DENTAL APPOINTMENTS:

Should you take antibiotics first for a HEART CONDITION?

 

 

For many years the dental profession recommended that patients with certain heart problems take antibiotics before a cleaning or more extensive dental work. The main condition we’re trying to avoid is infective endocarditis. This is a condition where bacteria will colonize on the heart valve or in the lining of the heart itself. This is of course fatal in most cases. Conditions where this was recommended included patients who had rheumatic fever or heart murmurs (mitral valve prolapsed was the big one).

Over time the American Heart Association has revisited this and has updated the guidelines. The current thinking is that the patients don’t receive any benefit from these antibiotics, so why prescribe them?

There are conditions when antibiotics are indicated before dental work: artificial heart valves, transplanted hearts, certain congenital heart defects, defects repaired with artificial material; a history of infective endocarditis.

As a dentist I don’t want any of my patients to suffer adverse reactions. However, I am treating only the mouth whereas the physician is the doctor responsible for the overall health of the patient. I always contact the physician and let them know that a dental procedure is recommended and I need some information. This year I did have a patient who has a heart condition so severe that the doctor did not want any treatment for this patient even with antibiotics, until the patient’s heart recovered some strength. There is also the legal aspects to consider. So, when deciding this, communication with the patient’s physician is standard.

WHAT IF I’M ALLERGIC TO PENICILLIN?

The most common drug prescribed is amoxicillin 2 gm, 30-60 minutes before the dental procedure. For people allergic to amoxicillin they can take 2 grams cephalexin, 600 mg. clindamycin or 500 mg. azithromycin, to be taken 30-60 minute before. There are intravenous/intramuscular preparations for patients who can’t take medicine orally.

With patients living longer and increased technology in repairing the heart, this aspect of dentistry will no doubt be revisited in the future with new guidelines and perhaps new antibiotics.