An Early Bite with Dr. John Paul: “Why Do I Have to Take Antibiotics Before My Dental Appointment?”

By Dr. John Paul, FDA Editor

How many of your patients complain when you prescribe their prophylactic antibiotics? In my practice, it’s all of them. No one complains about the drugs they think will make them feel better, but when they perceive no problem, they want no cure.

“It’s four big old horse pills that make me gag, I can never remember them and I read that it’s bad to take too many antibiotics. Why do I have to take them every time I come to the dentist?”

“Mrs. Gruntbuns, you’re right, it’s bad to take medicines you don’t need and it is four large pills. If it’s just the pills and remembering, we can get you a liquid (but it costs more and won’t last on the shelf) and we can call to remind you. If you need the medicine though, it might just be the difference between life and death, or at least between a relatively comfortable life and misery.

“Not as many people need or are prescribed an antibiotic before dental care today as when I started practice. Science has shown us some situations aren’t a risk while others remain. If you are likely to get an infection in your heart or on an artificial piece of equipment, then you should have an antibiotic before we do any procedure that may cause bleeding and let germs enter your blood stream.

“Remember, you have that artificial valve in your heart — that’s a place where bacteria can land and live, and since the artificial valve doesn’t have a blood supply, giving you antibiotics to kill the bugs that start living there is no easy matter. It won’t just be a couple of pills, but days in the hospital. I like you too much to risk you going to the hospital just because you had your teeth cleaned.”

Have a question you have a tough time answering? Send it to Dr. Paul at jpaul@bot.floridadental.org.