Dr. Stephanie Murphy, DDS
Dear Dr. Murphy,
I had been going to the same clinic for the past 35 years until recently. I never had to take an antibiotic prior to prophylaxis until the last time I was there exactly a year ago. They refused to treat me, even though they hinted (not demanded) that this could be coming during my last four visits. The demand started about the same time a new dentist bought the practice from the retiring dentist.
I can’t take Amoxicillin due to an allergic reaction. I had taken Clindamycin on a couple of occasions, albeit reluctantly, due to an abscess prior to a root canal. I don’t like taking pills to begin with, let alone being forced to take them because they might be nice to have. Due to the new antibiotic crisis (because of “super-bugs”), I have read that the ADA, etc. no longer recommend taking antibiotics for pretreatment prior to prophylaxis for most patients. But even so, I was told to get a prescription for antibiotics from the last doctor I had seen as they don’t write prescriptions for them! I stopped at one dentist’s office recently, asking what their antibiotics policy is. It read like a page out of an old textbook. Even though the ADA has been releasing the new findings and recommendations periodically, nobody seems to be getting the message.
I got a new shoulder exactly one year ago, and I know the orthopedic association is starting to adopt the same policy as the ADA regarding prophylaxis. My shoulder doctor is old-school and not quite ready to go along with the latest methods. So, basically, I’m between a rock and a hard place right now. I need to line up a new dentist.
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- Reader
Dear Reader,
Thanks in advance for your opinion. I can definitely understand that this has been frustrating for you, and you’re right, many of the guidelines are based on old studies and recommendations. In general, over the last several years, there has been a trend AWAY from antibiotic prophylaxis before dental procedures. In the past, patients with a history of some orthopedic surgeries and cardiac conditions were required to take a dose of antibiotics one hour before any dental treatment that might introduce bacteria into the blood stream. The previous thinking was that the antibiotics would prevent any bacteria in the blood from resulting in infection of the joint or heart.
More current studies have considered the potential of antibiotic resistance and the actual numbers of infections that have been attributed to dental procedures. For most patients, we now DO NOT require antibiotics to be taken before dental appointments. However, it is not a black-and-white decision; many factors must be considered. For instance, is the patient immune compromised, a poorly controlled diabetic, do they have a previous history of joint infection and are they taking any other medications that could increase their risk?
In your situation, it is the orthopedic surgeon that I would look to regarding any question about the necessity of antibiotics before dental treatment. As a dentist, I don’t have detailed information on the surgery, the health of the joint or if there were any issues with healing. If the surgeon’s office confirms that the patient does not need to pre-medicate, then I am comfortable proceeding. I have had offices simply fax me a letter stating that antibiotics are not required, and I have also had cases where, because of extenuating circumstances, they DID recommend antibiotics. It would be extremely unusual for a dentist to be unwilling to follow this recommendation. I would call your surgeon and explain the situation. Even if he is “old-school,” he is the one best positioned to determine your risk for infection.
Unfortunately, if your surgeon says you need the antibiotics, then your dentist is also “between and rock and a hard place.” If you were to have dental work completed without the antibiotics that the surgeon recommended, and it resulted in infection, your dentist would be responsible. Ultimately, it is your health (and your shoulder). You may find that there is no need to expose yourself to extra medication, or you might find that the benefits outweigh the risks in protecting your new joint!
Submit your questions at drmurphy@stephaniemurphydds.com.
