Updated: Aug 7
You've had a raging toothache for the past few days but luckily you secured an appointment with your dentist to have the tooth removed. Do you need antibiotics afterwards?
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Are antibiotics necessary after a tooth extraction?
The answer is that it depends on our overall health and how big the dental infection was. Our mouths are full of bacteria at all times and it is impossible to sterilize your mouth. The good news is that there are good and also bad bacteria. For most healthy patients, our body's immune system should be able to fight off all infections even with a tooth removal.
The only evidence you need is, do you recall taking antibiotics every time one of your baby teeth fell off? You probably didn't take any right? So, does that apply to adult teeth as well?
When a dental extraction requires antibiotics.
The most common reason for needing to take antibiotics would be an infection that results in a dental abscess. The abscess is usually accompanied by facial swelling. For large infections with diffuse facial swelling, your dentist will be prescribing you antibiotics even after they've extracted the tooth. The prescription is to help you fight and control the swelling after the procedure. It will also help to clear out the abscess faster.
The exception is when you have localized swelling that is caused by an infection. If it is localized, it is actually not required to take antibiotics afterwards. The most important treatment is to perform the extraction and establish a path of drainage for the infection. As long as you achieve that, it is not necessary to take the medication. Although we say that, our LIC dentists may still prescribe you some penicillin because it may be difficult to determine if the swelling whether it is facial swelling of gum swelling is truly localized or diffuse.
Aside from having a dental abscess, the last reason for needing the prescription would be if you had a health condition that requires antibiotic prophylaxis. Taking it is mostly to prevent infective endocarditits.
Prosthetic heart valuves including transcatheter implanted prosthesis and also homografts.
Prosthetic material used for a cardiac valve repair (annuloplasty rings and chords)
A prior history of infective endocarditis.
Cardiac transplant with valve regurgitation due to an abnormal valve
Congenital heart disease
Unrepaired cyanotic congenital heart disease which includes conduits and palliative shunts
Any repaired heart defect but with residual issues.
Prosthetic joints are NOT required to take antibiotic prophylaxis unless your orthopaedic surgeon specially requests it.
The prophylaxis is usually 2 grams of amoxicillin for those who are not allergic approximately one hour prior to dental surgery. If you miss the dose, you can still take it after the procedure as well but as soon as possible.
When antibiotics are not required after a tooth removal.
Aside from the situations above, most routine dental extractions do not require antibiotics. According to the cochrane study, taking the medication may help prevent infection after an extraction but the possible adverse effects may outweigh the benefits.
As long as the patient is healthy and does not require antibiotic prophylaxis, their immune system should naturally be able to prevent most infections after the procedure. Taking the prescription as a just in case may have unintended consequences such as developing antibiotic resistant strains of bacteria. Taking too many of them can create these super bugs and when you happen to get an infection and you need the antibiotics to work, they won't work. This is currently a big problem in the medical community.
For this reason, even if your tooth has been keeping you up at night but as long as you do not present with a swelling infection, you would not require to take any afterwards. We know that you may perceive it as very serious but developing a resistant strain of bacteria is even more serious.
Your oral health and your oral health are the most important thing to our office. Our long island city dentists will evaluate your condition and take into account all of your risk factors before prescribing you anything.