If you have had to
take antibiotics prior to dental treatment because of your heart condition, you
may not need to any more. The recent
guidelines from the American Heart Association recommend not taking antibiotics
prior to dental treatment in most heart condition cases. You should contact your cardiologist,
physician, and dentist to see if you should stop or continue.
For decades, the
American Heart Association [AHA] recommended that patients with certain heart
conditions take antibiotics shortly before dental treatment. This was done with the belief that
antibiotics would prevent infective endocarditis [IE], an infection of the
heart’s inner linings or valves. The
idea was bacteria in the mouth could enter the blood stream during dental
treatment and travel to the heart. It
was thought that with a heart murmur, turbulence in the blood flow caused by
the heart valve would allow the bacteria to eddy out and start a growth on the
valve – not a good thing. However, a
growing body of scientific evidence has shown this is not the case.
The scientific
evidence shows that the risks of taking preventive antibiotics out weigh the
benefits for most patients. The risks
include adverse reactions to antibiotics and development of drug-resistant
bacteria. Adverse reactions range from
upset stomach, nausea and diarrhea to allergic reactions such as hives or life
threatening anaphylactic shock. Allergic
reactions to medications, as well as, foods, environmental substances including
insect bites and stings can occur after years of never being allergic. If you have redness, swelling or itchiness
after taking medication, stop future pills and call your doctor. If you have accelerating symptoms especially
difficulty breathing, seek immediate emergency help, i.e., call 911. Use an epi-pen if available, which is found
in some emergency kits or carried by people who are allergic to bee stings.
The over use of
antibiotics causing the development of drug-resistant bacteria is another
reason the AHA guidelines have changed.
Drug-resistant bacteria are formed from antibiotic use. The inappropriate use of antibiotics
increases the risk of drug-resistant forms and prevents their effectiveness
when antibiotics are really needed.
Scientists also
found no compelling evidence that taking antibiotics before a dental procedure prevents IE in patients who are at risk of developing a heart infection. There is actually more exposure to bacteria
from their mouths during basic daily activities such as eating, drinking,
brushing or flossing. People with gum
disease are at a much higher risk of having bacteria enter their bloodstream
and causing infective endocarditis and heart disease. So a person’s best
defense against IE is preventing gum disease through good oral hygiene,
brushing and flossing, healthy diet, and regular professional cleanings with a
registered dental hygienist.
A bacterial
infection of the gums, called periodontal disease, can affect the entire
body. Gum disease is correlated with
heart disease, diabetes, strokes, ulcers and pre-term births. Bacteria that build up between the tooth and
gum can enter into the bloodstream when gums bleed. These bacteria can travel
throughout the body and cause serious health problems. Periodontal disease can
be prevented with good oral health habits; such as, brushing and flossing, and
regular professional cleanings.
AHA
Guidelines: Who Should Take Prophylactic Antibiotics Before Dental Treatment
The AHA guidelines
state that patients who have taken prophylactic antibiotics routinely in the
past, but no longer need them include people with mitral valve prolapse,
rheumatic heart disease, calcified aortic stenosis, or most congenital [present
from birth] heart conditions.
Certain heart
conditions still require pre-medication with antibiotics in patients who would
have the greatest danger of a bad outcome if they developed a heart
infection. Preventive antibiotics before
a dental procedure are advised for the following patients:
-Artificial heart
valves
-A history of
infective endocarditis
-Certain
specific, serious congenital heart conditions
-A cardiac
transplantation that develops a problem in a heart valve
If you have any of these heart
conditions, you should consult your cardiologist for the use of antibiotics
prior to dental procedures.
The new
recommendations apply to any dental procedures that could involve possible
bleeding in the gums or oral tissues.
Antibiotic use prior to dental treatment is not necessary for an
examination or x-rays, but is mandatory for teeth cleanings and oral surgery
treatment like extractions.
The AHA guidelines
emphasize that maintaining optimal oral health and practicing oral hygiene are
more important in reducing the risk of infective endocarditis than is the
taking antibiotics before a dental visit.
So keep brushing and flossing and have regular dental cleanings.
ENJOY LIFE AND KEEP SMILING!
George Malkemus has a Family and
Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call
585-8595, or email info@ malkemusdds.com.
Visit Dr. Malkemus’ Web site at malkemusdds.com
George A. Malkemus, DDS
Dentist in Rohnert Park
2 Padre Parkway Suite #200
Rohnert Park, CA 94928
MalkemusDDS.com Phone: (707) 585-8595
