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  • Preventative Antibiotics

For many years, the American Heart Association (AHA) recommended that patients with certain heart conditions take antibiotics shortly before having dental treatment, which includes a cleaning. Taking antibiotics before dental treatment is called antibiotic prophylaxis or premedication. It was meant to prevent infective endocarditis, a rare but serious infection of the heart's inner lining or valves. The infection, previously referred to as bacterial endocarditis, 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.

There is good news about the American Heart Association's most recent guidelines as of April 2007. The AHA recommends that many patients who previously needed short-term antibiotics as a preventive measure before their dental treatment no longer need to do so. This includes those patients who had rheumatic fever or mitral valve prolapse. The new guidelines are based on growing scientific evidence that indicates that the risk of taking the antibiotics regularly outweigh the benefits for most of these patients. Inappropriate use of antibiotics can also lead to the development of drug-resistant bacteria.

The guidelines now say that patients who previously have taken prophylactic antibiotics routinely in the past might no longer need them. It is important to check with your medical physician, though, before discontinuing the antibiotic in the future. These patients include people with:

• Mitral valve prolapse
• Rheumatic heart disease
• Bicuspid valve disease
• Calcified aortic stenosis
• Ventricular septal defect, atrial septal defect or hypertrophic cardiomyopathy

Who should take antibiotics under the new guidelines?

Those with the following:

• Artificial heart valves
• History of infective endocarditis
• Certain specific, serious congenital heart conditions
• A cardiac transplant that develops a problem in a heart valve

The American Academy of Orthopaedic Surgeons have also made some adjustments to their guidelines for the use of prophylactic antibiotics. One question that comes up is whether patients who have undergone joint replacements still need to take antibiotics before dental procedures. The answer is yes. However, in many cases it is determined that they may only need to do so for two years following the replacement. After that time, the orthopaedic surgeon may determine that it is no longer necessary except in immunocompromised patients and patients with certain comorbidities. However, it is best to refer to your physician's recommendation.  ‡