Public Health in the National News – For the past 60 years, millions of individuals with certain heart or joint conditions have received antibiotic prophylaxis (premedication) before dental treatment. Antibiotic prophylaxis typically consists of taking a few antibiotic pills 30-60 minutes before the dental visit, regardless of any dental infections.
This clinical practice is based on the theory that antibiotics could reduce heart and joint infections by blocking bacteria that travel from the mouth to the heart or joint through the bloodstream. However, is there good evidence that antibiotic prophylaxis actually prevents heart and joint infections, or is this practice more harmful than helpful?
To provide some direction, in 1955 medical organizations began to publish guidelines. Since that time, guidelines have evolved as more evidence has accumulated. The American Dental Association posts a summary of current recommendations at http://www.ada.org/2157.aspx.
However, research standards are higher today than they were in the past. Studies that might have been sufficient to produce a guideline in the past would no longer be acceptable today. In recent years, when scientists reviewed all prior research studies using modern standards, they noticed that some guidelines lacked strong supporting evidence and eliminated them. For example, the once popular use of antibiotic prophylaxis in individuals with a heart murmur is no longer recommended.
The use of antibiotic prophylaxis for individuals with total joint replacement is now under scrutiny. However, once guidelines are officially adopted and implemented on a national scale, they do not easily or quickly change. Until there is a resolution, guidelines not based on strong evidence create profound ethical and legal dilemmas. Health professionals are eager to follow rules, but they also wish to provide the best care for their patients and do no harm. Should a patient be advised to take antibiotics even though there may not be strong evidence that the antibiotic will do more good than harm? Intermittent use of antibiotics can lead to bacterial resistance (the antibiotic may no longer work the next time it is used), medication costs, trips to the pharmacy, delayed or cancelled dental visits, adverse events, and even death from a sudden allergic reaction. These risks should be balanced against potential benefits in individual patients.
Individuals who take antibiotics before dental treatment should continue to discuss possible benefits and harm with their dentist, and they should monitor any changes in guidelines. Regardless of where the body of evidence leads us, maintaining good oral hygiene remains an effective way to reduce oral bacteria.
This article was written by Lorena Baccaglini, DDS, PhD, associate professor in the UNMC COPH