FOR IMMEDIATE RELEASE
March 2000
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Fred Peterson
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Jann Ingmire
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Researchers Say Few Dental Situations Warrant Preventive Antibiotics
CHICAGO -- There are relatively few situations in which antibiotics would be needed before dental care, according to an article appearing in the March 2000 issue of The Journal of the American Dental Association (JADA).
In the JADA article, procedures commonly considered by dentists for the potential use of antibiotics to prevent infections were reviewed to determine if current evidence supported their routine use.
"The emerging trend seems to be to avoid the prophylactic use of antibiotics in conjunction with dental treatment unless there is a clear indication of need," wrote co-author Bruce R. Rothwell, D.M.D., M.S.D. Dr. Rothwell is associate professor and chairman, Department of Restorative Dentistry, and an adjunct associate professor of Oral and Maxillofacial Surgery, University of Washington at Seattle.
The evidence is now clear that not every dental procedure and very few medical conditions warrant the use of antibiotic prophylaxis, according to the authors.
It is safe to perform dental procedures (such as treating tooth decay and making dentures) in which the potential for bleeding is minimal in at-risk patients without the use of antibiotic prophylaxis, they wrote.
"Invasive treatment in which bacteremia is more likely to occur (such as periodontal scaling, gum surgery and tooth extractions) warrants the use of antibiotic coverage in patients with specific conditions, such as prosthetic heart valves and a history of endocarditis," Dr. Rothwell said.
The authors concluded that aside from the specific situations described in their article, there is little or no scientific basis for the preventive use of antibiotics in dentistry. They also said the risk of inappropriate use of antibiotics and widespread antibiotic resistance appear to be far more important than any possible perceived benefit.
"Whenever possible, dentists should follow the standard protocols recommended by the ADA, American Heart Association or the American Academy of Orthopaedic Surgeons," the authors suggested.
In the August 1997 issue of JADA, the American Dental Association (ADA) and American Heart Association published "Prevention of bacterial endocarditis: Recommendations by the American Heart Association," which calls for antibiotic prophylaxis for at-risk patients facing dental and oral procedures likely to cause bacteremia.
"In general," noted the article, "prophylaxis is recommended for procedures associated with significant bleeding from hard or soft tissues, periodontal surgery, scaling and professional teeth cleaning."
The ADA's Council on Scientific Affairs believes additional knowledge is needed on the differences in the risk of infections among various dental procedures such as tooth extractions, implant placement and other surgical procedures.
This information, according to the Council, is needed to confirm procedures associated with a higher risk of cardiac infection that continue to require antibiotic coverage for protection of at-risk patients against infective endocarditis. Likewise, further study is necessary before redefining some dental procedures as having low or no risk of bacterial endocarditis.
For more information about antibiotic prophylaxis, visit the ADA's web site at http://www.ada.org.
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