Johns Hopkins Health Alert
Should You Take Antibiotics Before Dental Work?
If you have a heart condition but your doctor or dentist neglects to give you an antibiotic prior to your next dental procedure, don't be alarmed. According to new guidelines published by the American Heart Association (AHA), few people with heart disease need to take this precaution.
The practice of taking antibiotics prior to dental procedures began decades ago to prevent infective endocarditis (IE), a rare but very serious heart infection that requires long-term treatment with antibiotics and, in severe instances, surgical valve replacement.
Getting your teeth cleaned or having a cavity filled causes small cuts in the gums that allow bacteria in the mouth to enter the bloodstream. It's very unlikely that these bacteria will cause IE. But because IE can lead to heart failure, arrhythmias, stroke, and death if untreated, antibiotics have been widely prescribed as a preventive measure prior to dental work for a broad group of people with heart conditions such as structural and valve-related heart defects that may make it easier for bacteria to get trapped in the heart's inner lining.
Why the change? Recently, the AHA convened a panel to review all IE studies published between 1950 and 2006. They concluded that only patients at high risk for serious complications from IE should continue taking preventive antibiotics -- a decision that amounts to a 90% reduction in the number of patients who will get prescriptions for antibiotics before going to the dentist.
A study published in the journal Heart looked at the death rates from endocarditis in France and estimated that even high-risk patients with artificial heart valves who do not take antibiotics prior to a dental procedure have only a one in 54,000 chance of getting IE. In fact, the risks of antibiotic use outweigh the benefits; people are more likely to have an allergic reaction to an antibiotic than to develop IE. Limiting unnecessary antibiotics will save patients money, reduce the number of medications they must take, cut the chances of allergic reactions, and help prevent antibiotic resistance. For most people, controlling the amount of bacteria in your mouth with good oral care -- brushing and flossing twice daily -- is the best way to prevent infection.
Who still needs antibiotics? The updated guidelines advise preventive antibiotics for high-risk patients only. This includes people with:
- previous episodes of infective endocarditis (IE)
- artificial heart valve replacements and repairs
- valve problems after a heart transplant
- congenital heart defects, both before and possibly after repair
Posted in Healthy Living on August 5, 2009
Reviewed January 2011
Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Johns Hopkins Health Alerts Disclaimer
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Is mitral valve prolapse considered a congenital heart defect for which continued antibiotics prior to dental work would be recommended.
Posted by: toorainey | August 8, 2009 10:10 AM
To "toorainey" I too have mitral valve prolapse but it is mild only a catagory 1. It goes along with my Fibromyalgia. Anyway, I was wondering too about the antibiotics before dental proceedures so I went to the AHA website and searched mitral valve prolapse and I have attached the website for you to check out. At least you can make an informed decision before your next appointment.
http://www.americanheart.org/presenter.jhtml?identifier=3047083
Nancy
Posted by: nanhug88 | August 8, 2009 1:22 PM
My dentist say the Orthopedic guidelines now say joint replacements require antibiotics before dental maintenance forever.
Posted by: donernst | August 8, 2009 2:17 PM
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This is not a major criticism, but I remind you that the generic term "doctor" applies to many professionals, not only MDs - such as PhD's in many disciplines, dentists, podiatrists, etc.
When referring to a medical practitioner, I suggest that you consider using the term 'physician' instead of the generic term "doctor".
(Dr.) RC Smithwick, DDS
Posted by: W6CS | August 5, 2009 12:13 PM