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Antibiotic Prophylaxis in Dentistry: Heart Patients, Joint Replacements & Allergies | Dr. Tom Viola
Description
Which patients still need antibiotic prophylaxis before dental treatment, and what do you prescribe when they're allergic to penicillin? Pharmacist and educator Dr. Tom Viola walks through the evidence behind the American Heart Association's updated guidance, why clindamycin was dropped, and what to do when a patient or their surgeon insists on antibiotics anyway.
In this episode:
- The Thornhill studies: the first strong evidence that prophylaxis prevents infective endocarditis
- Which heart patients still need it (and why mitral valve prolapse no longer counts)
- Why clindamycin was removed, and the trade-offs of cephalexin, doxycycline and azithromycin
- Why you shouldn't swap in antibiotics the guidelines don't list
- Prosthetic joints: what the ADA and orthopedic surgeons actually say
- "Do you want to die on that hill?" When patients insist on antibiotics
- What counts as an "invasive" dental procedure
- Using clindamycin safely for infections, with follow-up and probiotics
Guidance discussed as of 2023. Check the current AHA and ADA recommendations before changing your protocol.
📰 Plus dental news: the states with the most stained (and whitest) teeth, CBCT vs. ultrasound for measuring bone loss in orthodontic patients, and the pandemic preparedness bill returns.
Dr. Tom Viola is a board-certified pharmacist, educator and speaker with 30 years of experience. He founded Pharmacology Declassified, has lectured in all 50 states and consults for the ADA's Council on Scientific Affairs.
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