ANTIBIOTIC PROPHYLAXIS FOR CARDIAC PATIENTS
The use of antibiotics prior to dental treatment for specific patients as recommended by dentists or physicians is called antibiotic prophylaxis.
Many dental procedures, and even daily activities like brushing and flossing, can allow the bacteria present in the mouth to enter the bloodstream. For most healthy patients, this bacteremia is not problematic since the immune system prevents these bacteria from causing any harm. However, for certain people there is a concern that this bacteremia could cause a dangerous infection elsewhere in the body.
Guidelines for Patient Selection:
In 2008, the American Heart Association released guidelines identifying people with specific heart conditions who may require antibiotic prophylaxis before dental care.
According to these guidelines, antibiotic prophylaxis should be considered for people with:
- Artificial heart valves
- History of infective endocarditis – an infection of the lining of the heart or heart valves
- Heart transplant in which a problem develops with one of the valves
- Heart conditions present since birth, such as:
- Unrepaired cyanotic congenital heart disease, including people with palliative shunts and conduits
- Defects repaired with a prosthetic material or device (whether placed by surgery or catheter intervention) during the first 6 months after repair
- Cases in which a heart defect has been repaired, but a residual defect remains at the site or adjacent to the site of the prosthetic patch or prosthetic device used for the repair
Previous versions of these guidelines recommended antibiotic prophylaxis for a larger number of patients. Conditions for which antibiotic prophylaxis is no longer recommended include:
- Heart murmur, or more specifically mitral valve prolapse
- Rheumatic heart disease
- Bicuspid valve disease
- Calcific aorticstenosis
- Any heart condition present since birth that is not listed above, including ventricular septal defect, a trial septal defect, and hypertrophiccardio myopathy
Reason for Change in the Guidelines:
The antibiotic prophylaxis guidelines are reviewed every few years to ensure that they are based on the best scientific evidence. The most recent reviews have shown no evidence that taking antibiotics before dental treatment prevents infections of the heart. Therefore, for most people, the potential for side effects and/or allergic reactions when taking antibiotics may outweigh the uncertain benefits.
Please help us to ensure your safe treatment in our office. Depending on your past and present medical conditions, we may require a physician’s letter indicating whether or not antibiotic prophylaxis is recommended. It is ultimately your physician’s decision whether these guidelines are appropriate for your specific condition, and your willingness to help us obtain this information is appreciated.