For many patients taking a precautionary dosage of antibiotics prior to dental work is considered routine. Those with joint replacement, certain heart diseases, or evencongenital heart defects have been instructed to do so in the past. New findings have caused The American Heart Association to redefine the guidelines to account for new research information.
American Heart Association Findings
The American Heart Association recommends that only patients who have the greatest risk of a bad outcome from infective endocarditis (IE) should receive short-term preventive antibiotics before routine dental procedures. Infective endocarditis is an infection of the heart’s inner lining or the heart valves, which results when bacteria enter the bloodstream and travel to the heart. This can occur during routine dental procedures like a teeth cleaning.
These new guidelines now remove certain conditions from the list that have been there in the past. The following list shows the conditions that no longer need to be premedicated with antibiotics:
-Mitral valve prolapse
-Rheumatic heart disease
-Bicuspid valve disease
-Calcified aortic stenosis
-Congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.
These new guidelines are based on scientific evidence that shows the risks from taking preventive antibiotics outweigh the benefits received for most patients. The risks can include allergic reactions to antibiotics, stomach discomfort, yeast infection, or the development of antibiotic resistant bacteria.
The research also showed that infective endocarditis is far more likely to occur from everyday activities than from any dental procedures. Daily activities like brushing and flossing can expose bacteria from the mouth into the bloodstream just as easily as a dental procedure. The American Heart Association emphasized that patients should maintain good oral hygiene maintenance to reduce the risk of developing infective endocarditis.
Disease Conditions That Still Require Antibiotics
Some condition still require antibiotic premedication and these include:
-Patients with artificial heart valves.
-Previous history of having had infectious endocarditis.
-Presence of a congenital (born with) heart conditions.
-Heart transplant patients who develop issues with a heart valve.
The patients with conditions listed above would be at greatest risk of very bad outcomes if they were to develop infectious endocarditis. This is why the American Heart Association recommends antibiotic premedication for these patients. The benefits outweigh the risks for the groups listed above.
Patients should always ask their physician or cardiologist first, to assess their possible need for antibiotic premedication. You should also ask your dentist if you have any questions regarding antibiotic premedication. It is important that this is to be an informed decision between patient and provider, and done on an individual basis. The guidelines are just that, general guidelines, both you and your doctor will decide what is best for you.
Patients also need to be aware that overuse of antibiotics is not a good thing either. Overuse of antibiotics has led to an increase in the number of bacteria now resistant to antibiotics. When this occurs, new antibiotics must be developed to kill these new resistant bacteria. The new resistant bacteria are typically stronger and can cause more serious illnesses.
As always, maintain a good dental hygiene regimen and visit your dentist regularly for dental examinations and professional cleanings.
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