Certain dental procedures can increase the risk of bacteremia (the presence of viable bacteria in the circulating blood).¹ Thus, the American Heart Association’s 2007 guidelines recommend antibiotic prophylaxis for patients at high risk of endocarditis during specific dental procedures.² For some high-risk individuals, prophylactic antibiotics are advised for dental procedures involving the manipulation of gingival tissue and/or the periapical region of teeth or perforation of the oral mucosa.
According to PPN’s expert committee, patients with PANS/PANDAS may experience worsening symptoms following dental procedures involving gingival tissue manipulation, pericoronal regions of the teeth, or perforation of oral tissue. This includes procedures like extractions, cleanings, fillings, and oral surgeries. Although the exact mechanisms remain unclear, the resulting bacteremia may trigger an immune response, leading to a deterioration in clinical status.
To mitigate this risk, patients may benefit from starting antibiotic prophylaxis the day before the procedure and continuing for 4-7 days afterward. The dosage recommended to prevent PANS/PANDAS exacerbation is higher than that used for endocarditis prophylaxis and should at least match the dosing for treating strep pharyngitis.
¹CDC Guidelines for Infection Control in Dental Health-Care Settings — 2003
Gabriella True
