Kim Loos Dr. Kimberly A. Loos practices general dentistry in San Jose, California. She is also a clinical instructor at University of Pacific School of Dentistry and an editor for Dentistry On-Line. Dear Dan, Dentists premedicate patients with heart conditions including artificial valves, certain types of heart murmurs, and mitral valve prolapse, to prevent a condition called subacute bacterial endocarditis. It is hypothesized that patients with joint replacements also needed antibiotic premedication. This precaution has been taken because certain dental procedures, such as cleanings, extractions, implant placement, specific injections, endodontic surgery, and placement of orthodontic bands, can cause a bacteremia.
Bacteremia is basically a showering of bacteria into the bloodstream.
In patients with heart problems, as mentioned above, there is some possibility that this bacteremia can cause a serious infection of the heart. While bacteremias can also cause infection of the joint replacement, there is no correlation between joint replacement infections and subacute bacterial endocarditis because the anatomy, blood supply, and microorganisms are different. Also, bacteremias can occur in the course of daily life, and it is more likely that oral bacteremias are more commonly caused by daily events than by dental procedures. Guidelines for antibiotic coverage are now available. First, no antibiotic prophylaxis is recommended or necessary for patients with pins, screws, and plates.