Beautiful Smiles        Microscopically Assisted Dentistry        Gentle Dentistry

 

 Gregory C. Dilger D.D.S.           General Dentist            1353 Edgewater St.          West Salem          (503) 378-0466   

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Premed Guidelines

 

Pre-medication Regimens for a dental procedure (Heart):

 

SITUATION                                            

· AGENT                                              

(REGIMEN: SINGLE DOSE 30-60 MINUTES BEFORE PROCEDURE)                                                                          

· Adults                                    

· Children

 

Oral                                                        

· Amoxicillin                         

· 2 grams                             

· 50 milligrams per kilogram

 

Unable to Take Oral Medication                       

· Ampicillin                           

· 2 g IM* or IV       

· 50 mg/kg IM or IV                                               

OR                                                          

· Cefazolin or ceftriaxone                   

· 1 g IM or IV        

· 50 mg/kg IM or IV

                                                               

 

Allergic to Penicillins or Ampicillin Oral                                                        

· Cephalexin                        

· 2 g                     

· 50 mg/kg

OR                                          

· Clindamycin                       

· 600 mg                              

· 20 mg/kg

OR

· Azithromycin or clarithromycin         

· 500 mg                              

· 15 mg/kg                                                            

                                                                                               

Allergic to Penicillins or Ampicillin and Unable to Take Oral Medication                               

Cefazolin or ceftriaxone                   

· 1 g IM or IV        

· 50 mg/kg IM or IV

OR                                                          

· Clindamycin                                                                                                                       

· 600 mg IM or IV 

· 20 mg/kg IM or IV

 

ANTIBIOTIC PROPHYLAXIS FOR DENTAL PATIENTS WITH

TOTAL JOINT REPLACEMENTS

 

Note:  There currently does not exist a standard for premedicating patients with total joint replacements, i.e. knee and/or hip. Most infection experts now agree that joints should not be premedicated.  We will always check with your physician for their guidelines.   

 

TABLE 1. PATIENTS AT POTENTIAL INCREASED RISK OF HEMATOGENOUS TOTAL JOINT INFECTION*

  

Immunocompromised/Immunosuppressed Patients

·   Inflammatory arthropathies such as rheumatoid arthritis, systemic lupus erythematosus

·   Drug- or radiation-induced immunosuppression

 

Patients with Comorbidities†

·   Previous prosthetic joint infections

·   Malnourishment

·   Hemophilia

·   HIV infection

·   Insulin-dependent (Type I) diabetes

·   Malignancy

 

 

TABLE 2. INCIDENCE STRATIFICATION OF BACTEREMIC DENTAL PROCEDURES*

 

HIGHER INCIDENCE

·   Dental extractions

·   Periodontal procedures including surgery, subgingival placement of antibiotic fibers/strips, scaling and root planing, probing, recall maintenance

·   Dental implant placement and replantation of avulsed teeth

·   Endodontic (root canal) instrumentation or surgery only beyond the apex

·   Initial placement of orthodontic bands but not brackets

·   Intraligamentary and intraosseous local anesthetic injections

·   Prophylactic cleaning of teeth or implants where bleeding is anticipated

 

LOWER INCIDENCE

·   Restorative dentistry (operative and prosthodontic) with or without retraction cord**

·   Local anesthetic injections (non intraligamentary and non intraosseous)

·   Intracanal endodontic treatment; post placement and buildup

·   Placement of rubber dam

·   Postoperative suture removal

·   Placement of removable prosthodontic/orthodontic appliances

·   Taking of oral impressions

·   Fluoride treatments

·   Taking of oral radiographs

·   Orthodontic appliance adjustment

 

TABLE 3. SUGGESTED ANTIBIOTIC PROPHYLAXIS REGIMENS*

Patients not allergic to penicillin:
  • Cephalexin, cephradine or amoxicillin 2 grams orally 1 hour prior to the dental procedure

 

Patients not allergic to penicillin and unable to take oral medications:

  • Cefazolin 1 g or ampicillin 2 g intramuscularly or intravenously 1 hour prior to the dental procedure

 

Patients allergic to penicillin:

  • Clindamycin 600 mg orally 1 hour prior to the dental procedure

 

Patients allergic to penicillin and unable to take oral medications:

  • Clindamycin 600 mg IV 1 hour prior to the dental procedure

*No second doses are recommended for any of these dosing regimens.

 

by Dr. Gregory c. Dilger - July 30, 2009
Upddated September 20, 2011

Updated July 29, 2014
Back to Oral Health directory

 

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Patient Testamonials

 

Dear Dr. Dilger:

 

It all started with my initial phone call to Dr. Dilger's office. I felt so comfortable from the start and after I came in for my first visit it's been all about what I want and what Dr. Dilger and his staff recommends for me. All around, it's been the best dental experience I've ever had.

 

Al P.

 

 

 

Going to the dentist used to be a nightmare experience for me. That's all changed when I came to Dr. Dilger. Dr. Dilger's office staff are so warm and welcoming. Visiting them is like going home. Dr. Dilger's calm and caring manner erased all my dental anxiety and for the first time in my life I found myself relaxed in a dental chair. Dr. Dilger and his staff really took the time to get to know me and my concerns. They talked with me about my fears and helped me address my anxiety. Now I visit the dentist and I'm not afraid. I can not express the difference Dr. Dilger has made in my dental life! Thanks so much Dr. D.

 

Molly F.

 

 

 

I love my new smile.  It was so easy too.  Nearly pain free.  I am considering my lower teeth at a later date.

 

Debbie E.