Antibiotic Premedication and Infective Endocarditis



For decades, the American Heart Association (AHA) recommended that certain patients with heart conditions should take an antibiotic premedication prior to any dental treatment including cleanings. This was recommended with the belief that these antibiotics would prevent the possibility of infective endocarditis (IE), also referred to as Bacterial Endocarditis (BE). However, there is new information and guidelines that were published in the AHA’s scientific journal stating the following:

The AHA recommends that most of these patients no longer need short-term antibiotics as a preventive measure before their dental treatment.

The ADA participated in the development of the new guidelines and has approved this to be relevant to dentistry. The guidelines were also endorsed by the Infectious Diseases Society of America and by the Pediatric Infectious Diseases Society.

The new guidelines are based on a growing amount of scientific evidence that shows the risks of taking the premedication outweigh the benefits for most patients. The risks include adverse reactions to antibiotics that range from mild to severe, and in very rare cases, even death. Inappropriate use of antibiotics, through premedication or simply using antibiotics to treat an infection caused by a virus can lead to the development of drug-resistant bacteria.

Scientists also found no compelling evidence that taking antibiotics prior to any dental procedure prevents Infective Endocarditis in patients who are already at risk for developing a heart infection. Their hearts are already exposed to bacteria from the mouth on a regular basis, which can enter their bloodstream during basic daily activities such as brushing and flossing. The new guidelines are based on a comprehensive review of published studies that suggests IE is more likely to occur as a result of everyday activities than from a dental procedure.

The new guidelines suggest the following: patients who have taken antibiotic premedication in the past and no longer need to do so are:

· Mitral valve prolapse (MVP)
· Rheumatic Heart Disease
· Bicuspid Valve Disease
· Calcified Aortic Stenosis
· Congenital Heart Conditions such as:
o Ventricular Septal Defect
o Atrial Septal Defect
o Hypertrophic Cardiomyopathy

The new guidelines are for patients who would have the greatest risk of a bad outcome if they developed a heart infection.

The following patients should remain taking preventive antibiotics prior to a dental procedure:

· Artificial Heart Valves
· A history of Infective Endocarditis
· Certain Specific, Serious Congential (present from birth) Heart Conditions Including:
o Unrepaired or incompletely repaired Cyanotic Congential Heart Disease, including those with Palliative Shunts and Conduits
o A Completely Repaired Congential Heart Defect with Prosthetic Material or Device, placed by surgery or catheter intervention, during the first 6 months after procedure.
o Any repaired Congenital Heart Defect with Residual Defect at the site or adjacent to the site of a Prosthetic Patch or a Prosthetic Device.
· A Cardiac Transplant that Develops a Problem in the Heart Valve

The new recommendations apply to many dental procedures, including extractions and regular dental cleanings. Patients with Congential Heart Disease can have complicated circumstances. Patients should check with their cardiologist if there is any question at all as to what category you may fall under.

From your dentist:
We do our best at providing preventive care for our patients, please be patient if we require certification from your cardiologist or family doctor, stating with your current heart condition, whether or not you will need premedication for any type of dental treatment. We are only trying to do what is best for you in protecting not only your oral health, but your overall health as well.