice a day, flossing once a day, and regular visits to the dentist. The good news is that research has found that maintenance of optimal oral health and hygiene is more important than prophylactic antibiotics for reducing the risk of infective endocarditis. In other words, if you do the work every day to keep your mouth healthy, you are more likely to have more good bacteria and fewer harmful bacteria, which reduces the risk of infection from harmful bacteria entering your bloodstream and causing an infection somewhere else in your body.
Although getting a life-threatening infection from the bacteria in your mouth sounds terrifying, there are many steps you can take to minimize the risk. At Jungle Roots Children’s Dentistry and Orthodontics, we believe that prevention and education are important for children and their families to have optimal dental health. We take the time to educate you and your child on best practices for good oral hygiene and a healthy diet, and you can also speak with us if you think you are in the group of people who need antibiotic prophylaxis. When treatment is necessary, we talk you through the process and answer any questions you may have. Whatever health problems you may face, we want to work with you to gain the best dental health possible.
American Academy of Pediatric Dentistry Guidelines for Antibiotic Prophylaxis
Wilson, Walter, et al. “Prevention of Infective Endocarditis: Guidelines from the American Heart Association: a Guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group.” Circulation, U.S. National Library of Medicine, 9 Oct. 2007,
At Jungle Roots Children’s Dentistry & Orthodontics, we strive to provide the highest comprehensive pediatric and orthodontic dental care in a unique, fun-filled environment staffed by a team of caring, energetic professionals. We believe the establishment of a “dental home” at an early age is the key to a lifetime of positive visits to the dentist.
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