Does the Standard of Care in Georgia Require Pre-Procedure Antibiotics For Certain Dental Patients

As a recent dental article notes, antibiotics are frequently used in dental practice. To be sure, this is a broad statement and, as we all know, the devil is in the details. While the standard of care in dentistry certainly does not require the administration of antibiotics before and after every dental procedure, it does require this for certain patients who suffer from serious medical and dental conditions who are undergoing certain procedures. In other words, whether it is dental malpractice to not prescribe antibiotics when a dental procedure is performed is very fact-specific and is decided on a case-by-case basis.

The largest segment of dental patients that may require increased use of antibiotics is: immune compromised patients who have an active infection and/or who are undergoing an invasive dental procedure such as deep scaling, extraction, root canal, bone graft or placement of a dental implant. Strong consideration for prophylaxis antibiotics in these patients who are undergoing these procedures is required because, due to their compromised immune system, they are susceptible to infection and, once the infection is present, this could lead to serious infection and hospitalization.

According to the American Dental Association, prophylactic administration of antibiotics is not needed as much as previously thought. The following people should be screened more closely before dental procedures and may require pre-procedure antibiotics prior to have dental procedures performed such as extraction, deep scaling, and implants installed.

• In patients with prosthetic joint implants, “In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection.”
• For patients with a history of complications associated with their joint replacement surgery who are undergoing dental procedures that include gingival manipulation or mucosal incision, prophylactic antibiotics should only be considered after consultation with the patient and orthopedic surgeon; in cases where antibiotics are deemed necessary, it is most appropriate that the orthopedic surgeon recommend the appropriate antibiotic regimen and, when reasonable, write the prescription.
• For infective endocarditis prophylaxis patients, pre-medication may be indicated for a smaller group of these patients than previous thought. This change was based on a review of scientific evidence, which showed that the risk of adverse reactions to antibiotics generally outweigh the benefits of prophylaxis for many patients who would have been considered eligible for prophylaxis in previous versions of the guidelines. 
• Infective endocarditis prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. For patients with these underlying cardiac conditions, prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa.

As I stated earlier, every case is different and the facts of each case will determine who to prescribe and not prescribe antibiotics to before or after a dental procedure.

Attorney Robert J. Fleming has been handling personal injury cases, dental malpractice and medical malpractice lawsuits for individuals and families who have been harmed, injured or died as a result of the carelessness or negligence of another for more than 20 years in and around Atlanta, Georgia and its surrounding areas, including Alpharetta, Austell, Avondale Estates, Chamblee, College Park, Conyers, Duluth, Decatur, Doraville, Hapeville, Johns Creek, Jonesboro, Lawrenceville, Norcross, Peachtree City, Riverdale, Roswell, Sandy Springs, Stone Mountain, and Smyrna. If you have been seriously injured and would like quality legal representation, contact Robert J. Fleming directly on (404) 525-5150 or contact us online.