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.

How To Care For My Teeth As An Adult


As we discussed before, there are special dental issues that people of all ages should be made aware of for their particular age. Adults may face certain oral health issues, even if you brush and floss regularly. However, your dentist can help you with these challenges successfully. Some of these challenges are:
1. Gum disease
2. Periodontitis
3. Cavities
4. Sensitivity
5. Crowns

Gum Disease begins as gingivitis, which while in the early stage is treatable and reversible. Symptoms include red, swollen or tender gums that tend to bleed when they are brushed. If you notice any of these symptoms contact your dentist right away, before serious problems develop, because advanced stages of gum disease may lead to tooth loss.

Periodontitis, or periodontal disease, is gum disease that has not been treated and is characterized as irreversible bone loss. The health of your gums can affect your overall health. Recent studies have shown a possible link between periodontitis and other diseases such as, diabetes, heart disease, respiratory problems, stroke and a possible link to premature births.

Cavities around existing fillings, also called recurrent decay, and decay on the root surfaces of the teeth become more common as we age, because of the expansion and contraction of filling material and the progression of recession which occurs naturally over time.

Sensitivity can become an increasing problem as one ages. Because your gums naturally recede over time, exposed areas of tooth are not protected by enamel, therefore causing the teeth to become more sensitive. These areas are particularly prone to pain due to hot and cold foods or beverages. In severe cases, cold air as well as sensitivity to sweet and sour drinks and foods, can occur. In some cases sensitivity could be an indication of a more serious condition, such as a cavity or a cracked or fractured tooth, so be sure to see your dentist for any type of sensitivity you may have.

Crowns are used to strengthen damaged teeth. A crown entirely covers, or “caps” a damaged tooth. Besides strengthening a damaged tooth, a crown can also be used to improve its appearance, shape or alignment. Implants and bridges are also used to replace missing teeth. These could also be options for you, but you must visit your dentist for an exam, before determining which option is best for you.

White teeth are also something of a concern for most adults. Thorough cleanings by a dentist or hygienist will remove most external staining caused by coffee, tea, tobacco and certain types of food. Using a whitening toothpaste between dental visits, will help remove these surface stains. However, if stains have been present for years, you may need to have your teeth professionally whitened to remove the more stubborn external stains.
Internal stains due to nerve damage to the tooth, can be bleached, bonded or crowned. While all of these methods is safe and effective, your dentist will recommend which treatment is appropriate for you depending on the state of your teeth and the results that you wish to achieve.

In addition to greatly affecting your overall health, proper nutrition is also necessary for healthy teeth and gums. Eating a well-balanced diet gives your gum tissue and teeth the important nutrients and minerals they need to resist infections and stay strong. In addition, firm, fibrous foods such as fruits and vegetables tend to help keep teeth clean and tissue healthy. When you snack, choose foods such as cheese, plain yogurt, fruit or raw vegetables, otherwise, soft, sticky foods tend to remain on the grooves and between teeth, producing more plaque.

The bottom line is that no matter how old you are, the importance of taking care of your teeth never changes. Always be sure to brush twice daily and floss once daily, and visit your dentist on a regular recall program that your dentist or hygienist suggests to help maintain your overall oral health.