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

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.


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



  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!

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  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!


  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



  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

  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?

    • 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?

  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,

  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.

  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.


  22. My dentist has me to premed with amoxicillin just because I had rheumatic fever as a child. Is this necessary?



  25. Would strongly suggest that a hx of Lyme disease (past or present) might also be a reason for prophylactic antibiotics. The spirochetes tend to be in deep tissue and fibroblasts or other intracellular positions and often go into a cell wall deficient state where they can avoid death by antibiotic. Not usually killed by one quick round of treatment due to long reproductive time similar to TB.

  26. I have high blood pressure I’m 30 years old and have a abscessed tooth infection the dentist gave me antibiotic but I’m also taking nedipine for my blood pressure I get scared taking two different medication is it bad to take them both any risk?

    • Kimberley,
      You should be asking your pharmacist this question. The abscessed tooth is a concern because the infection can spread quickly if not treated appropriately. The infection can spread to other parts of your body through tissue planes and blood. Not something to mess with. The increase metabolising of either the antibiotic or the nifedipine can take place. Mostly you could end up with lower blood pressure (feel faint). My guess is you were prescribed amoxicillin, clindamycin or erythromycin for the antibiotic.

  27. Hi there, last year I had a dbl mastectomy with reconstruction using implants. 5 days ago I had a root canal. I mentioned that I was concerned about infection due to the implants as I had heard something about this. I was reassured that this should not be a problem as it’s not in a zone with much direct blood supply. Is this so or should I be concerned? Also if I was to get an infection would it have occurred already? Might I add that I was so concerned about it that I nearly opted to have the tooth extracted!

  28. I had #5 & # 12 extracted, then bone grafting, for the placement of (2) dental implants, 3 months later.
    I NEVER was prescribed antibiotics, during the extractions, or the bone grafting.
    Only when the anesthesiologist came in for IV sedation, when he was putting the implants in, was I prescribed antibiotics.
    I then reported to him, that I was vomiting on the amoxicillan, so he just told me to stop taking it.
    He never prescribed anti-nausea medication, or, try another antibiotic.
    Now, I have (2) failed BONE GRAFTS, in a row, because even the second time around, he FAILED to prescribe antibiotics before or after the actual GRAFTING procedure.
    Since the grafting was infected, how could he not think, to prescribe PRIOR to the scraping of the infected grafting, and adding the new? By “prior”, I mean (3) days before scraping and adding.
    I was told by another surgeon, that prescribing antibiotics “days” before, means there will be antibiotic in the blood clot, reducing the risk even more.
    The anesthesiologist was also trying to tell him, that, “she is a chronic pain patient, and she needs to be medicated more aggressively, following the procedure.”
    He handed me an ice pack, and a 3 oz bottle of Listerine.
    The temple & facial pain was incredible, and my right eye teared constantly.
    During the removal of grafting and the new implant, he only used novacaine, NO IV sedation, because it was “on him”.
    Now, #12 bone grafting has failed as well, so I am going to be left with both sides, having no tooth at all!
    Going on three years of pain and suffering, huge hit to the bank account, and I paid $3750.00, on (2) crowns, that are going into the trash.
    I am given no reassurance that he is going to make this right.
    He told me he should have done a sinus lift, to begin with on the side with “less bone”.
    Another dentist used the word “infection” to describe the “bone loss”.
    At this moment, I am walking around with (2) bone graft infections, and still no antibiotic or concern.
    He said to come back in a month, for another x-ray to see if the “bone loss” (INFECTION) has gotten worse or stayed the same.
    I always have an earache, that does not appear “red”, when viewed through the outer ear canal.
    An ENT told me, it is from the infected grafting.

  29. Hi, I am writing to ask about the need for antibiotics prior to dental work and/or dental cleaning.
    I had an anterior communicating artery clipped in my brain, with a titanium clip and I have some screws in my left temple area because they had to remove a portion of my skull to access the aneurysm.
    I have heard conflicting views on whether or not antibiotics should be given for this reason prior to dental work or dental cleaning.
    Additionally, I have had allergic or adverse reactions to quite a few antibiotics. I usually take Levaquin 500 mg daily when I have need for an antibiotic, and I was recently on both Levaquin and Flagyl when I had my last diverticulitis attack.
    Is an antibiotic required prior to dental work or cleaning for people like me who have clips and screws in there head as result of brain aneurysm surgery? If so, would the antibiotic Levaquin be adequate for use for this purpose, if an antibiotic is needed?
    Sincere thanks,

  30. just wondering if you plan on replying to my question; I could really use some direction about the antibiotic use for dental visits after having a brain aneurysm clipped. I am receiving conflicting views from dentists and physicians. thanks.

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  35. I went to my dentist office for a regular cleaning. The dental hygienist asked me if I had any problems with my teeth. I told her that my lower left rear tooth was a bit sensitive. I finished my cleaning and my dentist wanted x-rays done. I got them done and he noticed that I had a tooth infection and he prescribed me Amoxicillin 500mg 3 times a day.

    I am currently taking Humira for a immune condition (Ankylosing Spondylitis). Arthritis to be exact. My question is did I get a bacteria infection because I am taking Humira and lowering my resistance to fight infections or is it bad hygiene? Thank you for putting up this informative website.


  36. After being diagnosed with meningioma tumor as well as pseudo tumor cerebri. I had a lumber shunt operation; the surgeon warned me to always pre and post treatment any dental visit.

    Today my current physician said this was no longer necessary. Please help me with issue.


  37. My sister had a dental procedure on three of her teeth at one sitting, 2 of which was a root canals. All three were so infected that she suffered swelling on both sides of her face for quite some time. Before the procedure she asked the dentist shouldn’t she be prescribed antibiotics first and the dentist replied no. Before the procedure she was experiencing shortness of breath and her right leg seems strange. Since the procedure her speech has not been the same. She gradually, several months later lost the ability to speak properly. She has lost tremendous weight from a size (guessing) 16 to a size 1. She cannot walk on her own. All her foods must be liquified. The muscles in her legs neck and arms have become severely challenged. She has to constantly keep a napkin in her mouth due to uncontrollable drooling. Mentally, she is still very cognitive and fully intact. We communicate best via the computer. However, lately she does not use that source much anymore. She is not taking any medication as the side affects can only make her even more uncomfortable. The doctor’s diagnosed her as having ALS. However, she attributes her symptoms to be related to her blood being poisoned from the dental procedure. We believe that strong antibiotics can help to kill the bacteria in her body but the doctors want to treat her for ALS. Please advise!

  38. Hi Tom, I had ovarian cancer 7 years ago and I had chemo. I am healed from the cancer, yet 5 years ago I had a heart attack and a stent placed. I will be having 10 teeth pulled to have dentures, there seems to be a concern about whether I need antibiotics before hand. I was told it’s not necessary, I am not on any medications. Should I just go ahead and have my dentist prescrib them? Thank you for your input.
    Sandy, Phoenix Az

  39. Thanks for taking the time to discuss this, I feel about it and love learning more on this topic. If possible, as you gain expertise, would you mind updating your blog with more information? It is extremely helpful for me.

  40. Restoring your lost smile has valued much together with all other face assets. However, the procedure of placing and assimilation of dental implants to your gums takes a lot of time requiring several visits to your dentist.

  41. I had a total knee replacement a year ago, and it is now time for my 6 month cleaning on my teeth. My dentist prescribed me 2000 mg of Amoxicillin one hour prior to procedure. I understand that this is normal, but I donated a kidney in 2006, and now I only have one. Should I still take the 2000 mg? Is it safe for my kidney?

  42. So happy to see this article. I have gingivitis gum swelling and a very recent abcess occur with mild cheek swelling. I’ve seen nothing but non-professionals giving stern advice on going right ahead w/ draining & or removal. Dangerous, so convincing had me doubting myself, even having gobs through this 20 years… Low immunity, illness, gingivitis & infection can’t be spread into blood stream, to heart and brain… That’s what happens if you’re not carefully evaluated. Thank you off this article. Wish more people were powered w/ this knowledge…

  43. I have had mitral valve prolapse for 30 yrs, a heart murmur, heart anuerysm, ray nodes syndrome and my pcp said I no longer need to premedicate before dental work. We’ll I didn’t take any antibiotics (my dentist was upset with the AHA recent findings). My dentist was correct because I got infectious endocatditis which damaged my aortic valve. My surgeon also repaired my mitral valve & removed the aneurysm. The vegetation traveled to my brain causing several mild strokes & seizures. I have sustained some brain damage: memory loss, difficulty in speech. I will be on anti-seizure meds indefinitely. I believe the
    AHA had it wrong to put out this generalized change in protocol. My pcp was negligent as well. My dentist gave me a lifetime prescription for antibiotics ; she will not treat me without premeds.

  44. Omg… in my comment I wanted to say I have to be on anti seizure meds indefinitely. Friggin computers! Lastly I forgot to mention I have titanium rods in my back as well. Another reason for premeds; after the endocarditis, fluid was found on my spine.
    sorry for going on & on…..I guess I have a lot to say

  45. I hope this is the place to ask a question. I have two total knee replacement 3-4 years ago and always pre medicate before dental work. I Am scheduled for teeth cleaning today but have
    Had a sore throat for two days,
    . Should I wait to have the cleaning today?

  46. I also hope this is the correct place to ask a question. In 2013 I had a cadaver acl replacement. I have been told to premedicate with 2 grams of Amoxicillin prior to every dental appt. This seems to be a bit much. I am a 62 yo female with no known cardiac conditions. Your opinion would be welcome & appreciated. Thank you. Anne Malone

  47. Great article! I have a problem with communicating with my busy regular dentist. I saw him on the 20th for tooth discomfort, and he referred me to an Endodontist. On the 25th, the pain was so bad that I called him, and he prescribed Tylenol-Codeine#3 and Clindamcin 300mg 3x daily. I didn’t talk to him directly. The pain went away by the 27th, when I also saw the Endodontist. He said the tooth’s nerve was dying or dead. That explains the lack of pain. So we agreed that I’d just take ibuprofen as needed – which lately has been pretty low doses. An appointment for a root canal was made for Feb. 5.
    All good so far. So why am I writing to you?
    The Clindamycin is making me so ill that I can’t work – nausea, exhaustion, weakness, constipation. This is ridiculous! Why should I be taking something that is making me ill when, as far as I can tell, there is no tooth infection? — not to mention the dangers of overprescribing antibiotics.
    When I called the Endodontist, his staff said to call the regular dentist. I called the regular dentist. He also was too busy and finally returned my call and left a message at 5:45 last night, after his office had closed and I was in bed because I’m so miserably sick from the antibiotics.. He doesn’t take emergency calls, and his office is closed until Monday. The message was to continue the meds as prescribed and to call him back.
    This makes no sense to me. So I have cut back on the Clindamycin to 150 mg. twice a day and 300 mg at bedtime and am considering cutting back farther to just taking 300 mg doses the day before the root canal and the morning before it — so that I can have a normal life back next week.
    I don’t have any heart conditions or prostheses. I am 73 and in general good health except for high blood pressure. I am allergic to penicillin.
    What would you suggest?
    Thank you!

  48. A few days after a teeth cleaning…I started to have multiple symptoms. That was in Sept. I started to get weak also. In early Dec. I couldn’t walk. I was diagnosed with Guillian Barre and was paralyzed for a while. I also had a stroke. I had to learn to walk again.I went from a wheel chair to a walker to a cane. I still have a lot of trouble with my eyes and my scenes. It has been almost 3mos. I had chronic Lyme Disease that was cured for over 2 years and did have lingering micoplasym in my sinuses that was also cured. I wonder if that played a part.

  49. I have upcoming surgery for removal of a mengianoma in frontal lobe which is caused fluid on brain, i informed Dental asst. & Hygienist who proceed to poke gums to measure pockets (which bled) now 2 days later upper palette gum tooth area sensitive & neck gland area swollen & sensative to touch and Primary care physician prescribed amoxicillian since surgery in 3 weeks as a precaution.
    Should dental facility postponed or prior treated eith antibiotic?

  50. Thank you for your blog and information that alot of people are ignorant about.
    Would you please correct my comment to check the box to Receive follow up comments on my above question from C M @ same email as this. Thank you.

  51. Hi. I have no spleen (removed 2 yrs ago), I have just been to visit my dentist with toothache UR2 and X-ray showed access on apex and she commenced rct. Nothing was mentioned to me about taking my rescue course of amoxicillin but she is aware I take daily penicillin vk. Should I be taking my rescue course or not to stop sepsis or will just opening and treating the root canal be sufficient? I notice you haven’t been replying to few previous messages but I would really appreciate a reply please. Thank you

  52. I have a prosthetic mitral valve and a history of endocarditis. I take premedication in advance of each dental prophylaxis treatment. I am about to get crowns with custom abutments put on implant posts (posts have been in for months and are healed). Do I need premeds for that?

  53. I had a root canal today and have to medicate! Two hip replacements took 4 clindamycin at the DDS and then novacaine. I am experiencing terrible heart burn and nausea. When I get sick it looks like spit. Is this a normal side effect?

    • I realize this is late but maybe you still need an answer. Either take a pepcid before you go, or change antibiotics, and EAT SOMETHING. Antibiotics on empty stomachs are brutal. The bile vomit you describe is BC of an empty stomach. Sounds like your just puking up a bile, mucus looking, frothy substance which is exactly what you described. Anytime you vomit with an empty stomach, this fluid is what comes out…until no more is left then you just dry heave.

      HOWEVER, if you DID have a full stomach then see a gastroenterologist.

  54. I am going for 8implants on December 27 and my doctor has not prescribed an antibiotic. I had both knees replaced in 2006 and I am in early stages of cold. My knees are bothering me again. I have 500 mg amoxicillin that was given too me in August of this year. I am also on 250/50 mg of Advair twice a day and symbicort 80 mg. Do you recommend me taking amoxicillin before and how should I take it. I am scheduled for 1:30on Dec 27.

  55. I visited a dentist yesterday for a cavity and inflamed gums. I have been diagnosed with periodontal disease and the dentist wants to inject antibiotics into my gums…. a total of 20 injections at $70 each as well as $980 dollars for cleaning my teeth. Would these antibiotic injections be safe? Would it be better to take an oral antibiotic before the dental prodecure?

    I am also concerned for my health since I battle with Candida and have the knowledge that antibiotics could make my condition worse. Any wisdom or advice would be greatly appreciated!

    • I realize you wrote this a year ago. I hope you made the right decision. I hope Dr. Tom will see my post as I have a life threatening decision to make. A year and a half ago I began having a small white bump on my gums and tooth pain that would come and go. Later this small bump became a big abscess and it will move from right side to the left side of my gums and then it went away . Before this infection I have just moved in an old house which had mold in the air duck and I was breathing the mold spores for a year that were coming through the vents in the house. I began having shortness of breath, I was infested with parasites of al kinds and even liver fluke. I began having short seizures, and passing in and out for 7 hours. The ambulance took me at the hospital. My legs became temporary paralyzed, my tension went up to 180. I had convulsions and hallucinations. Every single lymph node in my body swell and my collar bone as well. Pressure in my neck and head and swollen bumps on my head and neck. My urine had white flakes in it . I was tested for everything possible at the hospital and the only thing they found out is that I had an old stroke. After 3 days of intravenous fluid I felt a little better and went home. I felt good for couple of weeks and then became sicker and sicker. testing stool after stool and urine after urine for a year and half each time everything was normal. No candida no parasites no nothing. I know this is long but please read and you will understand. I was diagnosed with delusion of seeing parasites and the doctors advised me to see a psychiatrist. Instead I washed all the parasites from my stool and the numerous different kind of eggs and made a big print picture and took it to my doctor for infectious disease. Finely he put me on Alinia 500 mg . As soon as I began taking this medicine all my teeth began hurting and the left side of my face dangerously swell. I lost my appetite and I lost 5 lbs in one week but I managed to finish this medicine. Immediately after the face swelling I went to see an specialist for root canal. He put me on Clindamycin 150 mg to take every 6 hours. The swelling of my face went down slowly but the infection on my gum is still here. The side effect of Clindamycin made my legs and hands freeze to death, I couldn’t breath. tingling in the legs and hands , numbness and weakens in my arms and legs. oral trash ,nausea ect… I was so sick I couldn’t finish the last 4 pills. This dentist said I have anaerobic infection in my tooth and he is pouching me to have this root canal immediacy done. he is asking me over $ 1600 for the root canal and he wants to drill trough my dental bridge to do it. he said if he finds out that this tooth is broken he is going to send me to a surgeon to extract the tooth but he said that in that case I would still have to pay him 350 that day. I’ve had X-ray with barium and those results showed I have a mild lungs collapse, liver calcification, heart disease, pancreatic inflammation. I suspect I have candida but haven’t been able to prove it to the doctor. I’m scared to death of having a root canal done with my health issue and I don’t know where to turn or what to do. I’m loosing vision on both eyes but especially the left one. I’m planning to go to Charlottesville VA , 3 hours drive to get tested at the different lab for blood infection and other things before I do any oral work done. Dear Tom, I know something serous is going on with me but I don’t know what it is. Please advise me , what ever this might be, I think it is going to kill me. One more thing; the neurologist I saw showed me the CT scan done at the hospital and said that I actually had 3 strokes and not one. The old house I lived has been flooded in 2015 but I didn’t know and I suspect that the water in the house was contaminated. I lost two cats in that house who were perfectly healthy before I moved in and they were both 4 years old. One died from stomach cancer the other from kidney failure and severe anemia. Tom thank you for helping everybody here and thank you in advance for your advise for my case. I will be waiting for your reply.

  56. I am having several teeth pulled and I have had a complete knee replacement about four years ago, My dentist has told me to take 2000 mgs of Cephalexin an hour before my appointment, does this seem like too much? Thank you

    • Yes Brian that is the dose usually written:
      Cephalexin (Keflex)
      2.0 g orally 1 h before the dental procedure
      Taken with or without food.

  57. in 2008 i had my spleen taken out to due to auto accident and i also cut my liver open and damaged several organs kidneys and so on i also have metal rod in femur and plates and screws in my arm left elbow i have a white cell count thats dubble than average and when im sick it goes to 20000 to 30000 or higher mostly stays around 10000 do i need antibiotics prior to deep root cleaning of my teeth?

  58. I have a bicuspid aortic valve. I have not had it replaced so far so good. Do I need antibiotics before cleanings or fillings?

  59. What a helpful website. So glad I found it. Being a patient isn’t always easy especially when one has every experienced pain during a procedure 🙁
    I love this website and it’s very thorough and I am grateful for it.
    Thank you 🙂
    Knowledge is power in any situation . . . .

  60. I am 21 and have a small VSD (ventricular septal defect) in my heart. It hasn’t caused me any problems ever. My cardiologist recommends visits every 3 years and nothing more.
    My dentist has scheduled for a deep scaling and polishing in 3 days and when I asked her if I need to premedicate with antibiotics she said no but if there is excessive bleeding, she’ll medicate me afterwards.
    I was satisfied when I read the current guidelines by the heart associations of most countries which do no recommend antibiotic prophlaxis for VSD but after reading some of the comments here (of people getting infected from medical procedures, not by VSD though), I am scared. What should I do? Should I force my dentist to prescribe me antibiotics before the procedure? or should I consult a cardiologist? (don’t want to waste money on the consultation though). What bad could the antibiotics really do, why not take them, just in case?

    • I’m a biochemist. I can’t believe what I’m reading. Take the pill! (But I realize your appointment is now over)

      How and why so much consternation and worry over a single dose pill???? This article is nothing more than a dentist pissed off because his instructor corrected him, so he came here to prove how smart he is. This article should have never been written. Take the pill next time and…use the time you spent worrying over a single pill and researching the internet and GO ENJOY YOUR LIFE!!!

  61. My son had a splenoctomy last year in Feb 2016, he needs to repair two cavities, he takes penicillin twice a day for the next four years, does he needs more medication?

  62. Im a biochemist. Believe the OLD guidelines!! The new ones are WRONG!!!

    Now, I will tell you straight up if you are going to make THIS big of an issue over a measly 2g dose of Amoxicillin, just to prove YOU WERE RIGHT when your prof corrected you, when LIFE THREATENING infections could and DO occur, (ie joint replacements are VERY vulnerable and susceptible to infection, as are people with immunodeficiencies), then I think two things: either you should choose another profession, or you need to let go of some of your ego, because it’s out of control. WHY would you risk a person’s LIFE over a pill issue, because YOU WANTED TO BE RIGHT? Be safe, not sorry. You’re hurting no one by giving that pill. Only your ego.

  63. Good evening I would like some advise. My daughter had brain surgery at age 5 and again April of this year since she was 5 y/o every dental produce she has needed to be premeditated. Now she has this new doctor and she’s having a dental cleaning and when I called her Doctor for a rx her nurse stated she does not need any antibiotic.
    I want to make sure..

  64. Hello Tom, I desperately need your advise. In 2016 I moved in an old house that has been flooded in 2015 and had mold in the air ducks and other areas. The water was probably contaminated as well. It was a nice house and I never suspected anything until I lost two healthy young cats. With me it all started with difficulty breathing and a small white bump on my gums. I became so ill and I ignored my tooth aches and the gum infection. I had 3 strokes, mild lung collapse, liver calcification, bone swelling, swollen lymph nodes all over my body. freezing legs and hands, liver flukes and numerous other parasites. urinary track infections , pressure in my head and neck. Last June I nearly died at the hospital from seizures, convolutions, hypotension, in and out of consciousness for 7 hours , 3 strokes, my legs were paralyzed on and of but all they came up with was an old stroke. After leaving the hospital I saw all kind of specialist and I was diagnosed with the things I wrote above. Stool after stool testing for parasites , always negative results , they diagnosed me with delusion of seeing parasite and advised me to see a psychiatrist. This really made me angry. So I decided to do my work I washed all parasites and eggs from my stool and took a pictures . made big print of the picture and took it to my doctor for infectious disease this month February 2018. When he saw the picture , he gave me a prescription of Alinia 500 mg and Bilcitrice for the liver fluke. As soon as I started the Alinia all my teeth began hurting and the left side of my face swell so bad and closed my left eye. I lost my appetite and lost 5 Lbs in one week. My dentist sent me to a specialist for a root canal and this doctor put me on clindamycin 150 mg to take every 6 hours one pill. The swelling of the face slowly went down but the clindamycin caused numbness, tingling and freezing in my legs, feet and hands. I had difficulty breathing and developed oral trash, stomach pain , nausea, irritability, anxiety ect… I became so sick I couldn’t finish the last 4 pills. The gum infection is still here. I’m loosing my vision and especially on my left eye where the gum infection is. however, in the past, the gum infection was moving from the left side to the right side and sometime all my teeth were hurting. I also experience jaw cracking. When I was at the hospital they never found out what nearly killed me. I also have a candida but I don’t know how to prove them as I have been tested for it so many times and it was always negative. I’m scared to death to have this root canal done but this dentist is pressuring me to do it quickly. he is asking $ 1600 for root canal and he wants to drill trough my bridge to do it. I have told him that my bridge has a temporary cement and that the bridge is removal but he still wants to drill. he said if he find out that the toot is broken he will send me somewhere else to remove it but he will still charge me $ 350 for that day visit. I always suspected that have some kind of dangerous infection that might have spread in my blood and I’m still experiencing a severe cold in my extremities in interval with burning and hot sensation in my body. Pressure in my neck and head, swollen lymph node since last year, swollen bumps under my skin on my chest and neck and swollen collar bone. I haven’t taken yet the medicine for the liver fluke , I’m scared . My plan is to drive 3 hour to Charlottesville VA to get tested by a different Lab . Please forgive me for this long message. Could you dear Sir advise me what to do? All the doctors I have seen are saying they have exhausted all options in my case. Thank you in advise and I thank God for creating a wonderful human being like You for helping those in desperate need. I’ll be waiting for your response . Thank you.

  65. I have had both hips replaced, one in 2006 and the other in 2013, I was told that I needed to take antibiotics before any dental work for the rest of my life. Which I always did until I had a severe reaction to an IV antibiotic in which I ended up with a hearing loss and was told by the Infectious Specialist and ENT dr that I was to stop taking the antibiotics before dental work. My problem is that I have recently had a tooth pulled and am having problems recovering from it. Is this because I didn’t do the pre-dental antibiotics?? If so, what can I do to fix this problem??

  66. What consideration is given to the fact that taking the premeds while perhaps protecting the patient against the infection also destroys the flora in the patient gut? The flora is required for proper digestion. Once destroyed, it can take a long time for the gut to recover. There have been cases where patients ended up in serious condition and in the hospital with the damage to their gut.

  67. Hello Tom: I have had complete knee replacement about 9 years ago. I am 92 years old. I take 4 Amoxicillin before each teeth cleaning. I have had two pacemaker infections this year. I am wondering if i should be taking antibiotics each time i have my toenails cut because the doctor makes them bleed. I thought i read this somewhere years ago. Should i be taking antibiotics each time i have my toenails cut and if so which kind?
    Thanks you.

  68. I had a partial knee replacement about 15 years ago and have been taking four 800 mg Amoxicillin
    capsules one hour prior to my dental appointment. The appt is for routine teeth cleaning and x-rays. Do I need to continue taking this after all these years? Last year I had C-Diff and worry about taking any antibiotics. I cannot get an answer from my dentist or ortho doctor. Need advice!


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