Antibiotics May Not Be Needed Before Dental Work - NBC 10 Philadelphia

Antibiotics May Not Be Needed Before Dental Work

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    (iVillage Total Health) - Dental patients who have had to take antibiotics before dental cleanings, tooth extractions and other procedures to avoid the risk of heart disease may no longer have to premedicate before dental work.

    New guidelines drafted jointly by the American Heart Association (AHA) and the American Dental Association (ADA) recommend dentists do not routinely prescribe antibiotics to prevent infective endocarditis (IE) in all patients with heart conditions. Endocarditis is a relatively uncommon but very dangerous inflammation, usually caused by infection in vulnerable areas of the endocardium - the innermost layer of the heart's chambers and valves. The condition is usually caused by bacteria that enter the body by various means, such as cuts, minor surgeries and dental procedures.

    For years, antibiotics (antimicrobial medications) have been prescribed to prevent illness that can result when bacteria in the mouth enters the bloodstream during dental work. Preventive use of antibiotics has often been recommended for patients who have certain pre-existing heart conditions or compromised immune systems.

    Under the new guidelines, only patients at the greatest risk of negative outcomes of IE should take antibiotics before dental procedures. These include heart transplant patients who develop cardiac valve problems, people with artificial heart valves, people with certain congenital heart conditions, recent (within the previous six months) recipients of artificial patches to repair congenital heart defects and anyone with a history of IE.

    People who will no longer need to take antibiotics prior to many dental procedures include those with mitral valve prolapse , rheumatic heart disease, bicuspid valve disease, calcified aortic stenosis or congenital heart conditions such as hypertrophic cardiomyopathy, ventricular septal defects or atrial septal defects.

    The reason for the change in recommendations is twofold: 1) for most patients, the risks of taking antibiotics (mild to severe adverse reactions) now outweigh the benefits, and 2) overuse of antibiotics has become a worldwide problem that has led to drug-resistant bacteria.

    Researchers also found that routine daily oral hygiene practices—such as brushing and flossing—may be more likely to lead to IE than dental procedures. The guidelines thus emphasize that good oral health and daily hygiene are more important for heart health than antibiotics.

    The new recommendations have been endorsed by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society. The guidelines will be published in the June issue of the Journal of the American Dental Association. They were published in the April issue of the journal Circulation.

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