Antibiotic Prophylaxis in Dentistry: Heart Patients, Joint Replacements & Allergies | Dr. Tom Viola

Which patients still need antibiotic prophylaxis before dental treatment, and what do you prescribe when they're allergic to penicillin? Pharmacist and educator Dr. Tom Viola walks through the evidence behind the American Heart Association's updated guidance, why clindamycin was dropped, and what to do when a patient or their surgeon insists on antibiotics anyway. In this episode: - The Thornhill studies: the first strong evidence that prophylaxis prevents infective endocarditis - Which heart patients still need it (and why mitral valve prolapse no longer counts) - Why clindamycin was removed, and the trade-offs of cephalexin, doxycycline and azithromycin - Why you shouldn't swap in antibiotics the guidelines don't list - Prosthetic joints: what the ADA and orthopedic surgeons actually say - "Do you want to die on that hill?" When patients insist on antibiotics - What counts as an "invasive" dental procedure - Using clindamycin safely for infections, with follow-up and probiotics Guidance discussed as of 2023. Check the current AHA and ADA recommendations before changing your protocol. 📰 Plus dental news: the states with the most stained (and whitest) teeth, CBCT vs. ultrasound for measuring bone loss in orthodontic patients, and the pandemic preparedness bill returns. Dr. Tom Viola is a board-certified pharmacist, educator and speaker with 30 years of experience. He founded Pharmacology Declassified, has lectured in all 50 states and consults for the ADA's Council on Scientific Affairs. Chapters: 0:00 Intro 2:06 News: the states with the most stained teeth 4:13 News: CBCT vs. ultrasound for bone loss in ortho patients 6:27 News: the pandemic preparedness bill returns 8:06 Is ultrasound the future of dental imaging? 10:54 Meet Dr. Tom Viola 13:37 What are the current antibiotic prophylaxis guidelines? 15:36 The Thornhill studies: proof that prophylaxis works 18:46 Why the AHA dropped clindamycin 20:18 Penicillin allergy: cephalexin, doxycycline or azithromycin 21:53 Can you substitute other cephalosporins? 23:50 Which heart patients still need prophylaxis? 26:35 Prosthetic joints: what the evidence says 28:58 When the patient insists on antibiotics 31:45 Why dentists get blamed for infections 35:56 Don't make substitutions to the guidelines 37:52 Breast implants and other implants 41:08 Penicillin allergy: what Tom would prescribe 42:39 What counts as an "invasive" dental procedure? 45:02 Treating infections without amoxicillin or clindamycin 49:44 Using clindamycin safely (and probiotics) 53:18 Closing 🎧 Listen to the podcast: Apple Podcasts: https://podcasts.apple.com/us/podcast/dentists-in-the-know/id1543254763 Spotify: https://open.spotify.com/show/2Elfj6LX0hCUyp0AgdTsij 📺 Make sure you subscribe to catch new episodes live every Wednesday at 8pm ET! https://www.youtube.com/@dentistsintheknow 🌐 Check out our brand new website: https://dentistsintheknow.com 🌟 Stay up to date on all the latest dental trends when you follow the DINKs: https://fanflet.com/dinks/social-2