DENTAL PREMEDICATION

 DENTAL ANTIBIOTIC PREMEDICATION:

There are certain medical conditions which require the patient to take a dose of antibiotics prior to their dental appointment. This is done to help prevent any bacteria introduced from the dental procedure, from causing an infection in another part of the body, such as the heart lining, called bacterial endocarditis.

This subject is of great debate, because there is conflicting evidence whether antibiotic dental premedication is needed at all, and the over prescription of antibiotics can lead to antibiotic resistant strains of bacteria.


CONDITIONS WHICH MAY REQUIRE PREMEDICATION:

(This list is not all inclusive, so check with your provider if you have any concerns)

  • Artificial Heart Valves
  • History of Rheumatic Fever
  • History of Infective Endocarditis
  • Kidney Dialysis
  • Mitral Valve Prolapse with Valvular Regurgitation
  • Certain Congenital Heart Conditions
  • Cardiac Transplants

DENTAL PROCEDURES WHICH REQUIRE PREMEDICATION: (This list is not all inclusive, so check with your provider if you have any concerns)

If significant bleeding is not going to occur, it is not necessary to take antibiotics prophylactically before your dental appointment.

RESEARCH ANY DENTAL DRUGS HERE.


The ADA (American Dental Association) says:

The following procedures and events do not need prophylaxis; routine anesthetic injections through non infected tissue, taking dental radiographs, placement and removal of removable prosthetics or orthodontic appliances, adjustment of orthodontic appliances, placement of orthodontic brackets, shedding of primary teeth, and bleeding from trauma to the lips or oral mucosa. (Jada, January 1, 2008, v139)



YES, ANTIBIOTICS ARE NEEDED:

All procedures which involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa, such as:

  • Extractions
  • Periodontal Surgery
  • Endodontic Surgery
  • Root Canal Therapy
  • Periodontal Cleanings

DOSAGE:

AMOXICILLIN, usually administered as 500mg x 4 tablets (2.0 grams), taken 1 hour before dental appointment.

or, if allergic to amoxicillin

CLINDAMYCIN, usually administered as 150mg x 4 tablets (600mg), taken 1 hour before dental appointment.

For more information on antibiotic premedication, read about the ADA guidelines here

Here is a summary of some of the new recommendations:


 

DENTAL PREMEDICATION FOR ANXIETY:

This is one area of dentistry which is probably UNDERUTILIZED. Many, many patients are not comfortable going to the dentist, which makes them procrastinate and not go, which in turn makes their dental problems worse, which makes their experience more involved, and the whole ordeal SNOWBALLS!

One way to help manage DENTAL ANXIETY, is by PREMEDICATING the patient before their dental appointment. Sometimes a light sedative, such as VALIUM or ATIVAN, can relax a patient a great deal, which relaxes the provider, and can make the experience much more tolerable for both parties.


NITROUS OXIDE AND OR ORAL SEDATION?

Some oral sedatives combined with nitrous oxide are considered a HIGHER LEVEL of sedation, which your dentist may not be licensed to perform. Therefore, it is often recommended to choose either one or the other.

PRO NITROUS: It does not have any lingering effects, therefore after your appointment, your activity will not be limited.

PRO ORAL SEDATION DENTAL PREMEDICATION: Since you take the medication before your appointment, much of the ANXIETY leading to the appointment is reduced. Also, without a NOSEPIECE from the nitrous, the dentist will have much easier access to do the needed work.

THE MAIN DRAWBACK: The main drawback is that after taking a sedative, you will need someone to drive you home, and may be sedated for several hours after the appointment.

DOSAGE: Everybody is different, but most people will probably do fine with one dosage about an hour before the dental appointment. Some may need to take a dose the night before, and another before the appointment.

IF YOU ARE EXTREMELY NERVOUS, ASK YOUR DENTIST ABOUT THIS POSSIBILITY!!


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