Prophylactic Antibiotics

During most periodontal procedures, including periodontal cleanings, the tooth is cleansed under the gum’s edge. This usually causes minor gum bleeding, which is often unnoticed by the patient. However, when bleeding occurs it is likely that some mouth bacteria will enter the bloodstream (bacteremia). This is a common phenomenon, and may even occur with tooth brushing or chewing if the gums are inflamed. Normally the bacteria are destroyed when they enter the bloodstream, but with certain medical conditions they may potentially cause a problem. For example, patients with a prosthetic heart valve, patients with recently repaired heart defects, patients with heart transplants, or those with a history of heart infections (endocarditis) are considered high risk for these infections. In these patients, the use of preventative antibiotics is recommended. The antibiotic regimen for antibiotic prophylaxis is noted below:

Historically, the 2 primary reasons for prescribing antibiotics to a patient to take prior to bacteremia producing dental procedures have been:

  1. Prevention of Prosthetic Joint Infection
  2. Prevention of Infective Endocarditis

For the prevention of Prosthetic Joint Infection: Current guidelines published by the American Dental Association in conjunction with the American Academy of Orthopaedic Surgeons states that, in general, for patients with prosthetic joint implants prophylactic antibiotics ARE NOT recommended prior to dental procedures to prevent prosthetic joint infection. Because each patient is evaluated on a case by case basis, please consult with your doctor at Periodontal Medicine and Surgical Specialists who will review your individual medical history and consult with your orthopaedic surgeon, if indicated.

For the latest evidence on the guidelines involving antibiotic prophylaxis for prevention of prosthetic joint infection click here.

In certain instances, we may wish to contact your orthopedic physician in order to coordinate care and provide you with the best possible treatment.

For the prevention of Infective Endocarditis: Infective Endocarditis prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from Infective Endocarditis.

Click here for the guidelines on the prevention of infective endocarditis from the American Heart Association:

High risk cardiac conditions which may require antibiotic prophylaxis with dental procedures are noted below:


For almost all cases, taking a single dose of antibiotics one hour before your appointment is all that is needed, unless surgery has been scheduled. Under surgical conditions, you may be prescribed abtibiotics post operatively for 7 – 10 days depending on the procedure and your individual circumstance.

Your doctor at Periodontal Medicine & Surgical Specialists, LTD, can answer any questions you may have about your need for antibiotic prophyaxis prior to dental procedures.

For definitions on medical terminology click here.

Please feel free to ask us if there is anything you have questions on: office@periodontalmedicine.org