Surgical Instructions

Medication Precautions

Antibiotic Pre-medication:

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.

People with the following conditions should still receive preventive antibiotics prior to Dental Procedures that involve manipulation of gingival tissue, or the periapical region of teeth, or perforation of the oral mucosa. The new recommendations apply to many dental procedures, including teeth cleaning and extractions.

Conditions:

  1. Artificial Cardiac Valves
  2. Previous Infective Endocarditis
  3. Congenital heart disease (CHD) with the following conditions
  4. Unrepaired cyanotic CHD, including palliative shunts and conduits
  5. Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention; during the first six months after the procedure.
  6. Any repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or a prosthetic devise (which inhibit endothelialization).

If you have the following condition and have taken prophylactic antibiotics routinely in the past; you no longer need them:

  1. Mitral valve prolapse
  2. Rheumatic heart disease
  3. Bicuspid valve disease
  4. Calcified aortic stenosis
  5. Congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

Moreover, prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective endocarditis.

Patients at potential increased risk of Hematogenous Total Joint Infection:

Immunocompromised / Immunosuppressed Patients:

  1. Inflammatory arthropatheis: rheumatoid arthritis, systemic lupus erythemoatosus
  2. Disease, drug, or radiation-induced immunosuppression

Bisphosphonate Precautions:

  1. Alendronate (Fosamax)
  2. Ibandronate (Boniva)
  3. Risedronate (Actonel)
  4. Etidronate (Didronel)
  5. Tiludronate (Skelid)
  6. Pamidronate (Aredia)
  7. Zoledronate (Zometa)

If you are currently taking any of the Bisphosphonate drugs listed above you may be at risk of developing Bisphosphonate-Related Osteonecrosis of the Jaw (BRON). While oral Bisphosphonate are associated with only a small number of Osteonecrosis cases at this time, it appears that the risk of developing BRON may be increases when the duration of therapy exceeds three years, and/or when oral Bisphosphonate are given concomitantly with long-term corticosteroids or chemotherapy, the patient has diabetes, smokes, uses excessive alcohol, or has poor hygiene.

If you are at risk of developing BRON we may ask that you contact your prescribing physician to discuss the possibility of discontinuing use of your Bisphosphonate drug for at least three months prior to oral surgery, and will be asked to not restart the medication until healing has occurred (about three more months).

Birth Control Precautions

If you are currently taking an oral birth control medication such as Yaz, or Orthotrycyclin and are given an antibiotic from our office it may disrupt the effectiveness of your contraceptive. Thus, you must use an alternative form of contraceptive while on your antibiotic.

Anti-coagulant Precautions

If you are currently taking an anti-coagulant medication such as coumadin, we may ask at the time of your consultation to discontinue use for a short period of time prior to your surgery to avoid any bleeding issues. We will have you restart your medication the day after your surgery.  These recommendations would be obtained by discussion with your prescribing physician.  In most cases, however, anti-coagulant medications do not need to be discontinued.  This does need to be determined prior to surgery. 

If you have any questions regarding your medication or pre medication please call our office at 508-699-0449.