Will you need antibiotics before having your tooth pulled?

Reasons why you may need to take antibiotics before having your tooth pulled.

Some extraction cases will require the added step that the patient will need to take antibiotics. Depending on their case specifics, the regimen might need to be started some days before or else on the same day as their procedure.

Common reasons for antibiotic use prior to extractions.

The following list contains the most common reasons why pretreatment antibiotics might be necessary 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.
• Antibiotics are considered necessary in helping to prevent postextraction infection.

1) Extraction cases requiring antibiotic premedication for medical reasons.

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

What’s the concern?

For these patients, a point of bleeding (the extraction surgical site) provides an entry point into their body for bacteria. The bacteria then spread via their bloodstream and this spread has the potential to result in the formation of an infection at a typically distant location (frequently the heart or a joint).

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 for tooth extractions.

• Patients with certain cardiac conditions. – Mitral prolapse with regurgitation, damaged or scarred heart valves (like damage from rheumatic fever), some congenital heart or valve defects, hypertrophic cardiomyopathy, a previous history of bacterial 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), 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 opinion 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

What antibiotic premedication regimen is used with extraction cases?

• 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.
• In most instances, the chosen antibiotic is taken as a single dose, 1 hour prior to the patient’s extraction procedure.
• Of course, the precise regimen that’s used with your case will be dictated by your dentist.

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

While pretreatment antibiotics aren’t usually required when extracting infected teeth (for healthy patients), cases that involve 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.

You might be surprised to learn.

Managing tooth-related swelling via the use of antibiotics alone is never your dentist’s first choice. And the presence of swelling on its own doesn’t dictate that they need to be used. Instead, what’s required is that your dentist takes steps that will aid in resolving the swelling as quickly and predictably as possible.

The preferred approach.

When possible, utilizing hands-on techniques makes the best plan when dealing with tooth-associated swelling. This may involve going ahead and extracting the tooth, or incising and draining the focus of its infection, or both.

Then afterward, depending upon the level of success achieved in bringing the swelling down, a decision to additionally begin a regimen of antibiotics might be made.

Diffuse swelling may not offer an opportunity for drainage.

Pretreatment antibiotics may be needed.

The last resort.

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?

When the use of antibiotics is indicated:

• Tooth-associated infections typically respond well to penicillin, amoxicillin, clindamycin, or metronidazole.
• Instructions will typically include starting the antibiotic several days prior to when the extraction is scheduled. A total course of 7 to 10 days is common, with the extraction taking place towards the end of the regimen.

▲ 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 their extraction procedure as a measure to prevent complications with postoperative infection.

In most cases, antibiotics are not indicated.

Potential complications include: allergic reaction, 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 prior to 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