ANTIBIOTICS BEFORE DENTAL TREATMENT

These are the guidelines for prevention of bacterial endocarditis effective June 1997. They are quite different from past guidelines. However, be aware that doctors are free to deviate from the guidelines based on a patient’s individual situation. The decision to use antibiotics prophylactically is a balance between the risk of inappropriate use of antibiotics resulting in antibiotic resistance and possible prevention of bacterial endocarditis.

Taking an antibiotic prior to receiving some dental treatments when a patient is considered to have a high or moderate risk heart condition is called prophylactic antibiotic coverage. The concern is that if a bacterial infection were to happen during dental (or medical) treatment, it could lead to bacterial endocarditis, which is an infection of the inner lining of the heart or heart valves. Symptoms may include unexplained fever, weakness, sluggishness, or feeling of illness following dental treatment with the worst case scenario being severe health complications or death.

People with the following conditions are considered HIGH RISK:

1. Prosthetic cardiac valves, including bioprosthetic and homograft valves

2. Previous bacterial endocarditis

3. Complex cyanotic congenital heart disease (e.g. single ventricle states, transposition of the great arteries,

tetralogy of Fallot)

4. Surgically constructed systemic-pulmonary shunts or conduits

People with the following conditions are considered MODERATE RISK:

1. Most other congenital cardiac malformations (other than those listed in high or negligible risk)

2. Acquired valvar dysfunction (e.g. rheumatic heart disease)

3. Hypertrophic cardiomyopathy

4. Mitral valve prolapse with valvar regurgitation and/or thickened leaflets

Dental treatments for which antibiotics are recommended:

1. Cleaning of teeth or implants where significant bleeding is anticipated

2. Periodontal procedures (surgery, scaling and root planing, probing)

3. Endodontic (root canal) procedures or surgery that extend beyond the apex

4. Subgingival placement of antibiotic fibers/strips

5. Intraligamentary local anesthetic injections

6. Initial placement of orthodontic bands (but not brackets)

7. Extraction of teeth

8. Dental implant placement

9. Reimplantation of avulsed teeth

PROTOCOL

Take the appropriate single dose of antibiotic 1 hour prior to your appointment.

The standard antibiotic and dose is: AMOXICILLIN (Adults: 2 gm, Children: 50 mg/kg of wt)

If penicillin-allergic, use instead: CLINDAMYCIN (Adults: 600 mg, Children: 20 mg/kg of wt)

or CEPHALEXIN or CEFADROXIL (Adults: 2 gm, Children: 50 mg/kg of wt)

or AZITHROMYCIN or CLARITHROMYCIN (Adults: 500 mg, Children: 15 mg/kg of wt)

Note: Whenever antibiotics are taken, the concurrent use of probiotics (lactobacillus acidophilus or bifidobacterium bifidus) to replace the beneficial bacteria eliminated by the antibiotics may be beneficial. It should be taken between doses of antibiotics. This therapy should also be continued after antibiotics are stopped to ensure repopulation of the gut.

Concerning the prophylactic use of antibiotics, some studies and reports have raised the serious question about whether the standard recommendation affords real benefit relative to the risks. For example, a 1990 paper entitled "Preventing Bacterial Endocarditis: A Statement for the Dental Profession," written by the Council on Dental Therapeutics of the American Heart Association states that, "Endocarditis may occur despite appropriate antibiotic prophylaxis...". Because of experienced or the possible negative side-effects of antibiotic use, some people choose not to take antibiotics, even though it is the widely accepted standard of care. The decision to use or not use antibiotics is the patient's responsibility and risk, and understand that not taking the prescribed antibiotics would not likely be encouraged or supported by a physician or dentist because of their concern for your health and possible malpractice charges if complications arose. If your physician or dentist allows you to make such a decision, be sure to discuss it with and inform your family, and expect to sign an informed consent form. Again, weigh the risks, both real and perceived, against benefits.

Some references on natural "antibiotics" or immune-boosting alternatives are:

1. Beyond Antibiotics...Healthier Options for Families, by Michael Schmidt, D.C.,

Lendon Smith, M.D., Keith Sehnert, M.D.

2. Natural Alternatives to Over-the-Counter and Prescription Drugs by Michael Murray, N.D.

3. Dr. Wright's Book of Nutritional Therapy by Jonathan Wright, M.D.

Alternatives to antibiotics that have been used are colloidal silver, Coneflower (Echinacea angustifolia), Garlic, Goldenseal (Hydrastis canadensis), Licorice (Glycyrrhiza glabra), Shitake Mushroom, Tea Tree Oil, Thyme Oil, Oregano Oil, Savory Oil, Eucalyptus, Inula Graveolens Oil, Lavender Oil, Vitamin C, homeopathics, Calendula, and Astragalus (Astragalus membranaceus). Mechanisms would be either ingestion and/or rinsing before and after dental procedures.

This information is provided for educational purposes only, and should not be considered a recommendation for any particular treatment, product, or philosophy. You have the sole responsibility to examine the benefits and risks of available options and decide what treatment, if any, is to be rendered. The First Amendment of the U.S. Constitution grants the right to discuss openly and freely all matters of public concern, and to express viewpoints no matter how controversial or unaccepted they may be.

Ronald L. King, DDS 6100 Excelsior Boulevard, Suite East St. Louis Park, MN 55416

Phone: 952-929-4545 FAX: 952-929-4592 e-mail: kingtooth@juno.com Web site: www.kingtooth.com