Gerald S. Fine, D.D.S.

   Oral and Maxillofacial Surgery

Brookline Office
Tel: 617-731-6060

Our commitment is to provide you the highest standard of oral and maxillofacial surgery in a professional manner.

The "NEW" Antibiotic Guideline (Revisited)

Although the American Heart Association had changed its antibiotic prophylaxis guidelines in 2007, I often receive telephone calls from both the dentist and from patients asking whether or not pre-medication is needed prior to an oral surgical procedure.

A fundamental conceptual change was made in the 2007 guidelines based on the individual's lifetime risk of acquiring infective (IE). The major practice changes are found in four areas.

  1. Antibiotics for dental procedures, even at 100% effectiveness will prevent only a very small number of infectious endocarditic (IE) cases.
  2. Only patients with underlying cardiac conditions that are linked to the highest risk of serious outcomes for IE need prophylaxis.
  3. Prophylaxis for these patients is needed whenever the procedure involves manipulation of the gingival tissue or the periapical region of the teeth, or perforation of the oral mucosa.
  4. Prophylaxis is not recommended solely on the basis of an increased lifetime risk of acquiring IE.

It should be noted that if antibiotic coverage is inadvertently omitted before the procedure, the agent may be given up to 2 hours after the procedure. If prophylactic antibiotic is to be used for more than one routine procedure, the procedures should be scheduled at least 10 days apart. If a shorter period is needed, it is best to use another antibiotic.

Medical conditions for which no antibiotic prophylaxis is recommended before dental treatment.

These guidelines may be confusing to patients who have taken antibiotics previously and are now told they are not needed. If patients or physicians feel uncomfortable with the new approach, it is their choice. If you and the patient's physician disagree, the physician can always prescribe prophylaxis on his or her own authority.

‍Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery‍