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Antibiotics for a Tooth Infection, Dental Implant, Bone Graft… Do I Need Them? 

In this short, but highly informative video, I review some of the common truths and misconceptions about antibiotics in relationship to tooth infections, dental implants and bone grafting.

Use of antibiotics should be judicious and carefully thought out.  Just because you have an “infection” in your tooth, it does not mean you need an antibiotic.  Also, not all “infections” are actually infections.  Not all infections can be cured by antibiotics alone.

Antibiotics are commonly needed for procedures that involved cutting through bone or addition of bone graft materials.  There is a limited supply of new blood vessels that can get your natural immune system’s protection in the first few days following a significant procedures such as a surgical extraction, a bone graft, sinus graft, apicoectomy and dental implants.

Antibiotics are extremely helpful in many situations.  I also discussed common questions such as antibiotic resistance and what happens with common stomach issues and what to do about them.

I think you will find this video helpful.  Please feel free to ask questions below.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry

106 thoughts on “Antibiotics for a Tooth Infection, Dental Implant, Bone Graft… Do I Need Them? 

  1. I had two extractions on bottom right with immediate implants on June 13, 2018. I developed an infection with swollen face, gums, under tongue, and throat. I was put on Clyndomiacin for 5 days. There is still redness and some pain on gums around bridge behind implants, and some swelling under tongue. Today is July 4th. I’ve asked if another round of antibiotics will help and the dentist is hesitant. I was told antibiotics just mask the symptoms, they are waiting for one of the implants to “commit” so they can determine if one needs to be taken out. Wouldn’t 5 more days of antibiotics be a better plan? Thanks for your advice.

    1. I agree with you. And also if you are not allergic to penicillin I would suggest you switch to something else besides clindamycin.

  2. I have had three implants for about ten years with no problems. Recently, there has been an infection develop even through I practice good hygiene. Do I need to have a procedure done to clean out the infection or take low-dose antibiotics to clear up the infection. The pain waxes and wanes from being very painful to a low level of pain. Please advise by email.

  3. Hi Dr. I had a periodontist do a bone graft behind #17 molar to correct a 10 mm pocket. The following day the flap began to turn necrotic then fell off. The doc said not to worry. 2 days later i had a horrible taste coming from the area and went back and he gave me a bottle of Peridex to put on the area and said to return in a week. My next visit I still had a foul taste but it had subsided some. I had research a little in between visits and heard of people getting antibiotics either before or after this procedure. I asked the doc why he didn’t put me on them and he response was “oh, I didn’t prescribe you antibiotics?” He the gave me a prescription for Augmentin 500 mg and said we will have to wait to see if the graft took. Meantime I have terrible sensitivity now that the root is exposed. What is usual protocol as far as antibiotics with this procedure?

    1. Is this a wisdom tooth? #17 in the American numbering system is a wisdom tooth unless you are making reference to the European system where this would be a second molar. If this was a wisdom tooth it seems strange to even try to save it with a 10 mm pocket. Under my care you would have antibiotics both before and after with this type of procedure but each practitioner has a different school of thought. Not all dental surgeries require antibiotics.

      1. I’m sorry it was second molar. Will that gum tissue ever grow back? Why do you think it died? Should i get a gum graft to cover the root or just leave it as is as long as the gum stays tight to the tooth? Thanks for your help. It takes a special person to make time like this for complete strangers.

        1. That area is Sometimes inoperable. Surgical access is very difficult. Sometimes the area can be more successfully treated with a carbon dioxide laser first and then try to bone graft the root. Each situation is very different.

  4. I am having a tooth (#30) extracted and bone graft for an implant on Thursday, June 7, 2018. The tooth has an old crown that came off and the dentist determined there was new decay and the tooth was not salvageable for a new crown. The periodontist that will do the extraction and implant has prescribed antibiotics but did not mention when I should begin taking them. When do I start taking the antibiotics? Days before the extraction, after the extraction? The periodontist office is closed so I cannot contact him until Monday, June 4, 2018.

    1. One hour before is usually the best. But the dose one hour before is different (bigger) than the regular. You will need to call them. They should have alerted the pharmacy to write this down on the bottle.

  5. Hello, I had a root canal with a crown done on the 1st week of April. On April 16th I found out that I had an ear infection. I wad prescribed Amoxicillin. On April 25th I went to my dentist for toothache. Found that I have an tooth infection below the root. I was still on my Amoxicillin meds from the ear infection. My dentist could not understand why out was there since I was on my medication since the 16th. He removed my crown an put medication down the root. A calcium oxide horrible tasting liquid. There was no puss so he irrigated the tooth and put the crown back on. I was very sore and could not eat anything not even a soft fry. When I woke up the next morning my gum and face was swollen. What should I do? Did my ear infection cause my tooth infection or vis-a-versa? Help?

    1. This would be a better question for an endodontist… A specialist in root canals. I am a dental implant specialist. The only words of advice I can tell you is that it is possible to get an infection while you are on an antibiotic.

  6. Hi!

    I recently had a bone graft on my lower jaw. It was the kind with the flap not the socket kind. Anyways, on day 8 I was still having pain and it was quite swollen. Went in to see my dentist and now I’m on clydimician and flagyl. For the first 7 days I was on amoxicilian. The swelling has gone down over the first 48 hours of these new antibiotics, but the oozing from the site has not ceased and I am still having some pain. Can infection post surgery be treated effectively with antibiotics? I’m worried that if the infection in the graft then an antibiotic isn’t going to affect it. Are my odds that this is going to cause the graft to fail and have to be removed?

    1. It is too early to tell but not a good sign. They usually heal despite infection if the bone graft technique is correct and you are healthy.

      1. One thing I notice is that the suture along my inner gum didn’t fully close. Could this be why the infection was caused?

          1. I’m three weeks post surgery and finished with my course of antibiotics. My pain is gone and there is no more discharge from the site, however my jaw still feels swollen. My oral surgeon told me this was the mass of the graft, but it feels like a previous infection I had from a failed apico. My face is slightly noticeabley swollen. Does this sound like it could still be infection?

          2. Give it a few more weeks. Some swelling takes one to 2 months to fully go away depending on your body’s response to inflammation and of course the type of procedure that was performed. Best of luck!

    2. Why only amoxil. . . Why not amoxil along with metro/trinidazole… I hope your tooth would be fine now. . . But ask your doc if there are some meds that work better in a combo. And about your question about the origin of infection; your dentist can better answer it.

  7. I had a (cadaver) bone graft on 3/27. Procedure went fine, and at first I only had pain that that I expected from dental surgery. Three days after surgery, I had horrible pain in the back of my jaw/gum line. It felt like it was from the Novocain needle poke. Had that same pain until I went back at the 2 week mark for stitch removal. At this point, I had been on 1 round of antibiotics pre and post surgery, then another round. At that appointment, she put me on a third round. Personally, I thought it was too soon for the stitches to come out bc the site looked like it was still healing. Anyhow, the stitches are out and almost a week later the incision site is in excruciating pain. There are late nights that I cry myself to sleep. I was put on Percocet and then Tylenol/codeine and they did nothing to stop the pain. I take anywhere from 3-4 ibuprofen, 3-4x per day. (Last night, I took 5!). As of yesterday, I’m also having pain near my ear and even up into my eye, and my jaw aches when I chew. Could my body be rejecting the implant? How can there possibly be an infection after being on antibiotics for 3 weeks? At this point, I wish I could reach in and pull the implant out on my own. By the way, I’m leaving for Florida in 2 weeks and there is no way I want to deal with this pain while on a family vacation.

    1. hmmm….There may be remaining infected tissue in the extraction socket. You may want to consider removing the entire graft if it does not get better very soon. Something is not right here. A basic x-ray should be taken and possibly another 3-D scan. Let me know what happens

      1. Turns out the gums were not healing correctly. When I looked in the mirror, I could see down into my gum line, the graft, and other things I did not want to see. I just called it a “flap” that was hanging there. Didn’t look like my gums were connected to anything! Doc said that I was basically walking around with an open wound. She put, what I call, liquid bandaid on it, then covered it with a gooey substance which she hardened/cured and made into a “papoose” that covered the open gums. Worked like a charm! Aside from having that wad of hard stuff in my mouth, I am just about pain free. The hope is that while my gums are covered and not being moved around and touched, that they will begin to heal.

  8. Dr,
    I had a sinus lift January 12, with 3 implants to my upper right teeth. That Thursday I went in to horrible pain and was told it was healing and I might be just slow to heal. I was taking Cipro.
    On Monday I couldn’t take it anymore and went it for severe pain. He said my gum was swollen and gave me augmenton 875mg tid. He said he didn’t know why I was hurting so bad. That night I had the worst pain of my lift and about 2 in the morning my gum busted open and thick green pus was pouring out. About 1/4 cup if I were to measure. I called the next morning and he said just keep taking my augmenton and he’ll see me Wednesday. I went in Wednesday and he said keep taking my augmenton and he’ll see me Friday.
    He didn’t want to do any scans at this point. He said in 22years he’s never had a graft fail. I also have a wierd air feeling in my gums when I sniff, but he wasn’t concerned. So I go in Friday and it’s the same story! I’m still hurting, I’m still draining but come back Monday. I go in Monday and he (the oral surgeon)was running late so his partner saw me. He added flagyl and they said they’d see me Wednesday. I go Wednesday and I’m still having pain but the swelling is going down some. I’m still having pus and bone fragments. He said I’ll see you in a week.
    So here I am the last day of flagyl and I’m still having pus and bone fragments. The pain is definitely less and it’s still a little swollen and definitely numb. The drainage is still green with a foul taste. My appointment is Wednesday so3 days away. I’m at a loss! This has been the worst experience of my life. 3 antibiotics and more than 50 Motrin 800’s plus Tylenol round the clock every 4 hours. He doesn’t want to go back in and says the antibiotic can heal it even if the lift is bad.
    I need another professional opinion:(
    I’m also severely nauseous from the flagyl. But I’ve taken it tid as prescribed.
    Thank you so very much!

    1. Yikes…3d scan to Make sure drainage hole for sinus is open, decongestants to open of passages, **REMOVE GRAFT** because it has been too long and antibiotics to not get rid of the dead stuff and pus, culture pus. Augmentin and Flagyl is a great combo. Ask for zofran for nausea.

      KEEP ME POSTED –not normal!!!!!

      1. I went in today and it’s going to get cleaned and drained on Wednesday. He said he’d know when he goes in if it’s the membrane or graft. Thank you for your advice!
        This has been a long and exhausting 3 1/2 weeks!

    2. Yikes…3d scan to Make sure drainage hole for sinus is open, decongestants to open of passages, **REMOVE GRAFT** because it has been too long and antibiotics to not get rid of the dead stuff and pus, culture pus. Augmentin and Flagyl is a great combo. Ask for zofran for nausea.

      KEEP ME POSTED –not normal!

      1. Update: I went in yesterday prepared for the surgeon to clean it out. The ct showed my right sinus was full, he said my gum looked better than 2 days ago and I didn’t have any pus so he wanted to give me round 4 of antibiotics and see me in 2 days. Well I woke up with green pus coming from my gums and pain once again. I was told that the antibiotic can heal the membrane if it’s infected. But I’m 4 weeks in now and my stomach is a mess from all these antibiotics and with continued draining I’m at a loss!
        Do I demand he go in even after my gums supposedly look better? But continue to pus?
        I’m at my breaking point!

          1. Thank you for all your advice! I agree and have a call in for the surgeon.
            I’ll keep you updated.
            Again, thank you for all that you do!

          2. He’s going to go back in today! My only concern is the pus and pain is intermittent and this morning I didn’t have pus. It still feels like a big knot in my cheek and gum area and I took alieve so I’m not in pain.
            This happened Wednesday and that’s why he wants to keep waiting.
            Should regardless have him go in?
            Thank you again!
            Making decisions are stressful and confusing since I don’t know what’s going on.

          3. I went in Friday and he finally opened it up. First, I was awake with nitrous and when he numbed me in the sinus area I felt and tasted all the pus and medicine drain down my throat in a rush. It was a very painful and stressful experience.
            He cleaned it out and said the membrane was bad and desolving and part of the graft didn’t look good either so he only took out the bad part then cleaned everything. I was put back on augmenton 875 bid. And since I don’t tolererate Sudafed told to take dimeatapp. I really hope this will be the answer for me to heal.
            I’m extremely sore and achey from the procedure today but I will say the green drainage that I was getting from my mouth and nose is gone at this time.
            I’m nervous because he didn’t take the entire graft out.
            I don’t want to ever have this traumatic experience again.

          4. This is definitely not a usual experience for most. Of course complications can happen but we try to avoid them at all costs. Seeing a very experienced provider will prevent or reduce the chance of complications. Just so you know, I have re-grafted patients that have had failed bone grafts in the past with great success. It is possible if you ever get the courage to do it again.

            thank you so much for sharing your entire story from beginning to end

  9. wish I could have heard your information, but sound of your voice was so soft I could not hear you. No way to turn up the volume

  10. Hello I hope it’s ok to leave this message here but I have recently had my bottom left 2nd molar from back retreated with root canal. The tooth itself is no longer sensitive like it was by I am still having some jaw ache and pressure type feeling and my gums feel very irritated but look fine. I also get sharp pain from ear down the side of jaw. My Endodontics said the next step would be extraction my fear is I am allergic to many antibiotics penicillin, azythromyacin, keflex and clindamycin which are all the preferred antibiotics for implant. If I go with a bridge to avoid antibiotics does this put my jaw or teeth at greater risk of anything?

  11. Dear Dr.
    I want to have extractions, cleaning, sinus lift, implants 8-10, and veneers in the Dominican Republic. It will take a team of 5 doctors to do the work right. I have to stay 2 weeks. Do you think it’s safe to do all this in two weeks?

  12. My wife has a root canal over 50 years ago. She had a root canal redo in ~1995 after a apical resection did not eliminate an infected root canal. Amazingly the infection subsided. Over a month ago she develop a mild pain in the upper gum with swelling in the apical area and was placed on antibiotics for three weeks while we were on vacation. She followed up with her endodontist who noted a pustule on the upper gum, opened it up, purulent material drained, and he noted a cracked root. Antibiotics were continued and she was sent to an implant specialist. His xrays demonstrated that the apical area was the only infected area. He is planning on extracting the tooth and inserting an implant on the same day. Would it be preferable to extract the tooth and let the area rest for a few months before inserting the implant? I am concerned that the infection could spread to a congenital heart valve abnormality. Thanks

    1. Thanks for your detailed explanation!!!
      Immediate implants by a skilled provider are very predictable. Of course a two stage procedure is completely ok but if the long term success is the same for both methods, then the choice becomes more obvious. If this is a front tooth it can make it more predictable or more risky. Just have a frank discussion with your dentist about it and ask about their past experiences in similar situations.

      Antibiotics should be on board before the extraction to prevent issues. If the infection has active pus, pain and redness I would not place the implant.

      The rules are different for one implant between natural teeth vs when I remove all teeth and place 12 implants simultaneously.

      Good luck. 🙂

  13. Hi Doctor Ramsey, Thank you for your post and video.
    Acute question: I just had a dental implant procedure done at a specialist clinic, not my normal dentist. I was given antibiotics to take post surgery (which is right now now): Amoxicillin for 7 days (no pre-antibiotics). I was not prepared for this and I don’t want to take Antibiotics..

    Im 30 and very healthy. No smoking or drinking, Taking lots of vitamin C and supplements.

    Do you think it’s a stupid risk to run not taking the antibiotics? I’ve read several studies online and see that succes rate without A is 94% vs, 97% with A. In healthy, low-risk people like me.

    Thank you, your opinion is very muc appreciated and I will read your other comments now.

    1. An implant is a foreign body that “in general” should be covered by antibiotics. Many of these studies are done with really simple, straightforward dental implants and not ones that are in bone loss situations or bone grafted situations. If it were me I would take the antibiotics and I would also take a yeast based probiotic along with. This way it does not cancel out the probiotic because it is a nonbacterial version. I like the brand floarstor and recommended routinely. I would also suggest to her mouth rinsing with 0.12% chlorhexidine 3 times daily for a week. This has antibiotic properties also. Without antibiotics, most of the surgical procedures done in medicine today would not even be possible!

      The providers experience, surgical sterility and time taken can also increase or decrease your chance of becoming infected

      1. Can the antibiotics be taken shorter than the 7 day traditional recommendation if no signs of infection/problems are present? I have read that there are a lot of conflicting or lack or research supporting the full duration of the antibiotic.

        1. antibiotics should be used very judiciously. But there are times where a shorter duration is fine and there are times where I will place a patient on an antibiotic for 2 solid weeks. This is not a decision that should be made by you but rather evaluated by your physician/dentist based on so many factors such as difficulty of surgery, surgical flap size, vascularity, medical comorbidities, bone density, medications, age, introduction of foreign bodies, bone graft dental implants etc. If you develop an infection will having any sort of advanced procedure your likely to lose the implant/graft etc.

  14. Dear Doctor, I had a tooth extracted, due to a cracked root canal and an immediate bone graft placed with an implant screw. The site was healing very nicely at week one, then it started to have a foul smell and part of the bone graft seemed to come out. Since then at week 3 I have a very swollen gum, it has swollen over the implant and I can no longer see the top of the implant. Also I now have pus draining from the site. I started on Azithromycin 500 mg. and am on day two of the antibiotic. I have also been doing salt water mouth wash. There is redness and pain in the area now. What should I do, I have travelled and am not in the same country as the implant was performed. Should I seek a local dentist? How long should I wait until I see someone?

    1. Do not wait to see a dentist. The area should be evaluated and a second antibiotic or different antibiotics should be used in addition to a possible Betadine irrigation or debridement. There is a good chance your losing bone or could lose the implant entirely. Find someone that focuses on implant dentistry rather than just regular dentistry.

  15. I think this is the most informative site about dental implants.
    I want to say thank you. There are just not enough honest open sites like this.
    I think there is a lot of people out there who have not been given the facts needed to make an informed choice.
    I wish I had found this before my surgery.

  16. Hi
    Dear Doc
    I had a root canal done 4 weeks ago..(bottom right) it caused terrible pain, also crown was too high,it has now been adjusted. It hurt for a full 7 days! While healing i noticed i had another pain i thought it was the top (upper right) of the teeth but the dentist said nothing was there, there was no crack! . But i just realized it was the tooth behind the root canal root.. it feels sensitive to biting!! I cant believe this is happening!! Its been so expensive! Is it possible that the tooth behind (root canal tooth) become infected? Does this happen ? Cant this be cleared by antibiotics… This tooth was fine before the one in front became infected! Just what do i do now? I cant afford any more time from work or money! Wont this just get better on its own?

  17. Dr. Amin,
    Thank you for your informative video. I have to do an extraction of tooth #3 this coming week because it is still infected after a root canal re-treat. The additional complicating factor is that I also need to have endoscopic sinus surgery for polyps and chronic sinusitis – this was originally scheduled for 2 weeks from tomorrow but now may need to be rescheduled. My sinus dips down right above the root of this tooth, so it might likely require a sinus lift procedure too.

    My question is on timing of the bone graft – whether it needs to be done at the time of extraction, or can be delayed a couple months. My periodontist said he always ideally likes to graft bone at the time of extraction if the plan is to do an implant for the missing tooth, which I want to do. This would mean delaying my sinus surgery, which could be done, but how long do you think I should wait before the sinus surgery if grafting is done? And what would be the disadvantages of waiting a couple months to do a bone graft?

    Also, if there is a pre-existing severe infection around the root of this tooth, does this make bone grafting at the time of extraction more risky? Thank you.

    1. The two procedures should be separated by a 2-3 months.
      I would take out the tooth first and graft at the same time as long as the infection hasn’t penetrated your sinus.

      This way if you have any sinus complications the ENT can help on the tail end.

  18. Dear Doc Amin,

    Good day, im 28yrs old from philippines. i am so worried of my bone graft and don’t know what would be the consequences. I had 2 implant and bone graft at the same time 1week ago on my upper front tooth. After 1 week i have to come back as the stitch on the other one was gone loose and the bone graft was exposed i can tatse the grafts so i came back to him and he stitch again. The graft still expose and 1 day later when i woke up today the bone graft that has been exposed became a whole now that makes me worried. The other one was all ok which he made extraction too. But this one here that makes all the complications was a missing tooth 11yrs ago. What can u advice me doc, i am so worried please help.

    Thanks

    Kind regards,
    Erma

  19. After, I had a infected tooth extracted and my face swelled up. I had to submitted to the hospital due, to swelling.

    1. I’m guessing this was a lower tooth like it wisdom tooth or second molar that can compromise your ability to breathe if the infection heads towards your throat or if you develop hematoma on the inside surface after extraction.

  20. I hope you can answer I am having an implant 6/17 no bone grafting planned…although this guy seems to prescribe antibiotics for implants regardless. I am dead set on not taking them unless infection occurs however i do have some holistic options on board for preventative. As I have no known health issues and am a clean unprocessed diet would this be an option you would entertain? I don’t really like what happens to me on antibiotics and it takes months for me to get my body back to normal after a round of them.

    1. There are more factors to decide this than I can answer in a single post.

      If the implant is really basic I would suggest at the minimum a single loading dose of antibiotics 1 hour prior to first incision. An implant is a foreign body entering the bone. The bone space connects to many non intra oral spaces that infections can spread.

      Just some food for thought. ?

  21. Dear Dr. Amin,

    At this time I’m hoping you will be able to give me your opinion in regards to my current situation.
    I had an implant placed last July after the tooth was pulled 5 months prior.
    I had no infection after the implant was placed. About 2 months ago the screw in crown was placed . When the crown was placed the area were it was inserted was very sensitive for almost a week.
    Because it was sensitive I made the mistake of not cleaning it for the first week. I then started having symptoms of infection. It was on a Saturday when I noticed the infection. Because the implant was placed in the area of my left nostril, I decided to pour warm salt water down my nose to hopefully get rid of the infection. When I did pour it the pain was extreme as if someone hit me in the face with a baseball bat. I immediately took some advil and kept rinsing my mouth with salt water for a few days. The dentist then put me on anti-biotics and the infection cleared up. A few weeks later I fell asleep after attending a dinner party without cleaning my teeth. I woke up with another infection and started to again rinse with warm salt water and Listerine. A few days later I went to my regular dentist to have her unscrew the implant crown to check for infection and she said there was nothing visible. After another round of anti-bio tics and rinsing after every meal, I have no more issues and it’s been almost a month now.

    The x-ray that my regular dentist took, according to her, showed a slightly dark and cloudy area around the new implant tooth. She emailed it to me as well as to the implant doctor. He then had me come in to check the implant via his own x-ray. He has told me that because I have no current symptoms of any infection and that the implant and crown are not wiggling or lose, that there seems to be no issue currently. He does want me to come back in a month so he can take another x-ray and has said he will take out the implant if I have symptoms that there is an infection.

    Here is my question which I would so much appreciate if you would answer—

    Does an x-ray that shows some a slight dark and cloudy area definitely mean the implant is infected and needs to be removed even when there are no symptoms of failure?

    It’s the implant on the right side that is the one in question. I’m not an expert but I don’t see any difference at all around the area of either implant.

    Thanks in advance for any info you are willing to share with me.
    PS—I have 2 digital x-rays but don’t know how to post them here. Is there a way I’m able to post the x-rays?

    Thanks for your help!
    Diane

  22. Hi … I have read through the blog and watched your video. I had an extraction and bone graft tooth #3 on 4/19/ 2016 after having a failed root canal and apico. The tooth showed signs of localized infection. I have a history of sever c diff and can’t take ANY antibiotics according to my GI. The extraction went well not much pain and day 2 zero pain however, your comments are concerning about the risk of infection . My oral surgeon said he cleaned the infection very well and all looked great and he understood I can’t take the antibiotics. Is there still a high risk of infection and how long until I am out of the woods?
    Thanks,
    Chip

    1. All you can really do is assume the risk at this point. Either way is risky whether or not you take antibiotics or you don’t. The size and technique of the graft also placed a big role on whether or not it becomes infected or not. Because you developed C. difficile before your likely to develop that again. As long as you have a good immune system, you don’t have any bad lifestyle habits and the graft is fairly small hopefully nature will just do its thing. Good luck!

      1. Thanks for your reply! After having 4 severe cases of c diff that lasted for over a year and ended needing a FMT to cure the c diff obviously infection concerns me. What is the general time frame one would be looking at if an infection was going to occur?
        Thanks!

        1. The first month after having the implant surgery and/or bone graft would be the most common to develop an infection. Did the FMT Fecal Microbiota Transplantation work?

  23. These videos are great. I had an upper molar extracted in November ’15 and have been putting off the implant process, even debating whether or not to replace it (the second from the back is what’s missing). The tooth originally had a crack under a crown and they attempted a root canal but it had to come out. I was on one course of climomycin (sp), then another on cipro back to back for the extraction. I developed C-Diff as a result. I’m only 55 and haven’t been near a hospital in 8 years and hadn’t been sick literally for 25 years prior to the tooth incident. I’ve recovered from that, but now I’m terrified not of getting an implant, but of having to take antibiotics. My dentist says there is no alternative. That’s why I’ve been considering leaving it alone. Have you heard of such a scenario? He doesn’t think I’ll need a bone graft – just the “tapping” procedure that you described. Thank you!

    1. Each situation and each patient’s history has to be evaluated carefully to make a decision to do a dental implant without any antibiotics at all including preoperative antibiotics. Regardless, you’re taking risk but you need to have this discussion with your dentist. You might want to see somebody who is very experienced and has a long track record of success to reduce your chance of infection if no systemic antibiotics will be used.

      Antibiotics are most important when bone grafts are involved.

  24. I was wondering if you have seen a situation where Clindamycin caused an increase in E. Faecalis? This happened and I was put on Doxy and Flagyl and they didn’t help.. my symptoms worsened and then I was put on Cipro and I feel as if I may get pancreatitis.

    1. you should see an infectious disease specialist and be tested for susceptibility and sensitivity for antibiotics

  25. I have diabetes. I was told I need antibiotics for tooth removal and possibly implants. Issue here is I have had awful side effects on these. It’s bad enough to need all this work done but even worse is the thought of medication. Antibiotics cause my nervous system to go crazy causing effects like body burning, anxiety and so much more. Are they really needed. And if so what could be a conservative plan? I appreciate your video. Thanks.

    1. each situation is unique. Her diabetes status needs to be evaluated in the context of the surgery and surgical technique/materials that will be used. You should speak to your dentist about this. Diabetics are much more prone to infection and slower healing of bone grafting and dental implants. The lower your blood sugar and hemoglobin A1c, the better

  26. Good Morning Doctor-

    I had bone grafting and 3 teeth implants done in Jan 22nd 2016… It is today Feb 22nd of 2016.. I have been on more medications and antibiotics, and I’m still in the same situation….. .. The middle implant got all infected, my Surgeon cleaned it all out and put me back on Biaxin for 10 days.. I’m going back this evening to see him, my Chin and bottom lip are all num… its already 5 weeks..

    Please reach out to me phyllism@bachrachgroup.com,

    1. If there is questions as towards whether the implants are causing the numbness they should be taken out. This will likely resolve the infection and allow areas to heal.

      I would also suggest a treatment with some steroids also. Keep us posted

  27. Hi Dr, Amin,

    Tomorrow my root canaled tooth #14 will be extracted. I am not prescribed antibiotics prior to my extraction which I am happy about it. My gum around tooth #14 is not swollen or sore. I feel fine. This is probably a dumb question but since I am very nervous about my extraction, will I feel pain during the extraction? I heard local injection will not numb my infection side if I don’t use antibiotics and having an infected root canal before the extraction date…

    My other question is I will have bone grafting right after the extraction. And then plan is having an implant in 4 months. I don’t like to use antibiotics especially because I used a lot of antibiotics in the past and I am only 30 years old.I would rather use vitamins and supplements to fight with the infection. But of course I do not now if it is required for my future implant operation. Do you suggest using antibiotics after bone grafting?

      1. Thank you Dr, Amin. Your articles made me somewhat knowledgeable and my doctor was suprised while I was asking him some questions before my extraction:) hopefully I did not bother him.
        I did not feel anything during the extraction. It actually happened pretty fast. I hope that area is cleaned very well… Extraction With the bone grafting took about 15-25 minutes of the nitrous didn’t fool me:)
        I was not given antibiotics prior. My dentist said that the only reason he is giving me antibiotics now is because bone grafting. It is called cephalexing. As for pain relievers I am using Vicodin and ibuprofen one at a time exchanging. I took a day of from work and will take today real easy. Hope my healing goes well without any contradiction.

  28. Hello Doctor,
    I had a block bone graft done a month ago and everything was going well until I noticed the gum above one of the teeth near where the graft was placed has now healed and also noticed small amount of pus coming out. I did not take any antibiotics after the surgery and the surgeon not placed me on it for a week. I do not have any pain unless I press heavily with my finger on the gum where the graft was placed. Should I avoid the area with my tongue completely or is it a good idea to massage it around the healthy area that has healed. I was told I can use the antibiotic mouthwash and my finger to massage the area around. Thank you very much.

  29. Hello Doctor,
    I had a block bone graft done a month ago and everything was going well until I noticed the gum above one of the teeth near where the graft was placed has not healed and also noticed small amount of pus coming out. I did not take any antibiotics after the surgery and the surgeon not placed me on it for a week. I do not have any pain unless I press heavily with my finger on the gum where the graft was placed. Should I avoid the area with my tongue completely or is it a good idea to massage it around the healthy area that has healed. I was told I can use the antibiotic mouthwash and my finger to massage the area around. Thank you very much.

  30. My son has infection smell in his mouth where the bone graft is, he loose teeth, it’s oozing and serious pain. The dentist is hard to get ahold of and we have a poor insurance. He is taking hydro for pain and penicillin for antibiotic. Now what? Surgery was 7 days ago.

    1. He needs to see the surgeon for a follow up asap….please reply when you find out the outcome for the benefit of other readers.

  31. I just had a dental implant done and it is infected. My dentist increased my Clindamycin to 300mg 4x per day. I’ve finally had some relief, but still am having pain. I have about 3 days left on my antibiotic….. How long does this type of infection take to clear up!! Thank you for a reply in advance!!

    1. Some infections can be aggressive and take 1-2 weeks to cure. I would suggest a culture and sensitivity test and perhaps switching antibiotics or adding a different antibiotic to the mix. Is the infection gone now as of Christmas Day?

      1. We switched to Augmentin about 3 days ago. They took the bone graft out on Monday. I’m feeling a lot better, but still a little swollen and slight pain. I’ve been able to just use 800mg Motrin. I think I’m on the mend. Thank you for your reply.

        1. wow…. Took the graft out….. I rarely have to do that and I do bone grafting procedures every single day.

          I’m glad you’re better but I am only sorry that you’ll end up having to repeat the procedure. There are other options of antibiotics and local treatment rather than removing the entire graft but sometimes it is the only option. Of course without seeing you there is no way that I could be certain.

          Thanks for the follow-up

  32. a month ago, firstly my doctor took a 3D scan of my mouth areas that I had been considering having dental implant, then he did a virtual surgery on the computer without touching my mouth. It didn’t hurt at all.

  33. I just had a dental implant and was given antiobiotics Metronizadole and swelling medicine Dasathasone. I took one of each immediately after the surgery. Is it compulsory for me to continue taking the medicine as i am trying for a baby with my wife and i was told by my urologist that it is not good if the baby is conceived while i am on such medication? Will infections occur if i do not take them? After a night of rest, i do not feel any pain around the implant area. Thanks.

    1. Hi Ng,

      You’re taking additional risks by not being on the antibiotics and the dexamethasone if it was prescribed by your implant surgeon. If it was a very straight forward, non-complicated dental implant without a bone graft and you’re a healthy young man with a healthy lifestyle, you will likely be okay.

      The experience of your dentist is got a lot to do with how well things will turn out. Also using a sterile set up like I have shown on this post, will help decrease the chance of infection. I’m sure you will be fine. Good luck on the baby….. I have a few kids myself and they are great!
      😉

      Happy Thanksgiving

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  34. Dr. Amin: I watched your video and have a few questions. I am post surgery from 9/18/15 and still having pain and swelling in the left lower jaw. I had two implants placed, teeth 20 and 21 and am beside myself. For two weeks I have been taking 800 mg of Ibuprofen and Hydrocodone for pain.

    I did go to a well known dental school in Philadelphia to have this work done but I am really tired of being in pain. I did go back a few days after surgery because I was in so much pain and the student dentist said everything looked good, no infection.

    I had the stitches out last Friday, October 2nd and again he said everything was healing nicely. If everything is healing nicely why do I have so much pain and swelling still. If I knew it was this much pain I would not have had this done and would have opted for a partial plate.

    Thank you for any input.

    1. Take a 3d scan to evaluate the position of the implants to the nerve. It is possible that it is pressing on the nerve.

      Also a scan and a regular X-ray can look for rare things such as osteomyelitis.

      I am sorry you are having so much pain…this is not common but can occur especially in the lower jaw.

      If pain is not gone in 4 weeks and it is that bad, you may want to remove the implants.

      Your past and current medical history may also be the cause of the pain.

  35. Hi there,

    I’m wondering if you can offer some advice? I had my back upper 3rd molar extracted approximately 7 weeks ago. It was done with stitches and a cheek flap. Since this time I have suffered from continual pain in the bone in and around the extraction site. I think it’s improving and then it starts getting worse again.

    I have also had sinus surgery recently due to a bacterial infection caused by perforation of the same tooth. My sinus issues still continue and I’m on 2 antibiotics and halfway through a course of pulmicort which I’m inserting into my sinus rinses. I’m doing salt water rinses and basic pain killers only take the edge of the pain.

    I’m at my wits end and I feel as though I’m annoying my oral surgeon as he cannot see anything wrong and xrays have shown no abnormalities. I’m 33 and have been on antibiotics for the most part of this year and am desperately unhappy. I’m wondering if you can offer any advice or suggest any avenues that have not been explored.

    1. Hmm…I hope you have had a ct scan and that the surgeon and the sinus doctor are the same person or they know what the other is doing. If not, see an ENT immediately.
      If you smoke or have any other medical conditions this could slow things down too.

      Some bone infections can get so bad that they turn into osteomyelitis and would require antibiotics via IV. Fortunately osteomyelitis is not that common in the upper though.
      The other likely thing is called an oral Antral fistula. This must be closed surgically for you to heal.
      Make sure if you reply to cut and paste this thread back into your new post.

      Good luck.

      1. Hmm…I hope you have had a ct scan and that the surgeon and the sinus doctor are the same person or they know what the other is doing. If not, see an ENT immediately.
        If you smoke or have any other medical conditions this could slow things down too.

        Some bone infections can get so bad that they turn into osteomyelitis and would require antibiotics via IV. Fortunately osteomyelitis is not that common in the upper though.
        The other likely thing is called an oral Antral fistula. This must be closed surgically for you to heal.

        Hi there,

        Thank you for your reply. Unfortunately, I cannot seem to find a doctor who can help with both the tooth and the sinus. I have seen two ENT’s and had the tooth removed by a reputable oral surgeon. The CT scan revealed that there is some congestion remaining in my sinus, however, I don’t believe that there was any evidence of an oral fistula. Every time I go off antibiotics, the sinus issue seems to flare up and becomes refilled with pus. I cannot help but feel that the pain at my extraction site is related. Examination of the site shows that everything is healing as it should. It is possible for an oral fistula to remain undetected on a CT scan? The new ENT I am seeing seems to think that the problem may be nerve related, but I am skeptical as the pain is always there. Anyway, any additional insight would be much appreciated.

        Thank you for your response.

          1. if you’re interested in the virtual consult with me please call my office and speak directly to Sophia

  36. My dental implant in #5 that also had bone grafting, shows bone loss in the latest x-ray. I was told, I cannot get the implant. He told me to come back in a month!
    I went to another dentist because he is giving me invisalign braces on my bottom teeth. He said the “bone loss” is an infection, and he prescribed me the Z-pack as we were going out of the country, and that area, had shooting pain.
    Why would he not make an appointment to have it removed again?
    It hurt like hell when he had to remove it the first time it failed.
    He only prescribed antibiotics when he drilled in the implant.
    No antibiotics during the first bone graft, or even the second one, when he had to SCRAPE out the infected graft.
    I have a headache now and also #12 has shooting pain.
    No x-ray to check even when I complained about it.

    Is this NORMAL behavior when things go bad?
    I am terrified, both implants HURT, and I am getting NO CALLS back from the dental surgeon, or my own dentist.
    I emailed PUBLIC HEALTH, because I cannot get anyone to help me.
    I do not want to sue anyone. I just want this mess addressed!!!!!
    What should I do now?

    1. 7-10 days would be considered normal.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

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About Ramsey A. Amin, DDS

Dr. Ramsey Amin has extensive experience in surgical and restorative implant dentistry. As one of only less than 400 Diplomates of the American Board of Oral Implantology/ Implant Dentistry (ABOI/ID) he is considered an expert, and board-certified in dental implants. He is a former instructor at the UCLA School of Dentistry.