Cardiovascular

For decades, the American Heart Association 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, an infection inside the heart. The American Heart Association's latest guidelines published in April 2007 have relaxed their guidelines.The AHA recommends that most of these patients no longer need short-term antibiotics as a preventive measure before their dental treatment.

The American Dental Association participated in the development of the new guidelines and has approved those portions relevant to dentistry. The guidelines were also endorsed by the Infectious Diseases Society of America and by the Pediatric Infectious Diseases Society.

The guidelines are based on a growing body of scientific evidence that shows the risks of taking preventive antibiotics outweigh the benefits for most patients. Scientists also found no compelling evidence that taking antibiotics prior to a dental procedure prevents infective endocarditis in patients who are at risk of developing a heart infection. Their hearts are already often exposed to bacteria from the mouth, which can enter their bloodstream during basic daily activities such as brushing or flossing. The new guidelines are based on a comprehensive review of published studies.

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
• Calcifies aortic stenosis
• Congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy

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

• Artificial heart valves
• A history of infective endocarditis
• Certain specific, serious congenital (present from birth) heart conditions including:
  • Unrepaired or 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

The new recommendations apply to many dental procedures, including teeth cleaning and extractions. Patients with congenital heart disease can have complicated circumstances and should check with their cardiologist.

Joint Replacement

Currently, the American Dental Association and the American Academy of Orthopaedic Surgeons recommend that all patients take antibiotics during the first two years following total joint replacement before certain dental procedures, and beyond two years in immunocompromised patients and patients with certain comorbidities.

These guidelines are periodically reviewed to ensure that the recommendations are based on the most recent scientific findings.

Do you have any questions regarding our pre-medication guidelines?