People who have artificial heart valves are required to take antibiotic medications prior to certain dental treatments to prevent a sometimes fatal heart infection called subacute bacterial endocarditis (SBE). The reason is that bacteria in the mouth during dental treatment can travel through the blood stream and infect the artificial valve. Those who have other prosthetic devices may be concerned whether their knee replacement, or pin in their arm, for example, is also at an increased risk for infection after dental treatment. Fortunately, most prosthetic devices are safe from infection and do not require antibiotics prior to dental treatment.
Prosthetic implants are very prevalent in the United States and worldwide. Each year, most of the 120,000 artificial heart valve surgeries performed are done in the United States. Other prosthetic devices, including about 900,000 implanted lenses, 140,000 hip prosthesis and breast implants, 115,000 knee replacements, and 35,000 penile implants are performed each year in the United States. With these numbers and wide range of implants, it's no wonder that some patients, dentists, oral surgeons, endodontists and medical doctors have questions about if and when antibiotics are appropriate to protect against infection after certain dental treatment. The dental procedures most likely to infect a prosthetic implant are those that are likely to cause bleeding (dental extractions, periodontal gum treatment, dental cleanings, placement of dental implants, biopsies, and placement of orthodontic bands for braces).
The following prosthetic devices do not require antibiotics prior to dental treatment after the implant has healed, which include: breast and dental implants, implanted lenses, most cerebrospinal fluid shunts and pins, screws, and plates used for fracture repair. There is little or no evidence that people with prosthetic hips or knees, penile implants, pacemakers, implanted defibrillators, or central intravenous lines require antibiotics prior to dental treatment unless consultation with the person's family doctor or specialist establishes a risk factor. There is some evidence that people with synthetic arterial graft or cardiac patches (especially before they have healed), uldal catheters, Hickman devices, and ventriculoatrial cerebrospinal fluid shunts will require antibiotics prior to dental treatment, but that should be considered on an individual basis with consultation of the person's family doctor or specialist. There is evidence to support the need for antibiotics prior to dental treatment for those who have mechanical or tissue-constructed artificial heart valves.
The use of antibiotics should not be taken lightly. The emergence of drug resistant bacteria, side effects, and potentially dangerous allergic reactions are all reasons for dentists to be very prudent in the administration of antibiotics. The decision to use antibiotics prior to dental treatment is one that should be made by you, your dentist and your family doctor or medical specialist.
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