Will you need antibiotics before having your tooth pulled?

You may need to take antibiotics before having your tooth pulled.

Circumstances and safety concerns associated with some extraction cases will require that the patient must take prescription antibiotics prior to having their procedure.

How many days of antibiotics are needed before an extraction?

What’s needed will vary according to the specific concerns associated with the patient’s case. In some situations, the course of antibiotics will need to be started a few days before the person’s procedure. For others, a one-time, same-day dose will provide the antibiotic coverage that they need.

Common reasons for antibiotic use prior to extraction procedures.

Here’s a list of the most common reasons why a patient might require pretreatment with antibiotics before having a tooth pulled.

Take antibiotics as directed.

Report any bothersome symptoms immediately.

• The patient has a medical condition or issue that requires the use of prophylactic antibiotics (antibiotic premedication).
• The tooth slated for extraction has an associated infection with swelling that needs to be managed before it can be removed.
• Coverage with antibiotics is considered necessary to help prevent post-extraction infection.

  (Note: In the vast majority of cases, a patient’s risk of developing infection is considered low and therefore the use of prescription antibiotics is not indicated.)

1) Extraction cases requiring antibiotic premedication for medical reasons.

Some medical conditions or issues place the patient at risk of developing a bacterial infection as a consequence of having their tooth pulled.

What’s the concern?

For these patients, bleeding that occurs during their procedure can provide an entry point into their body for bacteria. The bacteria can then spread via their bloodstream (termed a bacteremia). The bacteremia can result in the formation of infection at (typically) distant locations, like in the heart or bone joints.

Antibiotic prophylaxis.

When the patient’s risk for this scenario is considered high, it will be mandatory for them to take “prophylactic” antibiotics before their tooth extraction can be performed. Especially in sequelae involving the heart, not doing so could be life-threatening.

Medical conditions where antibiotic premedication may be required before tooth extraction.

• Patients with certain cardiac conditions. – Mitral prolapse with regurgitation, damaged or scarred heart valves (like damage from rheumatic fever), heart valve defects, congenital heart disease, congenital heart defects, cardiac (heart) transplant, hypertrophic cardiomyopathy, a previous history of bacterial endocarditis/infective endocarditis.
• Patients who have foreign objects that have been placed in their bodies. – Prosthetic (artificial) heart valves, heart valve repair with prosthetic materials (rings, cords), joint replacements/prosthetic joints (knee, hip, etc…), renal dialysis catheters.
• Medical conditions that affect host susceptibility to infection. – Uncontrolled or poorly controlled diabetes, having chemotherapy or immunosuppressive therapy, end-stage renal disease.

▲ Section references – Hupp

Print this list for discussion with your dentist about your risks.

Only your dentist can decide if pre-op antibiotics are indicated.

Our list above is not all-inclusive and is purposely vague. Research findings, as well as the opinions of the doctors and organizations who evaluate them when formulating current guidelines, are constantly evolving.

Current opinion about prophylactic antibiotic use.

The current trend in opinion is one where antibiotic premedication is utilized less frequently than in previous decades. This revision is based on the findings of more recent studies, many of which suggest that taking the antibiotic provides little benefit for the patient while leaving them at risk for adverse reactions to the antibiotic itself.

So, if you have a history of taking pretreatment antibiotics prior to having dental work performed, you should question your dentist. But their reasoning at this point in time may be based on more current guidelines.

• Don’t be surprised if your dentist feels that they must consult with your physician before they decide that prophylactic antibiotics are, or are not, needed.
• In cases where the patient is already taking an antibiotic for other reasons, the usual protocol is that a different one is chosen for use with their upcoming dental procedure.

▲ Section references – Koerner

Antibiotic prophylaxis – What regimen is used?

The regimen used for your antibiotic prophylaxis before your oral surgery will be tailored to you. Generally, it will take the following form.

How many days of taking antibiotics is required?

In most instances, only one day. The chosen antibiotic is typically taken as a single dose, 1 hour prior to the patient’s extraction procedure.

Additional details.

• The antibiotic that’s most frequently used is amoxicillin. In cases where an allergy to it is a concern, clindamycin is usually chosen as the alternative.
• Even if you are currently taking antibiotics for other reasons, your dentist will probably feel that taking an additional dose of a different antibiotic is needed.
• The precise regimen that’s used with your case will, of course, be dictated by your dentist. They may feel a need to consult with your physician before making a decision.

2) Managing existing tooth infections with pre-extraction antibiotics.

Pretreatment antibiotics aren’t usually required when extracting infected teeth for healthy patients. However, cases involving teeth that have caused extensive swelling may require management before the tooth can be pulled. And this management may need to include the use of pre-extraction antibiotics.

How dentists manage swollen infected teeth that need to be extracted.

You might be surprised to learn that managing tooth-related swelling due to the presence of infection via the use of antibiotics only is never your dentist’s first choice. And the presence of swelling or other signs of infection doesn’t necessarily dictate that antibiotics should be used.

Instead, what’s required is that your dentist takes steps that will aid in resolving the swelling associated with your tooth as quickly and predictably as possible.

The preferred approach for managing swelling due to infection.

Whenever possible, utilizing a hands-on approach makes the best plan when dealing with tooth-associated swelling.

One method involves “incising and draining” the infected tissues. To do so, the dentist will make an incision in the swollen tissues which then allows the pus they contain to drain out. The infected tissues may be allowed to drain for some days before the patient’s extraction procedure is then performed.

With some cases, the patient’s signs of infection and level of associated swelling may be such that the dentist determines that going ahead and extracting the tooth still makes a permissible choice. If so, the pus held by the swollen tissues will then drain out via the extraction wound.

The use of antibiotics may still be indicated.

Even when a hands-on approach is implemented, a dentist may determine that a course of oral antibiotics is still indicated. Doing so can aid in more fully, possibly more quickly, resolving the tooth’s infection and tissue swelling before its procedure.

In these cases, a regimen of 7 to 10 days of taking oral antibiotics is common, with the patient’s tooth being extracted on one of the last few days of the treatment course.

Diffuse swelling may not offer an opportunity for drainage.

Pretreatment antibiotics may be needed.

The last resort for dealing with swelling due to infection.

Related page – We now discuss this topic more fully here: Issues associated with Pulling infected teeth. – Including in the presence of swelling.

What pretreatment antibiotic regimen is used with infected tooth extraction cases?

How many days of taking antibiotics is required?

Taking four or five days of oral antibiotics before your extraction and then continuing on with them during the following days is common.

A total course of 7 to 10 days of taking antibiotics is typical, with the patient’s extraction procedure taking place towards the end of the regimen.

Additional details.

• Tooth-associated infections typically respond well to penicillin, amoxicillin, clindamycin, or metronidazole.

▲ Section references – Hupp

Extraction of an infected tooth.

3) The use of antibiotics to prevent postextraction infections.

Some patients may wonder if it’s necessary or routine to take antibiotics prior to oral surgery as a measure to prevent the risk of infection and associated complications following an extraction.

In most cases, taking antibiotics to prevent post-extraction infection is not indicated.

Potential complications associated with the use of antibiotics include: allergic reactions, systemic side effects (diarrhea, nausea, vaginitis, etc…), development of bacterial drug resistance.

What does the research say?

There is relatively little published literature about the need for antibiotics in preventing postoperative infections after non-wisdom tooth extractions.

A review that did try to investigate this subject (Lodi), but fell short, did conclude that even with wisdom tooth extractions (see below) included in the pool, the incidence rate of post-extraction infection was 1 out of 13 cases.

▲ Section references – Lodi

Considerations with using pretreatment antibiotics to prevent postextraction infection.

As possible factors to consider, we’ll mention the following points.

• The incidence rate of postoperative infection generally rises in relationship to the duration/extensiveness of the patient’s extraction procedure. For example, it is very common for a dentist to utilize preoperative antibiotics with impacted wisdom tooth surgeries, especially lower ones.

  [The highest post-extraction infection rate is associated with removing lower impacted wisdom teeth. Studies have placed this number at up to 12% of cases (O’Connor).]

• In cases where the use of antibiotics is indicated but not previously planned for, your dentist has some options.

  Taking oral antibiotics as little as 1 hour before your procedure may provide adequate coverage. They may administer systemic (I.V.) antibiotics. They may apply the antibiotic topically (place it in your extraction site immediately following your tooth’s removal).

▲ Section references – O’Connor