Pre-Med Patients

For more than half a century, it was recommended that patients with certain conditions take antibiotics shortly before having dental treatment. This was done with the belief that antibiotics would prevent infective endocarditis (IE), a rare but serious infection of the heart's inner lining or valves. The infection results when bacteria enter the bloodstream and travel to the heart. Bacteria are normally found in various sites of the body including on the skin and in the mouth.

Taking antibiotics before dental treatment is called antibiotic prophylaxis (or "Pre-med"). Patients with any kind of heart abnormality and some orthopedic patients were advised to take an antibiotic prior to dental work, even for teeth cleaning.

There is good news about the American Heart Association's most recent guidelines, published in its scientific journal, Circulation, in April 2007: The AHA recommends that most of these patients no longer need short-term antibiotics as a preventive measure before their dental treatment.

The New Guidelines

The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with:

  • 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
  • shunts
  • pins, plates, screws

Bacteria enters our bloodstream during simple daily activities such as brushing or flossing. The new guidelines are based on a comprehensive review of published studies that suggests IE (infective endocarditis) is more likely to occur as a result of these everyday activities than from a dental procedure.

Who should take preventive antibiotics?

Preventive antibiotics prior to a dental procedure are still advised for patients with:

  1. artificial heart valves
  2. a history of infective endocarditis
  3. certain specific, serious congenital (present from birth) heart conditions, including
    • unrepaired and incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
    • a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
    • any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device
  4. a cardiac transplant that develops a problem in a heart valve
  5. total joint replacement within the last two years (or longer depending on the surgeon)

The new recommendations apply to such common dental procedures as teeth cleaning and extractions.

Dr. Deemer recommends that heart and orthopedic patients contact their physician to see what is right for their specific condition.

For more information, visit http://www.heart.org.

Laurie Deemer, DMD
2104 Newton Drive, NE
Covington, GA 30014
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