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Antibiotic Premedication: When Your Dentist and Doctor Disagree

Many people need to take antibiotics before certain dental procedures.  To learn why, you can read my previous post about when you need to take antibiotics before dental work.  You can also read the general guidelines from the American Heart Association and the American Association of Orthopaedic Surgeons regarding antibiotic premedication before dental work.

Dental Antibiotic PremedicationAlthough there are clear guidelines concerning who needs antibiotics before certain dental procedures, there are certain gray areas that arise.

Patients have come to my dental school and insisted we prescribe antibiotics before we do dental procedures on them simply because they have received them in the past.  When I dig a little deeper, I sometimes find that many of these patients don’t need the antibiotics according to the latest guidelines.

It is more common for patients to request antibiotics when they don’t really need them, however that’s not always the case.  For example, a few weeks ago Diane left a comment on Oral Answers saying that she got in an argument with her dental hygienist because she didn’t want to take the antibiotics and her dental hygienist said she needed them.

When Your Doctor and Dentist Disagree About Antibiotic Premedication Before Dental Work

Suppose for a moment that you had a congenital heart defect that was completely repaired when you were a child.  You didn’t have anything artificial implanted in your heart, and you healed well and haven’t had any problems since.  Let’s say that your doctor has made it very clear to you that you need to take antibiotics before getting any dental work done.  You then go to your dentist and then your dentist tells you that according to the latest guidelines, you don’t need antibiotics before getting dental work done.

Not only does this leave you confused, but you wonder who is right.  Do you follow the advice of your physician and demand that your dentist prescribe you antibiotics, or do you simply decide that the dentist must know what he’s talking about?

Dr. Michael A. Siegel, a dentist and professor at Nova Southestern University’s Dental School said the following regarding this dilemma in an editorial in the Journal of the American Dental Association:

Certainly, this is a “no-win” situation for the dentist. On the one hand, the dentist is held professionally and legallyaccountable for his or her treatment decisions. On the other hand, the dentist does not want to be placed in an adversarial relationship with the patient’s physician. Unfortunately, this also becomes a problem for the patient, because he or she is potentially placed in a situation of choosing between the advice of dentist and of physician.

Dr. Siegel goes on to state that in these situations, he simply talks with the patient’s physician and discusses the issue, reiterating that the current guidelines don’t require antibiotic premedication.  In the end, if the physician still insists that the patient receive antibiotics before getting dental work done, then Dr. Siegel says that the physician should be the one writing the prescription for antibiotics, not the dentist.


In conclusion, it can be confusing when your doctor and dentist disagree regarding whether or not you should be getting antibiotics before dental work.  You can take comfort in knowing that both the dentist and the doctor are probably doing what they feel is best for you and just want you to be healthy.

The best thing you can do in these situations is do the research yourself by reading the general guidelines from the American Heart Association and the American Association of Orthopaedic Surgeons that discuss whether or not you really need antibiotics before certain dental procedures.

Do you have any questions, comments, or concerns about antibiotic premedication before dental work?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!




  1. When I worked in private practice as an assistant, this argument happened a lot, especially right after the guidelines changed. It always killed me that a patient would argue about this, but then refuse to take the BP meds!

  2. I have been a dental hygienist for 31 years. The patient needs to be informed about the information from the dentist and the doctor. Through the years of treating patients there have been what I refer to as “gray areas” between the dentist and the patient’s doctor. When that ocurred, the patient’s doctor made the final decision about pre medication. Last year, I had knee replacement and my Orthopaedic Surgeon recommends pre-medication for me and I prefer to pre medicate since I am very aware of the risks.Prehaps, if Lewis Grizzard had known his dental risks with having heart valve replacement, he might be with us today.

  3. I have titanium screws in my skull. I had an 8 hour brain surgery in 2010. My neurologist told me I would need a pre-med before dental cleaning appointments. Last time I went to dentist she said I needed to contact my old neurosurgeon to ask if I should continue with pre-meds due to guideline changes.
    Trying to get past the office robot at the neurologist office to ask that question was fruitless. Nothing in the list of options to click on addressed my question nor could I get past the robot.
    Do you have any answer.
    Cindy Dunham

  4. My husband has had bilateral hip replacement and has CLL and has been premedicating prior to dental treatment but now his dentist says it’s not necessary. We’re aware of the position of the AHA and the AAOS for most patients post joint replacement but there seems to be a gray area concerning immunocompromised patients. What are your thoughts on this?


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