Why You Might Need to Premedicate With Antibiotics Before You See Your...

Why You Might Need to Premedicate With Antibiotics Before You See Your Dentist

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Premedicate with Antibiotics Before Dental Cleaning
©Radu Razvan/Shutterstock.com

During my first few weeks as a student-dentist in the clinic at dental school, I had a new patient assigned to me.  She arrived late, and we were both in a hurry to get the oral examination and treatment planning finished so we could start working on her teeth.

Antibiotic Prophylaxis or Premedication For Dental TreatmentWithout going into too much detail, she had a history of heart problems as a child.  After mentally running through the guidelines for determining which patients need antibiotics, I didn’t think she needed to be premedicated.  I went ahead and did a screening procedure to check the health of her gums which made her bleed slightly.  When the dentist in charge came to review what I had done, he told me that this patient should have been premedicated with antibiotics for the procedure.  He had me immediately go over to the appropriate department and get 2 grams of amoxicillin for my patient.

I explained everything to the patient and she was very understandable.  However, with her particular condition, I still didn’t think she needed to take the antibiotics.   But I did what my professor told me to do.

At the end of the appointment, I told my professor that I felt like an idiot.

He replied, “You should.”  Then he told me that it wasn’t a big deal because her condition wasn’t too risky, and since we got her the antibiotics within two hours of the procedure, no harm was done.

As it turns out, my patient did not need the antibiotics that we gave her (according to the 2007 American Heart Association guidelines).  However, she would have needed them according to the old guidelines, which is probably what my professor had memorized.

All in all, it ended up being a good learning experience for me.  I learned to double-check with my dental professors about pre-medication before doing gingival/gum screenings.  I also learned the importance of not rushing, even if a patient is in a hurry.   As a health professional, I am responsible for ensuring that things are done properly so that the patient receives proper treatment..

After thoroughly researching this subject, I decided to share my findings about antibiotic pre-medication.  This is often called antibiotic prophylaxis; prophylaxis is defined as protective or preventive treatment.

Why Do Some Dental Patients Need Antibiotic Prophylaxis?

Simulated Bacteria That Can Travel from Mouth to Heart

We have billions of bacteria living on and inside our body.  However, our blood is usually kept free of bacteria as a result of our hard-working immune system.  If bacteria enters our bloodstream, it is known as a bacteremia.

When a dentist extracts a decayed tooth that is infected with millions of bacteria, some of those bacteria could enter the bloodstream.

So, let’s say that a patient needs a tooth extracted and he just had a plastic heart valve inserted into his heart.  The bacteria in that patient’s mouth have the ability to attach to the plastic heart valve in that person’s heart.  This could lead to a very serious condition known as infective endocarditis.

After seeing the patient I mentioned above, I went online to research which exact conditions require premedication.  I have summarized the information I gathered below.

6 Conditions For Which Antibiotic Pre-Medication Might Be Necessary

The heading to this section says “might be necessary” because the necessity for antibiotic pre-medication depends on which procedure is being performed.  In the next section, you’ll find a list of the dental procedures that do not require an antibiotic prophylaxis before visiting your dentist.

Heart Conditions

Antibiotics Can Save Your Heart from an Infection1 – Prosthetic Cardiac valve or prosthetic material used for cardiac valve repair.

2 – Previous case of infective endocarditis.

3 – If the patient has had congenital heart disease AND any of the following apply:

  • The patient has unrepaired cyanotic congenital heart disease, including palliative shunts and conduits.
  • The patient has a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during hte first six months after the procedure. Prophylaxis is reasonable because endothelialization of prosthetic material occurs within six months after the procedure.
  • Repaired congenital heart disease  with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization).

4 – Cardiac transplantation recepients who develop cardiac valvulopathy.

Those are the only heart conditions that require antibiotic premedication.  For your information, endothelialization refers to the tissue layer of the heart growing over the prosthetic material that was implanted.  The bacteria are easily able to colonize a prosthetic device in the heart.  Once the natural heart tissue grows back, there is no need to premedicate.

Prosthetic Joint Conditions

5 – Prosthetic Joints

Patients with prosthetic joints are at an increased risk of developing an infection.  If you have an artificial joint and it becomes infected with bacteria, it is very difficult for your body to fight off that infection due to a lack of blood vessels supplying the artificial joint.

The American Academy of Orthopaedic Surgeons recommends that “all patients with prosthetic joint replacement” receive antibiotic prophylaxis before an invasive dental procedure.

However, only patients with total joint replacements need to be premedicated.  “Patients with pins, plates and screws, or other orthopaedic hardware that is not within a synovial joint are not at increased risk for hematogenous seeding by microorganisms.” (Source, AAOS)

Note that these guidelines regarding total joint replacement will probably change within the next one to two years.  The American Dental Association has stated the following:

In collaboration with the ADA, the AAOS has assembled a work group to develop evidence-based clinical guidelines on the topic of antibiotic prophylaxis for patients with total joint replacements undergoing dental procedures. It is possible that the recommendations will change following an evidence-based review of this topic beginning in 2010 and extending through 2011. Therefore, you are encouraged to check the ADA Web site for the most current information.

I would expect that the guidelines will be more relaxed when it comes to premedicating those with total joint replacements.  In the past, dentists only premedicated for total joint replacements if it had been replaced within the last few years.

Immune Conditions

6 – Compromised Immunity.  If you have a compromised immune system, it may be harder for your body to fight off bacteremia caused by a dental procedure.  I made the following list of conditions that may qualify for antibiotic premedication before an invasive dental procedure from three papers: a paper by the American Academy of Pediatric Dentistry entitled, Guideline on antibiotic prophylaxis for dental patients at risk for infection; Antibiotic prophylaxis in dentistry: an update from the Academy of General Dentistry; and Antibiotic Prophylaxis for Bacteremia in Patients with Joint Replacements published by the American Academy of Orthopaedic Surgeons.

  • Human Immunodeficiency Virus (HIV)
  • Severe Combined Immunodeficiency (SCIDS)
  • Neutropenia
  • Immunosuppression (Drug-induced, radiation-induced, or any other type)
  • Sickle Cell Anemia
  • Within six months of a splenectomy (more studies needed)
  • Chronic Steroid Usage
  • Lupus Erythematosus or Rheumatoid Arthritis
  • Sickle Cell Anemia
  • Poorly-controlled Type I Diabetes
  • After an Organ Transplant if organ is being rejected, functioning poorly, or there is abnormally high immunosuppression.

You may not necessarily need an antibiotic premedication if you have any of the above conditions.  Your dentist and primary care physician (PCP) are qualified to understand your unique situation and determine whether or not you need to be premedicated with antibiotics before invasive dental procedures.

Antibiotic Premedication Is Only Necessary for Certain Dental Procedures

Do you need to premedicate before going to the dentist?If you have a condition above that requires antibiotic prophylactic premedication, you don’t necessarily need to take antibiotics before going to the dentist.  It all depends on what procedure you are having done at the dental office.

You only need to take an antibiotic premedication if the dentist will be doing a procedure that involves “manipulation of the gingival tissue or the periapical region of teeth or perforation of the oral mucosa.” (AHA guidelines)  The American Academy of Orthopaedic Surgeons came out with a more specific list in their guidelines from 2003, but did not include it in their most recent update.

Here’s the list from the American Academy of Orthopaedic Surgeons of dental procedures where antibiotic premedication is required:

  • Dental extractions (removing a tooth or teeth)
  • Periodontal procedures including:
    • Periodontal surgery (gum surgery)
    • Subgingival (below the gumline) placement of antibiotic fibers/strips
    • Scaling and root planing (a deep cleaning of the root surface of the teeth)
    • Periodontal probing (measuring the pocket between your tooth and gums)
    • Periodontal recall maintenance (a thorough examination of the gums with the possibility of additional cleaning needed)
  • Placement of dental implants
  • Endodontic instrumentation (root canal) or surgery that goes beyond the apex (end of the tooth root)
  • Initial placement of orthodontic bands (but not brackets – see below on list of procedures not requiring antibiotic premedication)
  • Intraligamentary (in the ligament) and intraosseous (in the bone) local anesthetic injections (but not routine anesthetic injections – see below)
  • Dental cleaning of teeth or implants where bleeding is anticipated.

Here’s a list from the Amerian Heart Association of dental procedures that do NOT require antibiotic premedication:

  • Routine anesthetic injections through non-infected tissue (routine “numbing” done before a procedure)
  • Taking dental X-Rays
  • Placement of removable prosthodontic appliances (dentures, removable partial dentures, etc.)
  • Placement of removable orthodontic appliances (retainers, etc.)
  • Adjustment of orthodontic appliances (tightening braces, adjusting palatal expanders, etc.)
  • Placement of orthodontic brackets (for braces)
  • Loss of a baby tooth
  • Bleeding from trauma to the lips or oral mucosa (mucosa is the lining of the mouth, such as the inside of the lips, cheeks, etc.)

What Antibiotic Will My Dentist Prescribe for Premedication?

Antibiotics for Dental Pre-MedicationThe current guidelines state that a single dose of antibiotics should be given 30 to 60 minutes before the dentist performs the procedure.

If you can take pills, then the dentist will prescribe 2 grams of amoxicillin for adults or for children 50 mg/kg, not to exceed 2 grams.

If you’re allergic to the penicillin family of medications, then the dentist can prescribe any of the following antibiotics:

  • Cephalexin – 2 grams for adults or 50mg/kg in kids.
    • Or another first or second-generation oral cephalosprin in equivalent adult or child dosage (i.e. – Cephradine.)
  • Clindamycin – 600 mg for adults or 20mg/kg in children.
  • Azithromycin – 500 mg for adults or 15 mg/kg in children.
  • Clarithromycin – 500 mg for adults or 15 mg/kg in children.

If You Can’t Take Pills

If you have difficulty swallowing pills, your dentist will provide the antibiotic through an IV or an injection.  There are many antibiotics available for this purpose, such as ampicillin, cefazolin, ceftriaxone, cefazolin, and clindamycin.

Conclusion

Do you have any questions on antibiotic premedication and dentistry?  Please leave them below in the comments!

I do plan on adding a follow-up article regarding the effectiveness of antibiotic premedication in the prevention of bacteremias and infections.  I’ll put a link here when I get it written.  Thanks for reading!

References and Extras

Antibiotic Prophylaxis in Dentistry: An Update from the Academy of General Dentistry

A printable, informative wallet card from the American Heart Association regarding antibiotic premedication (PDF file)

Antibiotic prophylaxis information from the American Dental Association

Reprinted American Heart Association information on antibiotic prophylaxis courtesy of the American Dental Association

Official guidelines on Antibiotic Prophylaxis for complete joint replacement from the American Academy of Orthopaedic Surgeons

28 COMMENTS

  1. I had a heart attack followed by a stent placement back in August 2009 and was wondering if I needed to premedicate to have a routine cleaning done? I realize that for extractions and implants (coming soon) it will require me to be medicated. Will having my spleen removed have any effect on having implants placed around the same time?

    • Hi Mark – I can’t give you specifics on your exact situation, but I can give you some general ideas about premedication in patients with similar situations as yours.

      The latest American Heart Association guidelines don’t mention anything about stent placement and the need for premedication. Premedication is usually reserved for more invasive procedures done on the inside of your heart, such as heart valve replacement. However, many dentists are overly cautious about premedication and might prescribe antibiotics for you to take.

      Even if you’d have had a prosthetic valve replacement, you wouldn’t need to be premedicated for a routine cleaning unless your dentist anticipated bleeding (for example, if you have gingivitis, or unhealthy gums that would bleed easily. If they bleed when you floss, you’d probably need the premedication.)

      As for the spleen removal (splenectomy), the following is from an article in the Journal of the American Dental Association that deals with premedication and splenectomy:

      “There is also no evidence that patients who have undergone splenectomy are at higher risk of developing infection from dental procedures than is the general population. These patients are, however, more susceptible to infections from encapsulated organisms such as Pneumococcus and Hemophilus type B species; physicians often recommend the use of antibiotic prophylaxis for invasive dental procedures in such cases.”

      My guess is that it wouldn’t hurt to have premedication with implant placement following a spleenctomy. It might give the implants a better chance at integrating successfully with your bone, but to be honest, I’m not positive. Your dentist would be much more qualified to discuss this with you as he or she has your full health history.

      I hope that helps – If you have any other questions, or if I wasn’t very clear, just let me know. Thanks for your question!

  2. hai..i want ask you,children have congenital heart disease compulsory take what drugs before remove the dental?tQ:)

    • Hi Intan – The American Heart Association recommends Amoxicillin, Clindamycin, Azithromycin, or Clarithromycin. Whether or not antibiotic prophylaxis is necessary depends on the individual patient and what type of congenital heart defect they have.

      I hope that helps. Thanks for your comment!

  3. Tom, should I pre-medicate if I have had breast implants for the last ten years? I’ve had no other health issues. My dentist has never said anything except to my husband, who had his left hip shaved. The dentist made him pre-medicate.

    • Hi Pat – Thanks for the question – I’ve been researching a lot about antibiotic dental premedication lately. Here’s your answer:

      There is actually only one reported case of a breast implant infection that was possibly caused by dental work. It occurred in a young, healthy woman who had silicone breast implants for three years before going to the dentist for multiple visits over an eight month period. Her right breast felt tender and swollen a few days after her last dental visit. Her breast implant needed to be removed and she received antibiotics.

      Later, in order to confirm that it the infection had originated from bacteria in her mouth, researchers tried to grow the organism from samples from the woman’s mouth and upper throat. They couldn’t grow that exact organism, which leaves us wondering whether or not the dental work was to blame…

      Because of the miniscule chances of getting a breast implant infection from dental work, I would lean towards NOT prescribing antibiotics before dental work for the sole purpose of preventing a breast implant infection.

      The California Dental Association published an article about different scenarios for pre-medicating patients. Here’s their main point about breast implants (I added the bold):

      “Bacteremic breast implant infections are truly rare. The fact that only one case of possible oral organism-related breast implant infection has been reported among the hundreds of thousands of breast implant patients lends credence to that assertion. If bacteremia truly put breast implants at risk of infection, then any woman immunosuppressed by virtue of drug therapy or disease would be an easy target for oral organisms. Hundreds of breast cancer survivors with breast reconstruction implants would presumably be at substantial risk, but no case reports confirm this. Despite the apparently negligible risk, some authors continue to recommend antibiotic prophylaxis prior to invasive dental procedures. The prudent dentist should always weigh the risk of prophylactic antibiotic therapy against the potential benefit in a particular group of patients. For the hundreds of thousands of women with breast implants, the decision not to prescribe prophylaxis is clearly justified. If the patient’s plastic surgeon is adamant about the necessity of antibiotic prophylaxis, then that physician should write the prescription.”

      I hope that helps, Pat. Thanks for your comment!

  4. Tom,

    I am in school for Dental Hygiene and this was very helpful! We are instructed to always premedicate in our clinic when in doubt because we don’t want to be in a situation where we should have. I agree that there was not really a necessity for premedicating but better to be safe!! Love the website!

    Britt

  5. I have a knee replacement and pre med before all dental cleanings. My question is this. I was told I needed deep cleaning and that I would require the application of a local antiobitic directly on teeth, as it was a different bacteria from which I had pre medicated for. Is this true or as I suspect a way to get more money other than what insurance pays for. One quadrant was going to cost out of pocket 380.00 dollars and most of the expense was for local antibiotics. thanks for your comment reqarding this.

    • Hi Gayle – Premedicating with antibiotics can help prevent your knee from getting infected. Some dentists do apply antibiotics to the gums when performing a deep cleaning. At my dental school, we simply do the deep cleaning. We may prescribe an antibiotic mouth rinse, but we don’t normally apply antibiotics directly to the gums.

      If you are uncomfortable with it, it’s a good idea to talk with your dentist to find out what would happen if they skipped the local antibiotics.

      • Hello Tom,
        I have been a dental hygienist for a little more than 10 years. In hygiene school we were taught a little bit about local antibiotic use and I suspect that the dental students aren’t really learning much about it at all.

        You seem to have a passion for the dental field and doing the very best for your patients, so I suggest that you do some research on Arestin, Atridox and the Perio chip . All of these locally olaced antibiotic can be used with periodontal treatment. Arestin is my favorite as in it is easy to insert into a periodontally involved pocket at 4 mm and greater.
        I continue to see amazing results with SRP in conjunction with Arestin, proper home care and frequent periodontal maintenance visits.
        P.S. Loved your article on when to have your patients premed.
        Tonya RDH

  6. I am having a abcessed teeth and when the pain developed the dentist has given me amoclan and flagyl and the pain went the third day of medication. Then i was adviced to extraxt the abcessed teeth, meanwhile I developed flu like symptoms, sorethroat and chest congesion. I took augmentin as prescibed by a general physician. During this period another tooth which had a cavity( which the dentist adviced for a rootcanal later on) started paining and a swelling with little puss is coming. The dentist is advising now to remove this teeth first and has asked me to premedicate with Roxil 500 anf Flagyl. Please advice whether I am going in the right direction of treatment. My cough and sore throat has not subsided yet, yellow phlem is coming when i spit.

    Please also advice how many days before the extraction should I start taking antibiotics (roxil 500)

  7. Hi Tom,

    Thanks for the website! I had a tooth extracted at a university faculty clinic in preparation for an implant, and wasn’t given antibiotics. I’d told them of my long history of lymphoma and treatment (including radiation and chemo). After four days I was still in a lot of pain, so called the dentist, who said I must be a slow healer. By the next day it was much worse and she FINALLY prescribed amoxicillin. When I returned for follow-up in a week, the faculty advisor read her out for failing to give someone with my health history antibiotics to begin with. Yesterday I went for the appointment to start the implant, and the same faculty person said I might now need a bone graft, since the infection may have damaged the bone. Is this really a possible outcome of an infection? Also, I was willing to let the four days of pain slide, but object to having to pay for a bone graft in addition because they screwed up. Thanks for any perspective you can give me.

  8. Hi Tom,

    Was researching the thoughts and recommendations of pre medicating a type 2 diabetic prior to a wisdom tooth extraction. I would be interested to hear your opinion on this.

    My boyfriend is type 2 diabetic, which is not well controlled at the moment due to lifestyle factors. He attended the dentist on Monday 25/06/2012 for removal of upper left wisdom tooth. His dentist had recommended the removal as it been giving him some pain and had been treated with a course of metronidiazole 200mg.

    He was not given any preventative antibiotic cover and is now in hospital suffering major infection. Could this have been prevented if he had of taken antibiotics. I am very angry about the fact that I didn’t realise diabetics immune systems were compromised and I feel he should of been given greater care and advice.

    I would appreciate any thoughts you have on this

    Thanks

    Sarah

  9. Hi Tom,
    I am 56 and have high blood pressure. I have to have periodontal work done for moderate gume disease, which include planing and scaling as well as opening up the gum to kill infection. My brother told me that he had work done, and he believes that bacteria got into his bloodstream and went to his heart, causing a heart attack. he was 54 then. He told me that his doctor said that he should have been given an antibiotic up to 3 days before periodontal work was done. Do you think that I should have antibiotics up to 3 days before my periodontal work?

  10. I am 50 and broke both bones on my left ankle about 1 1/2 yrs. ago. I have a plate and 7 pins on one side of my ankle and two large screws on the other side of the same ankle. I have my teeth cleaned every 3 months due to some periodontal tendencies. My orthopedic doctor’s office has given conflicting answers on whether I need to premedicate or not. I needed to have a blood transfusion a little over 2 yrs. ago, and had two pulmonary embolisms about 6 yrs ago which left my lungs compromised so I have asthma now and need to watch out that I’m not around anyone w/ pneumonia. I’ve been taking antifungal medicine for about 2 months now for some gross toenails that I’ve had for a long time.
    I have premedicated for cleanings and just 5 days ago didn’t because my orthopedic doctor’s offices’ people have said it’s not necessary. I’ve heard both answers. What do you think? What should I do for the future?
    How would I know if I’m having a problem w/ this issue? Will my ankle be more sore? What symptoms will clue that some bacteria has gotten into my bloodstream? In 5 more days, my dentist will be looking at removing a crown or filling a dark spot under an old crown but he won’t know what it needs until he looks at it. Would you premedicate for this? Or just for my cleanings, they do periodontal probing and check the size of the pockets,and scale my teeth and there is some blood. Should I take it just to be safe /or for peace of mind? All of the sudden I’m very worried about this. Sorry to give you all of my health history, but I don’t know if some parts are important to your response. Thanks so much.

  11. What a great blog….perhaps you could advise if a “post” antibiotic rinse is necessary after routine periodontal
    scaling… thanks
    l

  12. Hi Tom,
    My daughter has a Vagal Nerve Stimulator (VNS) for assisting in controlling her epilepsy. Her pediatric neurologist had one case of a child getting an infection in the VNS after dental work and recommended that she take a pre-med. I was fine with this, but recently, my mom got C-diff from taking antibiotics (amoxacillin). Do I need to think about the risks of this high dose of antibiotics, or should we just continue to do the premed prior to dental work. Her current neurologist does not think it is necessary, but was ok with continuing to prescrib the amoxacillin. What are your thoughts?
    Thanks,
    Jane

    • Hi Jane – You do always need to think about the risks of antibiotics along with the risks of a possible infection in her VNS.

      In dental school a couple of years ago, we were told to always give antibiotics to patients with joint replacements. However, recently, the AAOS and the ADA stated that there isn’t any conclusive evidence linking dental work with the risk of infection to an artificial joint in patients that have had joint replacements. Here’s a copy of the news release and a copy of their findings (PDF).

      I tell that story to illustrate that the evidence is inconclusive about things as common as joint replacements. In your daughter’s case, there probably aren’t many (if any) studies looking at the risk of infection to VNS’s after dental work. The best decision of how to proceed should be made with careful consultation of both your daughter’s dentist and the treating neurologist.

      I hope that helps, Jane. Thanks for your comment!

  13. I just want clarification that I understood it correctly. Is antibiotic premedication required before periodontal scaling and root planing procedure if a patient has low platelet count?
    Thanks,
    Mario

  14. My mother-inlaw had total knee replacement over 10 years ago. She is now 83. She is having impressions done for upper dentures. They told her she needed to premed. I don’t understand why. I have been in dentistry for 13 years and I have never heard of this. Is this new?
    Thank you for your help,
    Dee

  15. i went in for a simply cleaning. i have 13 pins and a steel plate in my foot from 1.2 years ago. they wouldn’t touch me unless i am on 2000 mg’s of antibiotics. she said this is place for 3 years following my surgery, down from the previous 5 years. is she right or full of it?lol thanks in advance!

  16. Many years ago I had a Harrington rod inserted and have been pre medicating for my dental appointments ever since.
    Now my dentist doesn’t think it necessary and wanted me to find out from orthopedic surgeons if it is still necessary.
    Since I have not received a response from orthopedists I would greatly appreciate any advice you could give me.
    Thanks.
    Myrna

  17. I have atrial fibrilation have no heart disease, Thank GOD. I’m a little anemic but overall healthy. I have gingivitis and my gums bleed a lot. My braces will be removed next month. Do I need to be on antibiotics?
    Please help. Thank you, Monica

    • Hi Monica, Noramlly antibiotics are not needed for atrial fibrillation and/or anemia.

      Even if you did normally need anitbiotics, it is usually not necessary to have antibioitics unless a lot of bleeding is anticipated when the brackets are removed.

      I hope that helps. Have a great day!

  18. Hi I have very low iron (17) and ferritin (2) so I am anemic. I have also had A prothrombin time test where inr and pt come back high, drs don’t know why yet. I’ve had extensive dental work done in the past and the last time I was at a dentist they couldn’t get my gums to stop bleeding, it was a scary and traumatic experience. I now need my wisdoms extracted, a molar extracted and a deep cleaning along with a few fillings. Any advice on any of this on how I should proceed? I’ve been putting it off for a long while as I am afraid of bleeding to death!! Thanks!

  19. Upper left side of my mouth has been hurting really bad. It’s extremely inflamed puffy and bleeding. I went to the dentist today to get scalding and route planning because it’s been hurting me so bad that I have been unable to eat anything but really soft foods that I only chew on the right set my mouth. When I went in there I thought he would give me antibiotics to take, but he didn’t and went to start the procedure. I told him I was not comfortable starting the procedure until I had the antibiotics since I strongly believe I had an infection. He refused to give it to me and I jumped out of my chair and said I’m just not comfortable unless I have antibiotics first. He then ran out of the room mad but came back with the prescription. Today is Thursday morning he said he cannot get in now until Monday morning. The amoxicillin he prescribed is 500 mg the directions on their say to take two capsules immediately and then take one capsule every six hours until finished. There are total of 30 pills. I think from what I’m reading above that this may be too much amoxicillin now. I was wondering what your opinion on this? Is this too much medicine? Also since today is only Thursday and my appointments not till Monday now, should I wait until Sunday to start this medicine? Thank you so much for your help.

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    \outl0\strokewidth0 \strokec2 Upper left side of my mouth has been hurting really bad. It’s extremely inflamed puffy and bleeding. I went to the dentist today to get scalding and route planning because it’s been hurting me so bad that I have been unable to eat anything but really soft foods that I only chew on the right set my mouth. When I went in there I thought he would give me antibiotics to take, but he didn’t and went to start the procedure. I told him I was not comfortable starting the procedure until I had the antibiotics since I strongly believe I had an infection. He refused to give it to me and I jumped out of my chair and said I’m just not comfortable unless I have antibiotics first. He then ran out of the room mad but came back with the prescription. Today is Thursday morning he said he cannot get in now until Monday morning. The amoxicillin he prescribed is 500 mg the directions on their say to take two capsules immediately and then take one capsule every six hours until finished. There are total of 30 pills. I think from what I’m reading above that this may be too much amoxicillin now. I was wondering what your opinion on this? Is this too much medicine? Also since today is only Thursday and my appointments not till Monday now, should I wait until Sunday to start this medicine? Thank you so much for your help. Just wanted to and do not have anything artificial my body, I have a weird condition in my left Arm where the rash that burns and penetrates into my muscle causing pain the doctors not been able to figure out for couple years.

  21. I am 66 years old, but have no prosthetics or implants, and take no medication at this time. I am having dental implants this Friday. The procedure was scheduled for last Friday, but the dentist did not have all that he needed to perform the placement. He had me start amoxicillin the Thursday before. After I found out the surgery would not happen as planned, I stopped taking the antibiotics. I had only taken two of the pills (500MG each).

    The dentist called me Thursday night and informed me that I needed to continue the medication until this Friday when the surgery will take place. He said the bacteria might mutate if I stopped taking the medication.. I did not resume the medication until Tuesday (yesterday). Is taking antibiotics for this long harmful? I do feel a slight discomfort in my chest area, something like gas or acid, and am trying to eat properly to compensate for all the good bacteria being killed off.

    Betty

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