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Why Some People Take Antibiotics Before Visiting The Dentist

Dentists prescribe prophylactic (to prevent the spread of disease) antibiotics before dental treatment for people with certain medical conditions. The American Heart Association, the American Dental Association, and the American Academy of Orthopedic Surgeons have recommended the guidelines for preventive antibiotics for these medical conditions. The current guidelines were developed for patient well-being, as well as in consideration of the current concern regarding the overuse of antibiotics. The guidelines outline specific medical conditions and provide examples of which dental procedures indicate the need for prophylactic antibiotics.

The risk of infective endocarditis (infection and inflammation of the lining of the heart and its valves) is increased with dental procedures that cause bleeding and the potential release of oral bacteria into the bloodstream of people with certain medical conditions. Individuals who have certain congenital or acquired heart defects, as well as some conditions or abnormalities of the heart, have an increased chance of a bacterial infection.

The link between dental procedures and infective endocarditis is controversial. Not all dental procedures require the use of antibiotic prophylaxis. Dental procedures that have minimal potential to cause bleeding are considered low risk for infective endocarditis. Antibiotic prophylaxis may be indicated for invasive dental procedures that are likely to cause bleeding and release of oral bacteria in the bloodstream.

Also, the release of oral bacteria into the bloodstream appears to increase the risk of developing an infection around a prosthetic joint in people with a depressed immune system. Use of prophylaxis antibiotics is recommended for individuals with total joint replacements who have certain other health conditions.

Antibiotic prophylaxis also can be prescribed for circumstances other than prevention of infective endocarditis and prosthetic joint infections. Some other conditions or situations that may indicate antibiotic prophylaxis include in-dwelling catheters, hemodialysis patients with arteriovenous shunts, shunts for hydrocephalus, oral surgical or operative procedures (depending on the patient's immune system), insulin-dependent diabetes, or diabetics whose disease is poorly controlled.

By Denise J. Fedele, DMD, MS

Find A Dentist: Frequently Asked Questions

Q. If a pain in a tooth goes away, should you still see a dentist?

A. Either minor or severe pain that goes away may indicate that you have a cracked tooth. A cracked tooth hurts because the pulp, the soft inner tissue of the tooth, is irritated. If treatment is delayed, the tooth may split and be more difficult to treat successfully.

The sudden absence of pain also may be a sign that the nerves of the tooth have died. It might also be due to a chronic infection that is draining. Even if the pain stops, if the pulp is damaged or diseased, pain will likely return and the tooth will require treatment. It is important to find a dentist who can treat the situation.

Q. After a traumatic injury, if teeth aren't chipped or broken but there's bleeding in the gums, is dental care necessary?

A. It's not always easy for people to tell when to seek a dental evaluation. However, if the gums bleed, it's important to see a dentist because the trauma may have caused damage. The tooth may have been "jammed" into the socket and severe problems could develop.

Prompt treatment often prevents more serious problems or complications from developing later. A tooth can develop problems long after the injury, so it's very important to be checked.

Q. What might be the cause of a dull ache in your upper teeth and cheek?

A. It can indicate several conditions. It could be associated with a tooth or gum problem, bruxism (grinding teeth), TMD (temporomandibular disorder), a sinus infection, headache, or salivary gland infection.

Check with your dental provider first, and if it's not related to a dental condition, you will be referred to a physician. Click here to find a dentist who specializes in TMJ/TMD.

Q. What should you do when you have a toothache?

A. Clean your mouth by rinsing with warm water and remove any food that is trapped between teeth with dental floss. Do not apply aspirin on the aching tooth or gum tissues. See your dentist as soon as possible.

Q. What should you do if your tooth is knocked out?

A. If your tooth is knocked out, you should carefully rinse the tooth with water. You should attempt to place the tooth back in its socket and secure it with a wet wrap. If you cannot place the tooth back in its socket, put it in a glass with either saliva or milk. Then you should contact your dentist so you can be seen immediately.

Q. What are extruded teeth?

A. Extruded teeth are teeth that are forced out of position.

Q. What is the treatment for a broken tooth?

A. Rinse the mouth with warm water. Try to remove any dirt, blood, or debris from the injured area using sterilized gauze or a clean cloth and warm water. Apply cold compresses on the face next to the injured tooth to reduce swelling. Cover the tooth with cotton or gauze if the rough edges are cutting you or if it is sensitive to air, and see your dentist immediately.

Q. What should you do if your tooth is pushed out of position?

A. If your tooth is pushed out of place, you should reposition it to its normal alignment using very light finger pressure. You should hold the tooth in place with a moist gauze or tissue. Make sure that a dentist sees you ideally within a half-hour.

Q. What causes a constant throbbing pain in your jaw or tooth?

A. A throbbing pain is usually a symptom from two different causes: either the nerve inside the tooth or the ligament around the tooth is damaged, irritated, or inflamed. A cavity, traumatic injury, or other factor can damage or irritate the pulp inside the tooth.

Severe gum disease affecting the ligament that surrounds and cushions the tooth roots can result in throbbing pain. An erupting tooth, including a third molar or wisdom tooth and TMD are also potential sources of throbbing pain.

Q. What is considered to be a minor tooth fracture?

A. A minor fracture is considered to be a tooth that is only broken in the hard outer enamel part.

Q. How do you treat a minor tooth fracture?

A. Your dentist can smooth a minor fracture with a sandpaper disc or just leave it alone. You can also restore the tooth with a composite restoration if necessary.

Q. What do you consider to be a moderate tooth fracture?

A. A moderate fracture is considered to be damage to the enamel, dentin, and/or pulp of the tooth.

Q. How do you treat a moderate tooth fracture?

A. A moderate fracture can be restored with a full permanent crown if the pulp is not permanently damaged. Sometimes, an onlay or bonding will be appropriate as well. Occasionally, root canal treatment (endodontics) may be required.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.